Functional hemispherectomy for catastrophic epilepsy in very young infants: technical considerations and complication avoidance

Dorfer, Christian; Ochi, Ayako; Snead, O. Carter; Donner, Elizabeth; Holowka, Stephanie; Widjaja, Elysa; Rutka, James T.

doi:10.1007/s00381-015-2794-3

Cited by 22 publications

(24 citation statements)

References 28 publications

(44 reference statements)

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“…Dorfer et al . () reported four cases (three female, one male) of infants with “catastrophic epilepsy” who underwent functional hemispherectomy at 2.4 to 4.2 months of age. Three of the four were completely seizure‐free after a median follow‐up of 4.3 years (range 1.3 to 7.9 years).…”

Section: Hemispherectomymentioning

confidence: 99%

Psychiatric and Behavioural Disorders in Children with Epilepsy: an ILAE Task Force Report

Besag¹,

Aldenkamp²,

Caplan³

et al. 2016

Epileptic Disorders

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A subtle behavioural or cognitive manifestation of epilepsy can be defined in two ways. First, epileptiform discharges not presenting as obvious seizures may nevertheless affect cognition and/or behaviour. Second, the actual seizures may be obvious but the way they affect cognition or behaviour may not be. There is a growing body of evidence indicating that the epileptiform discharges in benign epilepsy with centrotemporal spikes can affect behaviour and cognition. The focal discharges in other forms of epilepsy can also be associated with behavioural change. The Landau‐Kleffner syndrome, the CSWS syndrome, transitory cognitive impairment and transient epileptic amnesia provide further examples of cognitive and behavioural manifestations resulting from subtle manifestations of the epilepsy. Prompt, effective antiepileptic treatment with medication or surgery can improve behaviour and cognition in at least some cases.

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Section: Hemispherectomymentioning

confidence: 99%

Psychiatric and Behavioural Disorders in Children with Epilepsy: an ILAE Task Force Report

Besag¹,

Aldenkamp²,

Caplan³

et al. 2016

Epileptic Disorders

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“…It is likely that the edema and DI was caused by the obstruction of venous drainage, but the underlying mechanism for such an association remains unknown. Previous data showed that manipulation and retraction of the fragile brain and vessels of infant may result in markable postoperative brain edema (Dorfer et al 2015). We advocate that all infants should be extensively monitored for blood/volume imbalance, peripheral temperature and serum electrolytes.…”

Section: Discussionmentioning

confidence: 99%

Vertical parasagittal hemispherotomy for Sturge–Weber syndrome in early infancy: case report and literature review

et al. 2016

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IntroductionThe authors here present a rare case of a 3-month-old infant with unilateral Sturge-Weber syndrome (SWS) who had excellent seizure control and no aggravation of previous existed neurological deficits after vertical parasagittal hemispherotomy (VPH). To our knowledge, this patient with SWS was the youngest one who received VPH.Case description The use of VPH results in a successful treatment of intractable epilepsy in a patient with seizure onset in early infancy. At follow-up, the patient’s neurodevelopmental status has been improved since the surgery.DiscussionIt is generally accepted that early-onset seizures in children with SWS are associated with worse neurological and developmental outcomes. However, when surgical treatment should be considered and how it should be performed remain a longstanding controversy. We promote early surgery in children with SWS and early-onset epilepsy.ConclusionWe suggest that VPH may be a useful adjuvant in the management of SWS with refractory epilepsy in early infancy and this procedure carries low neurological risk.

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“…39 Refinements in surgical technique have reduced hemorrhagic complications, but recent reviews still point to a 0.9%-2% overall mortality rate after hemispherectomy. 17,21,37 Seizure control with hemispherectomy can be particularly dramatic and gratifying in infants with some of the most severe forms of epilepsy, 1,3,5,8,10,[15][16][17]20,21,25,27,37 but the risk of hemorrhage is greatest in babies with small total blood volumes and "immature brain and blood vessels that are fragile and vulnerable to bleeding." 10 While intraoperative death due to bleeding is exceedingly uncommon with modern anesthetic and resuscitative techniques, coagulopathy is common and even cardiac arrest can occur during hemispherectomy in the modern age of surgery.…”

Section: Discussionmentioning

confidence: 99%

Use of a contoured bioresorbable plate with a hemostatic plug to control life-threatening bleeding from the superior sagittal sinus during hemispherotomy: technical note

Tuite

Carey

Nelson

et al. 2016

PED

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Profuse bleeding originating from an injured cerebral sinus can be a harrowing experience for any surgeon, particularly during an operation on a young child. Common surgical remedies include sinus ligation, primary repair, placement of a hemostatic plug, and patch or venous grafting that may require temporary stenting. In this paper the authors describe the use of a contoured bioresorbable plate to hold a hemostatic plug in place along a tear in the inferomedial portion of a relatively inaccessible part of the posterior segment of the superior sagittal sinus in an 11-kg infant undergoing hemispherotomy for epilepsy. This variation on previously described hemostatic techniques proved to be easy, effective, and ultimately lifesaving. Surgeons may find this technique useful in similar dire circumstances when previously described techniques are ineffective or impractical.

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Functional hemispherectomy for catastrophic epilepsy in very young infants: technical considerations and complication avoidance

Cited by 22 publications

References 28 publications

Psychiatric and Behavioural Disorders in Children with Epilepsy: an ILAE Task Force Report

Psychiatric and Behavioural Disorders in Children with Epilepsy: an ILAE Task Force Report

Vertical parasagittal hemispherotomy for Sturge–Weber syndrome in early infancy: case report and literature review

Use of a contoured bioresorbable plate with a hemostatic plug to control life-threatening bleeding from the superior sagittal sinus during hemispherotomy: technical note

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