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Child's Nervous System

, Volume 22, Issue 8, pp 967–981 | Cite as

Peri-insular hemispherotomy in paediatric epilepsy

  • Jean-Guy Villemure
  • Roy Thomas Daniel
Special Annual Issue

Abstract

Objects

Outline the indications, investigation, surgical technique, pitfalls, complications and benefits of peri-insular hemispherotomy (PIH) in the surgical treatment of paediatric epilepsy.

Materials and methods

This report is based on a consecutive series of 43 children who underwent PIH. Sixty percent were males; there were slightly more left-sided surgeries. Median interval between seizure onset and surgery was 5 years. In more than half the cases, the anatomical substrate was congenital. There were few complications: one death, one hydrocephalus and two anatomically remote haemorrhages. Ninety percent of the patients have remained in Engel’s class I epilepsy outcome.

Conclusions

There are clear indications for hemispherectomy in children. In some instances of incomplete deficit, timing of surgery remains a major concern. The less invasive approach to eliminate the influence of the diseased hemisphere, in our opinion, is with disconnective techniques of hemispherectomy, and among the latter, peri-insular hemispherotomy provides, in our opinion, the best complications–benefits ratio.

Keywords

Peir-insular Hemispherotomy Epilepsy surgery Hemispherectomy 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Neurosurgery ServiceCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
  2. 2.Neurosurgery ServiceChristian Medical CollegeVelloreIndia

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