OBJECT: Corpus callosotomy and hemispherotomy are conventionally performed via a large craniotomy with the aid of a microscope for children with intractable epilepsy. Primary technical considerations include completeness of disconnection and blood loss. The authors describe an endoscopic technique performed through a microcraniotomy for these procedures. METHODS: Four patients with drop attacks and 2 with intractable seizures related to a neonatal stroke underwent endoscopic complete corpus callosotomy and hemispherotomy, respectively. The surgeries were performed through a 2- to 3-cm precoronal microcraniotomy. Interhemispheric dissection to the corpus callosum was done using the standard technique. Subsequently, the bimanual technique with a suction device mounted on an endoscope was used to perform a complete corpus callosotomy, including interforniceal and anterior commissure disconnection. In patients who had hemispherotomy, the fornix was resected posteriorly and lateral disconnection was done by unroofing the temporal horn. Anteriorly, endoscopic corticectomy was done along the ipsilateral anterior cerebral artery to reach the bifurcation of the internal carotid artery to complete the anterior disconnection. Postoperative MRI and diffusion tensor imaging (DTI) of the brain were performed to confirm complete disconnection. RESULTS: The procedure was accomplished successfully in all patients, with excellent visualization secured. None of the patients required a blood transfusion. Postoperative MRI and DTI confirmed completeness of the disconnection. Patients who underwent corpus callosotomy had complete resolution of drop attacks at a mean follow-up of 6 months, and patients who underwent hemispherotomy became seizure free. CONCLUSIONS: Endoscopic corpus callosotomy and hemispherotomy are surgically feasible procedures associated with minimal blood loss, minimal risk, and excellent visualization.
OBJECT: Corpus callosotomy and hemispherotomy are conventionally performed via a large craniotomy with the aid of a microscope for children with intractable epilepsy. Primary technical considerations include completeness of disconnection and blood loss. The authors describe an endoscopic technique performed through a microcraniotomy for these procedures. METHODS: Four patients with drop attacks and 2 with intractable seizures related to a neonatal stroke underwent endoscopic complete corpus callosotomy and hemispherotomy, respectively. The surgeries were performed through a 2- to 3-cm precoronal microcraniotomy. Interhemispheric dissection to the corpus callosum was done using the standard technique. Subsequently, the bimanual technique with a suction device mounted on an endoscope was used to perform a complete corpus callosotomy, including interforniceal and anterior commissure disconnection. In patients who had hemispherotomy, the fornix was resected posteriorly and lateral disconnection was done by unroofing the temporal horn. Anteriorly, endoscopic corticectomy was done along the ipsilateral anterior cerebral artery to reach the bifurcation of the internal carotid artery to complete the anterior disconnection. Postoperative MRI and diffusion tensor imaging (DTI) of the brain were performed to confirm complete disconnection. RESULTS: The procedure was accomplished successfully in all patients, with excellent visualization secured. None of the patients required a blood transfusion. Postoperative MRI and DTI confirmed completeness of the disconnection. Patients who underwent corpus callosotomy had complete resolution of drop attacks at a mean follow-up of 6 months, and patients who underwent hemispherotomy became seizure free. CONCLUSIONS: Endoscopic corpus callosotomy and hemispherotomy are surgically feasible procedures associated with minimal blood loss, minimal risk, and excellent visualization.
Authors: Aria Fallah; Evan Lewis; George M Ibrahim; Olivia Kola; Chi-Hong Tseng; William B Harris; Jia-Shu Chen; Kao-Min Lin; Li-Xin Cai; Qing-Zhu Liu; Jiu-Luan Lin; Wen-Jing Zhou; Gary W Mathern; Matthew D Smyth; Brent R O'Neill; Roy W R Dudley; John Ragheb; Sanjiv Bhatia; Daniel Delev; Georgia Ramantani; Josef Zentner; Anthony C Wang; Christian Dorfer; Martha Feucht; Thomas Czech; Robert J Bollo; Galymzhan Issabekov; Hongwei Zhu; Mary Connolly; Paul Steinbok; Jian-Guo Zhang; Kai Zhang; Eveline Teresa Hidalgo; Howard L Weiner; Lily Wong-Kisiel; Samuel Lapalme-Remis; Manjari Tripathi; Poodipedi Sarat Chandra; Walter Hader; Feng-Peng Wang; Yi Yao; Pierre-Olivier Champagne; Tristan Brunette-Clément; Qiang Guo; Shao-Chun Li; Marcelo Budke; Maria Angeles Pérez-Jiménez; Christian Raftopoulos; Patrice Finet; Pauline Michel; Karl Schaller; Martin N Stienen; Valentina Baro; Christian Cantillano Malone; Juan Pociecha; Noelia Chamorro; Valeria L Muro; Marec von Lehe; Silvia Vieker; Chima Oluigbo; William D Gaillard; Mashael Al-Khateeb; Faisal Al Otaibi; Niklaus Krayenbühl; Jeffrey Bolton; Phillip L Pearl; Alexander G Weil Journal: Epilepsia Date: 2021-09-12 Impact factor: 6.740