Chima Oluigbo1, Monica S Pearl2,3, Tammy N Tsuchida4, Taeun Chang4, Cheng-Ying Ho5, William D Gaillard4. 1. Department of Neurosurgery, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, USA. coluigbo@cnmc.org. 2. Department of Radiology, Children's National Health System, Washington, DC, USA. 3. Division of Interventional Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 4. Department of Neurology, Children's National Health System, Washington, DC, USA. 5. Department of Neuropathology, Children's National Health System, Washington, DC, USA.
Abstract
PURPOSE: Conflicting challenges abound in the management of the newborn with intractable epilepsy related to hemimegalencephaly. Early hemispherectomy to stop seizures and prevent deleterious consequences to future neurocognitive development must be weighed against the technical and anesthetic challenges of performing major hemispheric surgery in the neonate. METHODS: We hereby present our experience with two neonates with hemimegalencephaly and intractable seizures who were managed using a strategy of initial minimally invasive embolization of the cerebral blood supply to the involved hemisphere. RESULTS: Immediate significant seizure control was achieved after embolization of the cerebral blood supply to the involved hemisphere followed by delayed ipsilateral hemispheric resection at a later optimal age. CONCLUSION: The considerations and challenges encountered in the course of the management of these patients are discussed, and a literature review is presented.
PURPOSE: Conflicting challenges abound in the management of the newborn with intractable epilepsy related to hemimegalencephaly. Early hemispherectomy to stop seizures and prevent deleterious consequences to future neurocognitive development must be weighed against the technical and anesthetic challenges of performing major hemispheric surgery in the neonate. METHODS: We hereby present our experience with two neonates with hemimegalencephaly and intractable seizures who were managed using a strategy of initial minimally invasive embolization of the cerebral blood supply to the involved hemisphere. RESULTS: Immediate significant seizure control was achieved after embolization of the cerebral blood supply to the involved hemisphere followed by delayed ipsilateral hemispheric resection at a later optimal age. CONCLUSION: The considerations and challenges encountered in the course of the management of these patients are discussed, and a literature review is presented.
Authors: Jorge A González-Martínez; Ajay Gupta; Prakash Kotagal; Deepak Lachhwani; Elaine Wyllie; Hans O Lüders; William E Bingaman Journal: Epilepsia Date: 2005-09 Impact factor: 5.864
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Authors: B S Carson; S P Javedan; J M Freeman; E P Vining; A L Zuckerberg; J A Lauer; M Guarnieri Journal: J Neurosurg Date: 1996-06 Impact factor: 5.115
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