Modified periinsular hemispherotomy: Operative anatomy and technical nuances: Technical note

Timothy J. Kovanda, Roberto Rey-Dios, Jared Travnicek, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Surgical options for pediatric patients with marked dysfunction of a single epileptogenic hemisphere have evolved over time. Complications resulting from highly resective operations such as anatomical hemispherectomy, including superficial siderosis and secondary hydrocephalus, have led to the development of less resective and more disconnective functional hemispherectomy. Functional hemispherectomy has recently given rise to hemispherotomy, the least resective operation primarily aimed at disconnecting the abnormal hemisphere. Hemispherotomy is effective in decreasing seizure frequency and most likely decreases the risk of postoperative complications when compared with its predecessors. Hemispherotomy is a technically challenging operation that requires a thorough understanding of 3D cerebral anatomy to ensure adequate hemispheric disconnection without placing important structures at risk. The details of germane operative anatomy are not currently available because of the difficulty in exposing this operative anatomy adequately in cadavers to prepare detailed instructive illustrations. Using 3D graphic models, the authors have prepared 2D overlay illustrations to discuss the relevant operative nuances for a modified form of this procedure. Through hemispherotomy, experienced surgeons can effectively treat patients with unilateral epileptogenic hemisphere dysfunction while limiting potential complications.

Original languageEnglish
Pages (from-to)332-338
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Volume13
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Hemispherectomy
Anatomy
Siderosis
Hydrocephalus
Cadaver
Seizures
Pediatrics

Keywords

  • Disconnection
  • Epilepsy surgery
  • Hemispherotomy
  • Intractable epilepsy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Modified periinsular hemispherotomy : Operative anatomy and technical nuances: Technical note. / Kovanda, Timothy J.; Rey-Dios, Roberto; Travnicek, Jared; Cohen-Gadol, Aaron.

In: Journal of Neurosurgery: Pediatrics, Vol. 13, No. 3, 2014, p. 332-338.

Research output: Contribution to journalArticle

Kovanda, Timothy J. ; Rey-Dios, Roberto ; Travnicek, Jared ; Cohen-Gadol, Aaron. / Modified periinsular hemispherotomy : Operative anatomy and technical nuances: Technical note. In: Journal of Neurosurgery: Pediatrics. 2014 ; Vol. 13, No. 3. pp. 332-338.
@article{6d6d567c53ed4c5f8acfae22c150eaed,
title = "Modified periinsular hemispherotomy: Operative anatomy and technical nuances: Technical note",
abstract = "Surgical options for pediatric patients with marked dysfunction of a single epileptogenic hemisphere have evolved over time. Complications resulting from highly resective operations such as anatomical hemispherectomy, including superficial siderosis and secondary hydrocephalus, have led to the development of less resective and more disconnective functional hemispherectomy. Functional hemispherectomy has recently given rise to hemispherotomy, the least resective operation primarily aimed at disconnecting the abnormal hemisphere. Hemispherotomy is effective in decreasing seizure frequency and most likely decreases the risk of postoperative complications when compared with its predecessors. Hemispherotomy is a technically challenging operation that requires a thorough understanding of 3D cerebral anatomy to ensure adequate hemispheric disconnection without placing important structures at risk. The details of germane operative anatomy are not currently available because of the difficulty in exposing this operative anatomy adequately in cadavers to prepare detailed instructive illustrations. Using 3D graphic models, the authors have prepared 2D overlay illustrations to discuss the relevant operative nuances for a modified form of this procedure. Through hemispherotomy, experienced surgeons can effectively treat patients with unilateral epileptogenic hemisphere dysfunction while limiting potential complications.",
keywords = "Disconnection, Epilepsy surgery, Hemispherotomy, Intractable epilepsy",
author = "Kovanda, {Timothy J.} and Roberto Rey-Dios and Jared Travnicek and Aaron Cohen-Gadol",
year = "2014",
doi = "10.3171/2013.12.PEDS13277",
language = "English",
volume = "13",
pages = "332--338",
journal = "Journal of Neurosurgery: Pediatrics",
issn = "1933-0707",
publisher = "American Association of Neurological Surgeons",
number = "3",

}

TY - JOUR

T1 - Modified periinsular hemispherotomy

T2 - Operative anatomy and technical nuances: Technical note

AU - Kovanda, Timothy J.

AU - Rey-Dios, Roberto

AU - Travnicek, Jared

AU - Cohen-Gadol, Aaron

PY - 2014

Y1 - 2014

N2 - Surgical options for pediatric patients with marked dysfunction of a single epileptogenic hemisphere have evolved over time. Complications resulting from highly resective operations such as anatomical hemispherectomy, including superficial siderosis and secondary hydrocephalus, have led to the development of less resective and more disconnective functional hemispherectomy. Functional hemispherectomy has recently given rise to hemispherotomy, the least resective operation primarily aimed at disconnecting the abnormal hemisphere. Hemispherotomy is effective in decreasing seizure frequency and most likely decreases the risk of postoperative complications when compared with its predecessors. Hemispherotomy is a technically challenging operation that requires a thorough understanding of 3D cerebral anatomy to ensure adequate hemispheric disconnection without placing important structures at risk. The details of germane operative anatomy are not currently available because of the difficulty in exposing this operative anatomy adequately in cadavers to prepare detailed instructive illustrations. Using 3D graphic models, the authors have prepared 2D overlay illustrations to discuss the relevant operative nuances for a modified form of this procedure. Through hemispherotomy, experienced surgeons can effectively treat patients with unilateral epileptogenic hemisphere dysfunction while limiting potential complications.

AB - Surgical options for pediatric patients with marked dysfunction of a single epileptogenic hemisphere have evolved over time. Complications resulting from highly resective operations such as anatomical hemispherectomy, including superficial siderosis and secondary hydrocephalus, have led to the development of less resective and more disconnective functional hemispherectomy. Functional hemispherectomy has recently given rise to hemispherotomy, the least resective operation primarily aimed at disconnecting the abnormal hemisphere. Hemispherotomy is effective in decreasing seizure frequency and most likely decreases the risk of postoperative complications when compared with its predecessors. Hemispherotomy is a technically challenging operation that requires a thorough understanding of 3D cerebral anatomy to ensure adequate hemispheric disconnection without placing important structures at risk. The details of germane operative anatomy are not currently available because of the difficulty in exposing this operative anatomy adequately in cadavers to prepare detailed instructive illustrations. Using 3D graphic models, the authors have prepared 2D overlay illustrations to discuss the relevant operative nuances for a modified form of this procedure. Through hemispherotomy, experienced surgeons can effectively treat patients with unilateral epileptogenic hemisphere dysfunction while limiting potential complications.

KW - Disconnection

KW - Epilepsy surgery

KW - Hemispherotomy

KW - Intractable epilepsy

UR - http://www.scopus.com/inward/record.url?scp=84895474555&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84895474555&partnerID=8YFLogxK

U2 - 10.3171/2013.12.PEDS13277

DO - 10.3171/2013.12.PEDS13277

M3 - Article

C2 - 24410122

AN - SCOPUS:84895474555

VL - 13

SP - 332

EP - 338

JO - Journal of Neurosurgery: Pediatrics

JF - Journal of Neurosurgery: Pediatrics

SN - 1933-0707

IS - 3

ER -