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Functional hemispherectomy

Qi Xu, Shimrit Uliel-Sibony, Christopher Dunham, Harvey Sarnat, Laura Flores-Sarnat, Ledia Brunga, Scott Davidson, Winnie Lo, Adam Shlien, Mary Connolly, Cyrus Boelman, Anita Datta
Hemimegalencephaly is a hamartomatous malformation of one hemisphere. Functional hemispherectomy, the definitive treatment, is associated with significant morbidity and mortality in early infancy. Dysregulation of the mTOR pathway can result in malformations of cortical development, and mTOR inhibitors can effectively reduce seizures in tuberous sclerosis complex. We report a 6-day-old female with hemimegalencephaly and frequent seizures despite 9 antiseizure medications. At 3 months of age, while awaiting hemispherectomy, an mTOR inhibitor, rapamycin, was initiated by the neurologist...
December 5, 2018: Journal of Child Neurology
(no author information available yet)
OBJECTIVEAppropriately 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.METHODSThree silicone-injected, formalin-fixed cadaver heads were used to establish the steps of the procedure in the laboratory...
October 1, 2018: Journal of Neurosurgery. Pediatrics
C Luis, E Vilà, L Moltó, A Pardo, J L Fernández Candil, S Pacreu
No abstract text is available yet for this article.
December 2018: Revista Española de Anestesiología y Reanimación
Olga Savina, Daniel Guitton
A critical question in neurology is how the brain reorganizes its structure and function following injury. Here, we consider oculomotor control following a massive brain lesion, a hemispherectomy. We used the oblique anti-saccade task which requires the suppression of a saccade towards a visual cue, flashed anywhere in a patient's seeing hemifield, and the generation, in the dark, of an anti-saccade to a task-dependent location in the opposite blind hemifield; inverting either the horizontal or both horizontal and vertical components...
October 17, 2018: Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
Joon Won Kang, Soyong Eom, William Hong, Hye Eun Kwon, Soyoung Park, Ara Ko, Hoon-Chul Kang, Joon Soo Lee, Young-Mock Lee, Dong Seok Kim, Heung Dong Kim
OBJECTIVE: We aimed to evaluate the long-term outcome of resective epilepsy surgery in patients with Lennox-Gastaut syndrome (LGS). METHODS: We reviewed the case reports of 90 patients with LGS who had undergone resective surgery between 2003 and 2014 at the Severance Children's Hospital and managed them for a minimum period of 2 years. RESULTS: At the time of surgery, the patients were between 3.0 and 23.5 years old (mean ± SD: 9.3 ± 4...
October 2018: Pediatrics
Ju-Seong Kim, Eun-Kyung Park, Kyu-Won Shim, Dong Seok Kim
Hemispherectomy constitutes an established surgical method in the management of patients with medically intractable epilepsy secondary to severe unilateral hemisphere damage. As opposed to focal resections, in hemispherotomies, the entire hemisphere is disconnected from the remaining nervous system, including the functional regions and fibers. Despite this, hemispherotomy is recommended for certain indications, and has good functional and epilepsy outcomes. Here we describe the indications, epilepsy outcomes, and surgical techniques for several hemispheric surgeries...
June 2018: Journal of Epilepsy Research
Xiuyu Du, Sichang Chen, Yuguang Guan, Jingjing Gu, Meng Zhao, Tianfu Li, Junhong Pan, Guoming Luan
BACKGROUND: Anatomic hemispherectomy is an effective surgical treatment for patients with hemispherical intractable epilepsy. Different degrees of brain shifting have been observed, but whether these shifts can predict motor function recovery is unknown. The aim of this study was to analyze the correlation between brain shift ratios of different brain areas and motor function before and after surgery. METHODS: Medical records and magnetic resonance imaging of 23 patients who underwent anatomic hemispherectomy from 2006 to 2013 at a single center were retrospectively reviewed...
October 2018: World Neurosurgery
Loraine Georgy, Bert Jans, Marco Tamietto, Alain Ptito
Blindsight refers to the ability of some patients with destruction of the primary visual cortex (V1) to respond to stimuli presented in their clinically blind visual field despite lack of visual awareness. Here we tested a rare and well-known patient with blindsight following hemispherectomy, DR, who has had the entire cortex in the right hemisphere removed, and in whom the right superior colliculus is the only post-chiasmatic visual structure remaining intact. Compared to more traditional cases of blindsight after damage confined to V1, the study of blindsight in hemispherectomy has offered the invaluable opportunity to examine directly two outstanding questions: the contribution of the intact hemisphere to visual processing without awareness, and the nature of plastic and compensatory changes in these remaining contralesional visual areas...
