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Vertical extraventricular functional hemispherotomy: a new variant for hemispheric disconnection. Technical notes and results in three patients

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A Commentary to this article was published on 19 August 2015

Abstract

Purpose

Hemispherectomy and disconnective hemispherotomy are the most effective epilepsy surgical procedures for the treatment of epilepsy due to hemispheric pathologies such as Sturge-Weber syndrome, diffuse hemispheric cortical dysplasia, and posttraumatic and postischemic focal lesions. Disconnective hemispherotomy is nowadays preferred to reduce surgical morbidity in term of early and late complications (i.e., cerebral superficial hemosiderosis). Despite the number of existing technical variants conceived to further reduce the amount of brain tissue to be removed, postoperative hydrocephalus still persists and may account for an average incidence of 15–41 % according to different series and reviews. A new variant of disconnective vertical hemispherotomy we termed vertical extraventricular parasagittal hemispherotomy is described aiming to further reduce the amount of removed brain tissue and so the risk of postoperative hydrocephalus in favor of a pure hemispheric disconnection.

Methods

Three patients affected by drug-resistant epilepsy due to different hemispheric pathologies (posttraumatic epilepsy, Sturge-Weber syndrome, diffuse hemispheric cortical dysplasia) were considered to be candidates for vertical extraventricular parasagittal hemispherotomy disconnective based on presurgical evaluation protocol. The oldest patient was 15 years old, the two youngest were both 2 years old.

Results

None of the patients experienced early and late surgical complications. After a mean follow-up of 36 months (range 12–60 months), two patients were seizure free, one relapsed seizures 18 months later. Postoperative hydrocephalus never occurred.

Conclusion

Vertical extraventricular parasagittal hemispherotomy may be an efficacious and less invasive technique as it consists in a pure disconnection of the hemisphere with less amount of brain tissue removed and a theoretical reduced risk of postoperative hydrocephalus.

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Acknowledgments

We thank Anna Rosati, MD, PhD for her collaboration in reporting final end results and outcomes

Conflict of interest

Nothing to disclose

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Authors and Affiliations

  1. Neurosurgery – Department of Neurosciences, Anna Meyer Pediatric Hospital, Viale Pieraccini 24, 50139, Florence, Italy

    Flavio Giordano, Barbara Spacca & Lorenzo Genitori

  2. Pediatric Neurology Clinic – Department of Neurosciences, Anna Meyer Pediatric Hospital, Florence, Italy

    Carmen Barba, Francesco Mari, Tiziana Pisano & Renzo Guerrini

Authors
  1. Flavio Giordano
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  2. Barbara Spacca
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  3. Carmen Barba
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  4. Francesco Mari
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  5. Tiziana Pisano
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  6. Renzo Guerrini
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  7. Lorenzo Genitori
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Correspondence to Flavio Giordano.

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Giordano, F., Spacca, B., Barba, C. et al. Vertical extraventricular functional hemispherotomy: a new variant for hemispheric disconnection. Technical notes and results in three patients. Childs Nerv Syst 31, 2151–2160 (2015). https://doi.org/10.1007/s00381-015-2788-1

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  • DOI: https://doi.org/10.1007/s00381-015-2788-1

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