Corticotomy Closure Avoids Subdural Collections After Hemispherotomy

Blauwblomme, Thomas; Harkness, William

doi:10.1227/neu.0b013e3181f742b2

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…Possible explanations for the better result in our patients may be the above-mentioned extensive irrigation of the ventricular system, and the closure of the corticotomy tunnel with fibrin flue and Lyostypt, which helped to restore a normal CSF circulation. This assumption is supported by reports from other centers, where postoperative subdural hygroma formation was reported to be avoided by closure of the corticotomy with fibrin glue (Blauwblomme & Harkness, 2010). Another factor might be the higher rate of MCD patients in the series of Delalande (36%) compared with our series (27.5%).…”

Section: Discussionsupporting

confidence: 89%

Vertical perithalamic hemispherotomy: A single‐center experience in 40 pediatric patients with epilepsy

et al. 2013

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Summary Purpose The current concept for hemispherotomy includes various lateral techniques and the vertical perithalamic hemispherotomy introduced by Delalande in 1992. We have chosen the vertical approach because of advantages that possibly influence outcome: the possibility to completely disconnect the hemisphere at the level of the thalamus obviating both the need to resect the insula and the need to open and dissect the subarachnoid space of the Sylvian fissure. Methods We retrospectively analyzed prospectively collected data of all patients who underwent vertical hemispherotomy at the Vienna pediatric epilepsy center. Seizure outcome was classified according to the International League Against Epilepsy (ILAE) proposal 2001. Key Findings Follow‐up data of 40 patients (22 male/18 female; median age 5.5 years; range 4.4 months to 20.1 years) were analyzed. Hemispherotomy was left in 26 and right in 14 patients. The underlying pathology was ischemic vascular in 19, malformation of cortical development (MCD) in 11, and other pathology in 10. No serious intraoperative complications were encountered. Only two infants (5.0%) needed blood replacement. There was one death on the fourth day after surgery caused by intractable hyponatremic brain edema. Three patients developed cerebrospinal fluid (CSF) disturbances, but only one needed a permanent ventriculoperitoneal (VP) shunt (2.5%). For outcome analysis we included 37 of 40 children with at least 12 months of follow‐up. Thirty‐four (91.9%) of 37 children were seizure‐free (class 1a) after a median follow‐up time of 3.7 years (range 12 month to 14.8 years). Significance We confirm the efficacy and safety of vertical parasagittal hemispherotomy as described by Delalande in a consecutive series of patients treated at our center since 1998. In addition, complete disconnection of the hemisphere in patients with MCD and/or patients with significant involvement of the insula was possible without the complications usually reported with other techniques.

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Section: Discussionsupporting

confidence: 89%

Vertical perithalamic hemispherotomy: A single‐center experience in 40 pediatric patients with epilepsy

et al. 2013

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“…Involvement of the basal ganglia and/or thalamus in the resection may predispose to hydrocephalus because such techniques can involve broad exposure of the lateral ventricle to blood products. Recently, Blauwblomme and Harkness (2010) reported on 16 patients undergoing hemispherotomy surgery with closure of the ventricular cavity using fibrin glue and pial sutures. Their technique includes resection of the basal ganglia with broad intraoperative exposure of the lateral ventricle.…”

Section: Discussionmentioning

confidence: 99%

Posthemispherectomy hydrocephalus: Results of a comprehensive, multiinstitutional review