June 30, 2018: Neuropsychologia
O Foesleitner, K-H Nenning, T Traub-Weidinger, M Feucht, S Bonelli, T Czech, C Dorfer, D Prayer, G Kasprian
BACKGROUND AND PURPOSE: Asymmetry of the corticospinal tract in congenital lesions is a good prognostic marker for preserved motor function after hemispherectomy. This study aimed to assess this marker and provide a clinically feasible approach in selected cases of unilateral polymicrogyria. MATERIALS AND METHODS: Corticospinal tract asymmetry of 9 patients with unilateral polymicrogyria substantially affecting the central region was retrospectively assessed on axial T1WI and DTI...
August 2018: AJNR. American Journal of Neuroradiology
Prem Chand, Pooja Manglani, Qalab Abbas
Isolated hemimegalencephaly (iHME) is a rare form of congenital malformation of cortical development characterized by enlargement of all or part of one cerebral hemisphere. It typically presents with intractable seizures, developmental delay, contralateral hemiparesis, and hemianopia. We report a case of an 18-month-old girl who presented first with focal seizures at tenth day of life, with no other physical or behavioral abnormality. Initial EEG showed excessive sharp EEG transients more over the right hemisphere; repeated EEG showed spikes, polyspikes, sharps, and slow wave discharges predominately over the right hemisphere...
January 2018: Journal of Pediatric Neurosciences
Ivair Matias, Daoud Hibrahim Elias-Filho, Camila Araújo Bernardino Garcia, Guilherme Henrique Silva, Jorge Mejia, Francisco Romero Cabral, Ana Cláudia Camargo Miranda, Sérgio Gomes da Silva, Luíza da Silva Lopes, Norberto Cysne Coimbra, Hélio Rubens Machado
OBJECTIVE The objective of this study was to describe a new experimental model of hemispherotomy performed on laboratory animals. METHODS Twenty-six male young adult Wistar rats were distributed into two groups (surgery and control). The nonfluorescent anterograde neurotracer biotinylated dextran amine (BDA; 10,000 MW) was microinjected into the motor cortex area (M1) according to The Rat Brain in Stereotaxic Coordinates atlas to identify pathways and fibers disconnected after the experimental hemispherectomy...
June 8, 2018: Journal of Neurosurgery
Xiu-Yu Du, Si-Chang Chen, Yu-Guang Guan, Jing-Jing Gu, Meng Zhao, Tian-Fu Li, Jun-Hong Pan, Guo-Ming Luan
OBJECTIVE: Hemispherectomy has been used successfully for patients with medically intractable epilepsy. However, it is difficult to predict postoperative motor function. The aim of the present study was to analyze whether the preoperative asymmetry of cerebral peduncles could be used to predict motor function restoration before hemispherectomy for young patients with medically intractable epilepsy. METHODS: The clinical record and magnetic resonance imaging data of 53 patients were analyzed retrospectively...
August 2018: World Neurosurgery
Jonas Vanags, Monisha Sachdev, Gerald Grant, Mohamad A Mikati
Two patients at our center experienced florid visual hallucinations following hemispherectomy. The first patient had drug-resistant left hemispheric focal seizures at 20 months of age from a previous stroke. Following functional hemispherectomy at age 3, he experienced frightening hallucinations 1 month post-operatively lasting 3.5 months. Our second patient underwent subtotal hemispherectomy at age 6 for drug-resistant focal seizures from right hemispheric cortical dysplasia. Eighteen months later he developed scary visual hallucinations during which he would shout and throw things...
2018: Epilepsy & Behavior Case Reports
C Luis, E Vilà, L Moltó, A Pardo, J L Fernández Candila, S Pacreu
We present the case of an adult patient with drug-resistant epilepsy caused by extensive inflammation in the right cerebral hemisphere. She was scheduled to undergo right functional hemispherectomy, which is common in pediatric surgery, but about which few studies have been published with respect to adult patients. During the intraoperative period, the density spectral array of the bilateral bispectral index (BIS) VISTATM monitoring system was used. We observed a power increase in low frequency (0.1-4Hz) and alpha bands (8-12Hz) in the right hemisphere, where the epileptogenic focus was...
