Modified periinsular hemispherotomy: operative anatomy and technical nuances

2014 
Surgical options for pediatric patients with marked dysfunction of a single epileptogenic hemisphere have evolved over time. Complications resulting from highly resective operations such as anatomical hemispherectomy, including superficial siderosis and secondary hydrocephalus, have led to the development of less resective and more disconnective functional hemispherectomy. Functional hemispherectomy has recently given rise to hemispherotomy, the least resective operation primarily aimed at disconnecting the abnormal hemisphere. Hemispherotomy is effective in decreasing seizure frequency and most likely decreases the risk of postoperative complications when compared with its predecessors. Hemispherotomy is a technically challenging operation that requires a thorough understanding of 3D cerebral anatomy to ensure adequate hemispheric disconnection without placing important structures at risk. The details of germane operative anatomy are not currently available because of the difficulty in exposing this oper...
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