Second surgery after vertical paramedian hemispherotomy for epilepsy recurrence

Baltus, Cedric; M’Kaddem, Bouchra EL.; Santos, Susana Ferrão; Vaz, José Géraldo Ribeiro; Raftopoulos, Christian

doi:10.1016/j.heliyon.2023.e14326

Cited by 1 publication

(1 citation statement)

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“…Three other patients needed revision surgery for persistent or recurrent seizures. Patients 14 and 16 had seizure recurrence with predominantly vegetative symptoms and had an amygdala residue resection: they are currently seizure-free [22].…”

Section: Seizure Outcomementioning

confidence: 99%

Modified Vertical Parasagittal Sub-Insular Hemispherotomy—Case Series and Technical Note

Del Gaudio,

Ferrao Santos,

Raftopoulos

2023

Brain Sciences

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(1) Background: Hemispherotomy is the generally accepted treatment for hemispheric drug-resistant epilepsy (DRE). Lateral or vertical approaches are performed according to the surgeon’s preference. Multiple technical variations have been proposed since Delalande first described his vertical technique. We propose a sub-insular variation of the vertical parasagittal hemispherotomy (VPH) and describe our case series of patients operated on using this procedure. (2) Methods: Data from a continuous series of patients with hemispheric DRE who were operated on by the senior author (CR) using the modified sub-insular VPH technique were analyzed retrospectively. Pre-operative demographic and epilepsy characteristics, functional outcome, and surgical complications were extracted from medical charts. (3) Results: Twenty-five patients were operated on between August 2008 and August 2023; 23 have at least 3 months of follow-up. Of this group, 20 (86.9%) patients are seizure-free. Only two patients developed postoperative hydrocephalus (8.7%). All patients who were able to walk autonomously preoperatively and 20 (86.9%) of those with follow-up were able to walk without assistance. A total of 17 (74%) patients were able to perform adapted social activities at the latest follow-up. (4) Conclusions: Modified sub-insular VPH is a successful surgical technique for hemispheric DRE with seizure freedom rates similar to the largest series reported in the literature. Compared to other series, patients who were operated on with our modified technique had a lower rate of postoperative hydrocephalus and excellent long-term motor and cognitive outcomes.

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Section: Seizure Outcomementioning

confidence: 99%