October 2018: Revista Española de Anestesiología y Reanimación
Solon Schur, Victoria Allen, Andrew White, David Mirsky, Nicholas Stence, Brent O'Neill, Michael Handler, Roy Dudley, Pramote Laoprasert
BACKGROUND: Interictal 18F-fluorodeoxyglucose-positron emission topography (FDG-PET) hypometabolism is routinely used in the presurgical workup of children with medically intractable epilepsy (MIE). FDG-PET hypermetabolism, however, is rarely seen, and the significance of this finding in the epilepsy workup is not well established. METHODS: We performed a retrospective study of patients who underwent FDG-PET during the presurgical workup of MIE over a 4-year period, between 1 January 2010 and 31 December 2013, at the Children's Hospital Colorado, CO, USA...
2018: Pediatric Neurosurgery
Alessandra Moletto, Irene Bagnasco, Patrizia Dassi, Piernanda Vigliano
OBJECTIVE: To study the long-term neurocognitive changes of a right-handed girl with intractable epilepsy after late right hemispherectomy and compare them with data in the literature. METHOD: The girl was affected by an epileptic encephalopathy associated with right fronto-temporo-parietal polymicrogyria; she was submitted to right hemispherectomy at the age of 5 and examined with cognitive and neuropsychological tests at the age of 17 years. The girl took advantage of neurocognitive rehabilitation for several years; she is currently seizure-free and off therapy...
August 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
X Rodriguez-Osorio, F J Lopez-Gonzalez, J Eiris-Punal, C Frieiro-Dantas, C Gomez-Lado, M Peleteiro-Fernandez, A Prieto-Gonzalez
INTRODUCTION: Functional hemispherectomy consists in palliative epilepsy surgical procedure usually performed in patients with pharmaco-resistant epilepsy and hemispheric syndromes. It is based on the neural disconnection of the affected hemisphere with preservation of the vascular supply. AIM: To analyze long-term prognosis and safety of the hemispherectomies performed in our institution. PATIENTS AND METHODS: Retrospective analysis collecting the following variables: age, gender, age of epilepsy onset, type of seizures, etiology, age of epilepsy surgery, prognosis and potential surgical complications...
March 1, 2018: Revista de Neurologia
Michael Nahm, David Rousseau, Bruce Greyson
Neuroscientists typically assume that human mental functions are generated by the brain and that its structural elements, including the different cell layers and tissues that form the neocortex, play specific roles in this complex process. Different functional units are thought to complement one another to create an integrated self-awareness or episodic memory. Still, findings that pertain to brain dysplasia and brain lesions indicate that in some individuals there is a considerable discrepancy between the cerebral structures and cognitive functioning...
December 2017: Journal of Nervous and Mental Disease
Allen L Ho, Arjun V Pendharkar, Eric S Sussman, May Casazza, Gerald A Grant
Hemispherectomy is a highly effective treatment option for children with severe, unilateral, medically refractory epilepsy. Many patients undergoing hemispherectomy are younger patients with dysmorphic brains, making accomplishing a complete disconnection challenging due to anatomic distortion, even with the aid of intraoperative navigation. Diffusion tensor imaging (DTI) has been proposed as a valuable imaging adjunct perioperatively to help guide surgeons intraoperatively, as well as for post-surgical evaluation and confirmation of complete hemispheric disconnection...
September 18, 2017: Curēus
Mashael AlKhateeb, Richard McLachlan, Jorge Burneo, David Diosy, Seyed Mirsattari
Septo-optic dysplasia (SOD) is a rare disorder associated with optic nerve hypoplasia, pituitary abnormalities and agenesis/dysgenesis of midline brain structures including the septum pellucidum and corpus callosum. Though sometimes associated with drug-resistant epilepsy, this association has not been well studied. We report six SOD patients with associated malformation of cortical development (MCD) and drug-resistant epilepsy who underwent video-EEG telemetry at our centre between 1998 and 2016 for drug-resistant epilepsy...
2017: Epilepsy & Behavior Case Reports
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