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Peri-insular hemispherotomy in paediatric epilepsy

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Abstract

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.

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Authors and Affiliations

  1. Neurosurgery Service, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Jean-Guy Villemure

  2. Neurosurgery Service, Christian Medical College, Vellore, India

    Roy Thomas Daniel

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  1. Jean-Guy Villemure
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  2. Roy Thomas Daniel
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Correspondence to Jean-Guy Villemure.

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Villemure, JG., Daniel, R.T. Peri-insular hemispherotomy in paediatric epilepsy. Childs Nerv Syst 22, 967–981 (2006). https://doi.org/10.1007/s00381-006-0134-3

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