Endoscopy-Assisted Interhemispheric Transcallosal Hemispherotomy

Abstract

This study describes a pilot novel technique and the feasibility of performing a minimally invasive, endoscopy-assisted hemispherotomy.

Letter to the Editor: Arterial spin labeling in evaluation of venous drainage pattern in brain arteriovenous malformations

“…We became aware of their work months after, when their paper was published online. 1 Indeed, we added their paper to the reference list of our final article and stated that there were critical differences in the methodologies as highlighted in our paper and their letter. In this regard we feel we have appropriately cited and acknowledged their work.…”

“…In general, ITB infusion is considered only when oral baclofen causes intolerable side effects or systemic toxicity at the dose level required to achieve therapeutic response. 1 We believe that the pre-trial oral baclofen dosage information is critical, especially when considering a very high positive trial rate. We wonder if the reported positive response rate of 98% was partially contributed to by prior systemic baclofen doses that had not yet been excreted.…”

“…In our study we report a severely affected group of pediatric patients, mostly nonambulant; 38 of 41 were classified as Gross Motor Function Classification System (GMFCS) Level IV or V (Level IV in 5, Level V in 33). 1 For these patients the goal areas were mostly related to comfort and ease of care. Care activities such as dressing or nappy change are usually performed by caregivers with the child lying on a bed.…”

“…The evolution of our work was independent of theirs and is a continuation of our description of using an endoscope with mounted suction along the interhemispheric fissure for transcallosal resection of intraventricular and thalamic tumors. 3 Both papers 1 describe the application of an endoscope in somewhat different ways to perform a slight variation on vertical hemispherotomy originally described by Delalande et al 2 While Chandra et al stated the use of a holder/assistant to hold and maneuver the endoscope, 1 we have used a suction with the endoscope attached, which the surgeon can maneuver using his/her left hand to the required field of surgery and, at the same time, use the attached suction to bimanually perform the procedure. This is conceptually different from their method, 1 which is traditionally used in transsphenoidal procedures, where the position of the endoscope does not need to be frequently changed since the field of surgery is small and is essentially the same as the field of vision through the endoscope.…”

“…7 of their article. 1 Finally, with a fixed endoscope, reintroducing an instrument into the field is done blindly until it reaches beyond the tip of the endoscope where it can be seen. Alternatively, the endoscope has to be unmounted and remounted, which is somewhat tedious even with use of a robotic arm.…”