Endoscope-assisted hemispherotomy: Translation of technique from cadaveric anatomical feasibility study to clinical implementation

Kathryn Wagner, Francisco Vaz-Guimaraes, Kevin Camstra, Sandi Lam*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

OBJECTIVE Appropriately chosen candidates with medically refractory epilepsy may benefit from hemispheric disconnection. Traditionally, this involves a large surgical exposure with significant associated morbidity. Minimally invasive approaches using endoscopic assistance have been described by only a few centers. Here, the authors report on the feasibility of endoscope-assisted functional hemispherotomy in a cadaver model and its first translation into clinical practice in appropriately selected patients. METHODS Three silicone-injected, formalin-fixed cadaver heads were used to establish the steps of the procedure in the laboratory. The steps of disconnection were performed using standard surgical instruments and a straight endoscope. The technique was then applied in two patients who had been referred for hemispherectomy and had favorable anatomy for an endoscope-assisted approach. RESULTS All disconnections were performed in the cadaver model via a 4 × 2–cm paramedian keyhole craniotomy using endoscopic assistance. An additional temporal burr hole approach was marked in case the authors were unable to completely visualize the frontobasal and insular cuts from the paramedian vertical view. Their protocol was subsequently used successfully in two pediatric patients. Full disconnection was verified with postoperative tractography. CONCLUSIONS Full hemispheric disconnection can be accomplished with minimally invasive endoscope-assisted functional hemispherotomy. The procedure is technically feasible and can be safely applied in patients with favorable anatomy and pathology; it may lead to less surgical morbidity and faster recovery.

Original languageEnglish (US)
Pages (from-to)178-186
Number of pages9
JournalJournal of Neurosurgery: Pediatrics
Volume23
Issue number2
DOIs
StatePublished - Feb 2019
Externally publishedYes

Keywords

  • Endoscope-assisted
  • Endoscopic
  • Epilepsy
  • Hemispherectomy
  • Hemispherotomy
  • Keyhole
  • Seizure surgery

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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