L'hémisphérotomie péri-insulaire: technique chirurgicale, monitoring EEG intraopératoire et résultats sur le contrôle de l'épilepsie [Periinsular hemispherotomy: surgical technique, intraoperative EEG monitoring and results on seizure outcome]

Details

Serval ID
serval:BIB_375F1340330F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
L'hémisphérotomie péri-insulaire: technique chirurgicale, monitoring EEG intraopératoire et résultats sur le contrôle de l'épilepsie [Periinsular hemispherotomy: surgical technique, intraoperative EEG monitoring and results on seizure outcome]
Journal
Neuro-Chirurgie
Author(s)
Pollo C., Debatisse D., Pralong E., Levivier M.
ISSN
0028-3770
Publication state
Published
Issued date
2008
Peer-reviewed
Oui
Volume
54
Number
3
Pages
303-310
Language
french
Abstract
Peri-insular hemispherotomy is a surgical technique used in the treatment of drug-resistant epilepsy of hemispheric origin. It is based on the exposure of insula and semi-circular sulci, providing access to the lateral ventricle through a supra- and infra-insular window. From inside the ventricle, a parasagittal callosotomy is performed. The basal and medial portion of the frontal lobe is isolated. Projections to the anterior commissure are interrupted at the time of amygdala resection. The hippocampal tail and fimbria-fornix are disrupted posteriorly. We report our experience of 18 cases treated with this approach. More than half of them presented with congenital epilepsy. Neuronavigation was useful in precisely determining the center and extent of the craniotomy, as well as the direction of tractotomies and callosotomy, allowing minimal exposure and blood loss. Intra-operative monitoring by scalp EEG on the contralateral hemisphere was used to follow the progression of the number of interictal spikes during the disconnection procedure. Approximately 90% of patients were in Engel's Class I. We observed one case who presented with transient postoperative neurological deterioration probably due to CSF overdrainage and documented one case of incomplete disconnection in a patient presenting with hemimegalencephaly who needed a second operation. We observed a good correlation between a significant decrease in the number of spikes at the end of the procedure and seizure outcome. Peri-insular hemispherotomy provides a functional disconnection of the hemisphere with minimal resection of cerebral tissue. It is an efficient technique with a low complication rate. Intra-operative EEG monitoring might be used as a predictive factor of completeness of the disconnection and consequently, seizure outcome.
Keywords
Adolescent, Adult, Amygdala/surgery, Cerebral Cortex/pathology, Cerebral Cortex/surgery, Child, Child, Preschool, Corpus Callosum/surgery, Electroencephalography, Epilepsy/surgery, Female, Fornix, Brain/surgery, Hippocampus/surgery, Humans, Infant, Magnetic Resonance Imaging, Male, Monitoring, Intraoperative, Neurosurgical Procedures/methods, Postoperative Complications/epidemiology, Seizures/surgery, Treatment Outcome
Pubmed
Web of science
Create date
12/10/2009 11:56
Last modification date
20/08/2019 14:25
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