et al. 2012

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SUMMARY Purpose Hemispherectomy surgery for medically intractable epilepsy is known to cause hydrocephalus in a subset of patients. Existing data regarding the incidence of, and risk factors for developing, post-hemispherectomy hydrocephalus has been limited by the relatively small number of cases performed by any single center. Our goal was to better understand this phenomenon and to identify risk factors that may predispose patients to developing hydrocephalus after hemispherectomy surgery. Methods Fifteen pediatric epilepsy centers participated in this study. A retrospective chart review was performed on all available patients who had hemispherectomy surgery. Data collected included surgical techniques, etiology of seizures, prior brain surgery, symptoms and signs of hydrocephalus, timing of shunt placement and basic demographics. Key findings Data were collected from 736 patients who underwent hemispherectomy surgery between 1986 and 2011. Forty-six patients had pre-existing shunted hydrocephalus and were excluded from analysis, yielding 690 patients for this study. One hundred sixty-two patients (23%) required hydrocephalus treatment. The timing of hydrocephalus ranged from the immediate post-operative period to 8.5 years after surgery, with 43 patients (27%) receiving shunts more than 90 days after surgery. Multivariate regression analysis revealed anatomic hemispherectomies (OR 4.1, p<0.0001) and previous brain surgery (O.R. 1.7, p=0.04) as independently significant risk factors for developing hydrocephalus. There was a trend towards significance for the use of hemostatic agents (O.R. 2.2, p=0.07) and the involvement of basal ganglia or thalamus in the resection (O.R. 2.2, p=0.08) as risk factors. Significance Hydrocephalus is a common sequela of hemispherectomy surgery. Surgical technique and prior brain surgery influence the occurrence of post-hemispherectomy hydrocephalus. A significant portion of patients develop hydrocephalus on a delayed basis, indicating the need for long-term surveillance.

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Section: Discussionmentioning

confidence: 99%

“…Subdural collections are directly related to opening of the ventricles that is mandatory in all disconnection techniques, while they may be prevented by closure of the CSF access by fibrin glue. 15 While etiologies and contralateral MRI abnormalities are consensual predictive factors for seizure freedom after hemispherotomy, the impact of the surgical approach on seizure outcomes is still debated. Indeed, if the post hoc analysis of the Hemispherotomy Outcome Prediction Scale study showed an odds ratio of 3.67 for seizure recurrence when comparing lateral with vertical hemispherotomy, the difference in the sample size (600 in the lateral group vs72 in the vertical) questions the validity of the statistical analysis.…”

Section: Limitationsmentioning

confidence: 99%

Interhemispheric Vertical Hemispherotomy: Technique, Outcome, and Pitfalls—A Bicentric Retrospective Case Series of 39 Cases

Pilioneta,

Chen,

Losito

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: When seizure onset affects a whole hemisphere, hemispheric disconnections are efficient and safe procedures. However, both lateral peri-insular hemispherotomy and vertical paramedian hemispherotomy approaches report a failure rate around 20%, which can be explained by residual connections giving rise to persistent seizures. In this study, we present the interhemispheric vertical hemispherotomy (IVH), a technical variation of the vertical paramedian hemispherotomy approach, that aims to increase seizure control avoiding residual connections while exposing the corpus callosum. METHODS: This is a retrospective study of IVH in two centers, with analysis of clinical and MRI data and outcomes. A detailed description of the technique is provided with a video. RESULTS: IVH was performed in 39 children. The mean age at surgery was 7.2 years, and etiologies were as follows: malformations of cortical development (n = 14), Rasmussen's encephalitis (n = 10), stroke (n = 10), post-traumatic (3), and Sturge-Weber Syndrome (2). Hemispheric disconnection was complete on postoperative MRI in 34 cases. There was no mortality, hydrocephalus occurred in one case, and subdural collection occurred in four cases. A second surgery was performed in four cases because of seizure relapse (n = 3) and/or incomplete disconnection on MRI (n = 4). With a mean follow-up of 3.2 years, International League Against Epilepsy class I epilepsy outcome was obtained for 37/39 patients. CONCLUSION: IVH is a safe and effective variation of the vertical approaches for hemispheric disconnection. It allows a good exposure and anatomic control of the corpus callosum, which is a frequent site of incomplete disconnection. IVH may be limited by the thalamic volume and the ventricular size, notably in hemimegalencephaly cases.

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Corticotomy Closure Avoids Subdural Collections After Hemispherotomy

Abstract: We recommend closing ventricular access after functional hemispherotomy, notably in patients who have had a stroke.

Cited by 5 publications

References 14 publications

Vertical perithalamic hemispherotomy: A single‐center experience in 40 pediatric patients with epilepsy

Vertical perithalamic hemispherotomy: A single‐center experience in 40 pediatric patients with epilepsy

Posthemispherectomy hydrocephalus: Results of a comprehensive, multiinstitutional review

Interhemispheric Vertical Hemispherotomy: Technique, Outcome, and Pitfalls—A Bicentric Retrospective Case Series of 39 Cases

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