Salvage Trans‐Sylvian Peri‐Insular Hemispherotomy After Embolic Hemispherectomy
ABSTRACT Background Hemispherectomy and hemispherotomy represent well‐established treatments for drug‐resistant hemispheric epilepsy. An alternative endovascular procedure has been explored for cases with challenging surgical anatomy, which seeks to achieve the clinical effect of hemispherectomy via...
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| Language: | English |
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Wiley
2025-06-01
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| Series: | Annals of the Child Neurology Society |
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| Online Access: | https://doi.org/10.1002/cns3.70003 |
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| author | Michael E. Baumgartner Sudha Kessler Kathleen Galligan James E. Baumgartner Benjamin C. Kennedy |
| author_facet | Michael E. Baumgartner Sudha Kessler Kathleen Galligan James E. Baumgartner Benjamin C. Kennedy |
| author_sort | Michael E. Baumgartner |
| collection | DOAJ |
| description | ABSTRACT Background Hemispherectomy and hemispherotomy represent well‐established treatments for drug‐resistant hemispheric epilepsy. An alternative endovascular procedure has been explored for cases with challenging surgical anatomy, which seeks to achieve the clinical effect of hemispherectomy via embolization of the major cerebral arteries and subsequent hemispheric infarction. Neither the safety nor effectiveness of this procedure has been established. Patient Description A 4‐month‐old girl with a history of drug‐resistant focal epilepsy due to left‐sided hemimegalecephaly previously treated with endovascular hemispherectomy at another institution presented for surgical evaluation due to ongoing electroclinical seizures despite multiple antiseizure medications. Pre‐operative magnetic resonance imaging (MRI) revealed viable tissue, including mesial temporal structures, and a salvage hemispherotomy was performed. The embolized cortex was surprisingly well‐perfused intra‐operatively. Postoperatively, she has had no further seizures at 1‐year follow‐up. Conclusion Embolization of the three large hemispheric arteries achieved neither complete hemispheric destruction nor complete disconnection in this case and did not resolve the patient's seizures, necessitating salvage hemispherotomy. While it is difficult to draw definitive conclusions from a single patient's course, our experience suggests that endovascular hemispheric destruction may not be an effective substitute for surgical hemispherectomy or hemispherotomy. |
| format | Article |
| id | doaj-art-b75f64a1bb8e4a49b5763429a6ece46a |
| institution | DOAJ |
| issn | 2831-3267 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of the Child Neurology Society |
| spelling | doaj-art-b75f64a1bb8e4a49b5763429a6ece46a2025-08-20T03:21:27ZengWileyAnnals of the Child Neurology Society2831-32672025-06-013211011410.1002/cns3.70003Salvage Trans‐Sylvian Peri‐Insular Hemispherotomy After Embolic HemispherectomyMichael E. Baumgartner0Sudha Kessler1Kathleen Galligan2James E. Baumgartner3Benjamin C. Kennedy4The Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USADivision of Neurology The Children's Hospital of Philadelphia Philadelphia Pennsylvania USADivision of Neurosurgery The Children's Hospital of Philadelphia Philadelphia Pennsylvania USADepartment of Neurosurgery College of Medicine, University of Central Florida Orlando Florida USADivision of Neurosurgery The Children's Hospital of Philadelphia Philadelphia Pennsylvania USAABSTRACT Background Hemispherectomy and hemispherotomy represent well‐established treatments for drug‐resistant hemispheric epilepsy. An alternative endovascular procedure has been explored for cases with challenging surgical anatomy, which seeks to achieve the clinical effect of hemispherectomy via embolization of the major cerebral arteries and subsequent hemispheric infarction. Neither the safety nor effectiveness of this procedure has been established. Patient Description A 4‐month‐old girl with a history of drug‐resistant focal epilepsy due to left‐sided hemimegalecephaly previously treated with endovascular hemispherectomy at another institution presented for surgical evaluation due to ongoing electroclinical seizures despite multiple antiseizure medications. Pre‐operative magnetic resonance imaging (MRI) revealed viable tissue, including mesial temporal structures, and a salvage hemispherotomy was performed. The embolized cortex was surprisingly well‐perfused intra‐operatively. Postoperatively, she has had no further seizures at 1‐year follow‐up. Conclusion Embolization of the three large hemispheric arteries achieved neither complete hemispheric destruction nor complete disconnection in this case and did not resolve the patient's seizures, necessitating salvage hemispherotomy. While it is difficult to draw definitive conclusions from a single patient's course, our experience suggests that endovascular hemispheric destruction may not be an effective substitute for surgical hemispherectomy or hemispherotomy.https://doi.org/10.1002/cns3.70003endovascular hemispherectomyepilepsyhemimegalencephalyhemispherotomy |
| spellingShingle | Michael E. Baumgartner Sudha Kessler Kathleen Galligan James E. Baumgartner Benjamin C. Kennedy Salvage Trans‐Sylvian Peri‐Insular Hemispherotomy After Embolic Hemispherectomy Annals of the Child Neurology Society endovascular hemispherectomy epilepsy hemimegalencephaly hemispherotomy |
| title | Salvage Trans‐Sylvian Peri‐Insular Hemispherotomy After Embolic Hemispherectomy |
| title_full | Salvage Trans‐Sylvian Peri‐Insular Hemispherotomy After Embolic Hemispherectomy |
| title_fullStr | Salvage Trans‐Sylvian Peri‐Insular Hemispherotomy After Embolic Hemispherectomy |
| title_full_unstemmed | Salvage Trans‐Sylvian Peri‐Insular Hemispherotomy After Embolic Hemispherectomy |
| title_short | Salvage Trans‐Sylvian Peri‐Insular Hemispherotomy After Embolic Hemispherectomy |
| title_sort | salvage trans sylvian peri insular hemispherotomy after embolic hemispherectomy |
| topic | endovascular hemispherectomy epilepsy hemimegalencephaly hemispherotomy |
| url | https://doi.org/10.1002/cns3.70003 |
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