Right Peri-insular Hemispherotomy: 2-dimensional operative video

Authors

  • Cleiton Formentin Division of Neurosurgery, Department of Neurology, University of Campinas, SP, Brazil.
  • Andrei Fernandes Joaquim Division of Neurosurgery, Department of Neurology, University of Campinas, SP, Brazil.
  • Helder Tedeschi Division of Neurosurgery, Department of Neurology, University of Campinas, SP, Brazil.
  • Enrico Ghizoni Division of Neurosurgery, Department of Neurology, University of Campinas, SP, Brazil.

DOI:

https://doi.org/10.46900/apn.v4i2(May-August).137

Keywords:

encephalitis, epilepsy, hemispherotomy, hemispherectomy

Abstract

This is a surgical technique video of a right peri-insular hemispherotomy in a child with Rasmussen’s encephalitis. The patient is a 5-year-old boy with focal onset impaired awareness seizures started 6 months before surgery, developing different subtypes of focal seizures and evolving to drug-resistant epilepsy. In neurological examination, he already had a left-sided hemiparesis with pyramidal signs. Magnetic resonance imaging showed right-sided cortical atrophy and fronto-insular subcortical hyperintensity signal areas. The preoperative electroencephalogram revealed frequent right-sided central mid temporal spikes. The history and complementary exams raised a hypothesis of Rasmussen’s encephalitis, a rare neurological condition, characterized by unilateral chronic inflammation of the cerebral cortex, causing drug-resistant epilepsy, and evolving to progressive neurological decline1. The hemispherotomy is an effective procedure aimed to isolate the entire hemisphere functionally with minimal removal of brain tissue, and remains the only cure for seizures caused by Rasmussen’s encephalitis2,3. Long-term seizure freedom may be achieved in around 80% of patients and improves quality of life4. It’s already accepted that briefer duration of epilepsy preceding the surgery is associated to better adaptive functioning postoperatively due to the high neuroplasticity of young patients4. Three years after surgery, the patient remains seizure free, walking without help.

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References

Varadkar S, Bien CG, Kruse CA, et al. Rasmussen’s encephalitis: Clinical features, pathobiology, and treatment advances. Lancet Neurol [Internet] 2014;13(2):195–205.

Hung TW, Rhoton AL, Marino R. Anatomical landmarks for hemispherotomy and their clinical application. J Neurosurg 2004;101(5):747–55.

Villemure JG, Mascott DR. Peri-insular hemispherotomy: surgical principles and anatomy surgical anatomy. Neurosurgery 1995;37; 975-981.

Santos MV, Teixeira TL, Ioriatti ES, Thome U, Hamad AP de A, Machado HR. Risk factors and results of hemispherotomy reoperations in children. Neurosurg Focus 2020;48(4):1–8.

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Published

2022-05-09

How to Cite

1.
Formentin C, Fernandes Joaquim A, Tedeschi H, Ghizoni E. Right Peri-insular Hemispherotomy: 2-dimensional operative video . Arch Pediat Neurosurg [Internet]. 2022 May 9 [cited 2022 Aug. 17];4(2(May-August):e1372022. Available from: https://archpedneurosurg.com.br/pkp/index.php/sbnped2019/article/view/137