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OBJECTIVEEndoscope-assisted hemispherotomy (EH) has emerged as a good alternative option for hemispheric pathologies with drug-resistant epilepsy.METHODSThis was a prospective observational study. Parameters measured included primary outcome measures (frequency, severity of seizures) and secondary outcomes (cognition, behavior, and quality of life). Blood loss, operating time, complications, and hospital stay were also taken into account. A comparison was made between the open hemispherotomy (OH) and endoscopic techniques performed by the senior author.RESULTSOf 59 cases (42 males), 27 underwent OH (8 periinsular, the rest vertical) and 32 received EH. The mean age was 8.65 ± 5.41 years (EH: 8.6 ± 5.3 years; OH: 8.6 ± 5.7 years). Seizure frequency per day was 7 ± 5.9 (EH: 7.3 ± 4.6; OH: 15.0 ± 6.2). Duration of disease (years since first episode) was 3.92 ± 1.24 years (EH: 5.2 ± 4.3; OH: 5.8 ± 4.5 years). Number of antiepileptic drugs per patient was 3.9 ± 1.2 (EH: 4.2 ± 1.2; OH: 3.8 ± 0.98). Values for the foregoing variables are expressed as the mean ± SD. Pathologies included the following: postinfarct encephalomalacia in 19 (EH: 11); Rasmussen’s syndrome in 14 (EH: 7); hemimegalencephaly in 12 (EH: 7); hemispheric cortical dysplasia in 7 (EH: 4); postencephalitis sequelae in 6 (EH: 2); and Sturge-Weber syndrome in 1 (EH: 1). The mean follow-up was 40.16 ± 17.3 months. Thirty-nine of 49 (79.6%) had favorable outcomes (International League Against Epilepsy class I and II): in EH the total was 19/23 (82.6%) and in OH it was 20/26 (76.9%). There was no difference in the primary outcome between EH and OH (p = 0.15). Significant improvement was seen in the behavioral/quality of life performance, but not in IQ scores in both EH and OH (p < 0.01, no intergroup difference). Blood loss (p = 0.02) and hospital stay (p = 0.049) were less in EH.CONCLUSIONSEH was as effective as the open procedure in terms of primary and secondary outcomes. It also resulted in less blood loss and a shorter postoperative hospital stay.

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Background In trauma practice, there are no guidelines on the necessity or value of repeat CT scan. The purpose of the present study was to determine the role of serial CTs in demonstrating changes in intracranial lesions and the influence on management. Methods In this study, 201 patients of traumatic brain injury were followed with serial CT scans for a maximum of up to 5 scans. The presence of different types of intracranial lesions at each CT scan as well as the evolution of lesions was recorded. The development of new lesions was noted. The management decisions at the time of each CT was detailed. Results Progression of lesion was seen most often in patients with mixed lesions (21.8%). New lesions were seen in 5.5% of patients at CT-2 and in 5.8% at CT-3. Out of total 201 patients, 47 (23%) had change in management. 26 (55%) decisions of change in management were based upon clinical deterioration and 21 (45%) upon radiological changes only. A higher incidence of surgical intervention was seen in patients who had the first CT scan within 6 h of initial trauma. However, a few patients in whom the first CT scan was 6 h after trauma as well as some patients in whom CT scan was repeated as a routine without any clinical deterioration also had a change in their management. Conclusions Repeat CT scans resulted in management changes even in patients with no clinical deterioration and thus may be of value in detecting changes at an early stage.

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