title: "Endovascular embolic hemispherectomy": a strategy for the initial management of catastrophic holohemispheric epilepsy in the neonate.
abstract: OBJECTIVE
  Conflicting challenges abound in the management of the newborn with intractable epilepsy related to hemimegalencephaly. Early hemispherectomy to stop seizures and prevent deleterious consequences to future neurocognitive development must be weighed against the technical and anesthetic challenges of performing major hemispheric surgery in the neonate.
  
  
  METHODS
  We hereby present our experience with two neonates with hemimegalencephaly and intractable seizures who were managed using a strategy of initial minimally invasive embolization of the cerebral blood supply to the involved hemisphere.
  
  
  RESULTS
  Immediate significant seizure control was achieved after embolization of the cerebral blood supply to the involved hemisphere followed by delayed ipsilateral hemispheric resection at a later optimal age.
  
  
  CONCLUSIONS
  The considerations and challenges encountered in the course of the management of these patients are discussed, and a literature review is presented.
authors: Department of Neurosurgery, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, USA. coluigbo@cnmc.org.
authors: Chima
authors: http://orcid.org/0000-0002-7851-3792
authors: C
authors: Oluigbo
authors: Department of Radiology, Children's National Health System, Washington, DC, USA.|Division of Interventional Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Monica S
authors: MS
authors: Pearl
authors: Department of Neurology, Children's National Health System, Washington, DC, USA.
authors: Tammy N
authors: TN
authors: Tsuchida
authors: Department of Neurology, Children's National Health System, Washington, DC, USA.
authors: Taeun
authors: T
authors: Chang
authors: Department of Neuropathology, Children's National Health System, Washington, DC, USA.
authors: Cheng-Ying
authors: CY
authors: Ho
authors: Department of Neurology, Children's National Health System, Washington, DC, USA.
authors: William D
authors: WD
authors: Gaillard
mesh_terms: D019468:Disease Management; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male
keywords: Cerebral hemispheric infarction; Endovascular embolization; Epilepsy; Hemimegalencephaly; Neonates