Modified Peri-Insular Hemispherotomy in Pediatric Epilepsy: A Non-Middle Cerebral Artery Sparing Approach: 2-Dimensional Operative Video

Abstract

Hemispherectomy is a highly complex procedure that demands a steep learning curve and requires precision for successful seizure control.1-5 The aim of this operative technique video was to present a modified peri-insular hemispherotomy for pediatric epilepsy. Our case involves a 14-year-old adolescent with Rasmussen Syndrome and intractable seizures, undergoing a technique that involved 7 stages: patient position and surgical approach, opercular resection with ligation of the middle cerebral artery in the proximal sylvian fissure, transventricular callosotomy, fronto-orbital disconnection, anterior temporal disconnection, posterior temporal disconnection, and closure. Twelve months postsurgery, the patient achieved Engel I status with complete seizure freedom, improved hemiparesis (Gross Motor Function Classification System II), and enhanced neurocognition, as confirmed by the treating neurologist. Our findings underscore the potential benefits of this modified technique inmanaging pediatric epilepsy. The patient and her parents providedwritten consent for the surgical procedure and for the publication of her video and images. Appropriate consent was obtained for the publication of the cadaveric images. This study did not require an Institutional Review Board review because it was based exclusively on the retrospective analysis of previously collected anonymized data, in accordance with relevant regulations