J Korean Neurosurg Soc.  2019 May;62(3):336-343. 10.3340/jkns.2019.0031.

From Resection to Disconnection for Seizure Control in Pediatric Epilepsy Children

• Hwang JK
• Kim DS

• KMID: 2453239
• DOI: http://doi.org/10.3340/jkns.2019.0031

Abstract

Epilepsy surgery revealed dramatically improved seizure outcomes over medical therapy in drug-resistant epilepsy patients. Children with epilepsy, however, have multiple epileptic focuses which require multilobar resection for better seizure outcome. Multilobar resection has not only the several severe surgical complications, such as hydrocephalus and shunt-related craniosynostosis, due to intracranial volume reduction. Isolation method (disconnection surgery) was progressively studied over epileptic focus removal (resective surgery) for seizure control. This concept was first introduced for functional hemispherotomy, and its primary principle is to preserve the vital vascularized brain that is functionally disconnected from the contralateral healthy brain. Currently in most epilepsy centers, the predominant disconnection surgical methods, including functional hemispherotomy, are continually being refined and are showing excellent results. They allow the functional isolation of the hemisphere or multi-lobe, affected by severe epilepsy. This review describes recent findings concerning the indication, surgical technique, seizure outcome and complications in several disconnection surgeries including the functional hemispherotomy for refractory pediatric epilepsy.

Keyword

Functional hemispherotomy; Cerebral decortication; Epilepsy

MeSH Terms

Brain
Cerebral Decortication
Child*
Craniosynostoses
Epilepsy*
Humans
Hydrocephalus
Methods
Seizures*

Figure

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  Fig. 1. Postoperative MRI of several functional hemispherotomies. A : Postoperative MRI of peri-insular functional hemispherotomy. B : Postoperative MRI of transcortical transventricular functional hemispheroctomy. C : Postoperative MRI of transcallosal transventricular functional hemispherotomy. MRI : magnetic resonance imaging.

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  Fig. 2. Operative finding of several subhemispheric surgeries. A : Operative finding of anterior quadrantectomy. B : Operative finding of posterior quadrantectomy. C : Operative finding of posterior quadrantectomy, followed by frontal lobectomy. Final cortical incision margin (red line below) added on posterior quadrantectomy (light sea green line below). Lt. : left, H : hemisphere, F : frontal, PQ : posterior quadrantectomy.

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  Fig. 3. Postoperative magnetic resonance imaging of posterior quadrantectomy, followed by frontal lobectomy.

Reference

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