Peri-insular hemispherotomy in paediatric epilepsy.
- Villemure JG Neurosurgery Service, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland. jean-guy.villemure@chuv.ch
- Daniel RT
- 2006-06-29
Published in:
- Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - 2006
Adolescent
Adult
Cerebral Cortex
Child
Child, Preschool
Electroencephalography
Epilepsy
Female
Follow-Up Studies
Hemispherectomy
Humans
Magnetic Resonance Imaging
Male
Pediatrics
Treatment Outcome
English
OBJECTS
Outline the indications, investigation, surgical technique, pitfalls, complications and benefits of peri-insular hemispherotomy (PIH) in the surgical treatment of paediatric epilepsy.
MATERIALS AND METHODS
This report is based on a consecutive series of 43 children who underwent PIH. Sixty percent were males; there were slightly more left-sided surgeries. Median interval between seizure onset and surgery was 5 years. In more than half the cases, the anatomical substrate was congenital. There were few complications: one death, one hydrocephalus and two anatomically remote haemorrhages. Ninety percent of the patients have remained in Engel's class I epilepsy outcome.
CONCLUSIONS
There are clear indications for hemispherectomy in children. In some instances of incomplete deficit, timing of surgery remains a major concern. The less invasive approach to eliminate the influence of the diseased hemisphere, in our opinion, is with disconnective techniques of hemispherectomy, and among the latter, peri-insular hemispherotomy provides, in our opinion, the best complications-benefits ratio.
Outline the indications, investigation, surgical technique, pitfalls, complications and benefits of peri-insular hemispherotomy (PIH) in the surgical treatment of paediatric epilepsy.
MATERIALS AND METHODS
This report is based on a consecutive series of 43 children who underwent PIH. Sixty percent were males; there were slightly more left-sided surgeries. Median interval between seizure onset and surgery was 5 years. In more than half the cases, the anatomical substrate was congenital. There were few complications: one death, one hydrocephalus and two anatomically remote haemorrhages. Ninety percent of the patients have remained in Engel's class I epilepsy outcome.
CONCLUSIONS
There are clear indications for hemispherectomy in children. In some instances of incomplete deficit, timing of surgery remains a major concern. The less invasive approach to eliminate the influence of the diseased hemisphere, in our opinion, is with disconnective techniques of hemispherectomy, and among the latter, peri-insular hemispherotomy provides, in our opinion, the best complications-benefits ratio.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1007/s00381-006-0134-3
- PMID 16804712
- Persistent URL
- https://sonar.ch/global/documents/278018
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