Endoscopic assisted inter hemispheric trans-callosal hemispherotomy: Preliminary description of a novel technique

Background: Various hemispherotomy techniques have been developed to reduce complication rates and achieve the best possible seizure control.

Objective: We present a novel and minimally invasive endoscopic assisted approach to perform this procedure.

Method: Endoscopic assisted inter hemispheric transcallosal hemispherotomy was performed in 20 children (April 2013–June 2014). The procedure consisted of the use of a small craniotomy (4 × 3 cm), just lateral to midline using a trans-verse skin incision. Following dural opening, the surgery was performed with the assistance of a rigid high-definition endo-scope, bayonetted self-irrigating bipolar, and other standard endoscopic instruments. Steps included a complete corpus callosotomy followed by the disconnection of the hemisphere at the level of the basal nuclei and thalamus. The surgeries were performed in a dedicated operating room with intra-operative MRI and neuro navigation. Intra-operative MRI confirmed a total disconnection.

Results: The pathologies for which surgeries were performed included sequelae of middle cerebral artery infarct (8), Rasmussen's (4), and hemimegalencephaly (8). Four patients had a class I Engel and one patient had a class II outcome at a mean follow up of 10.2 months (range: 3–14 months). The mean blood loss was 80 cc and mean operating time was 220 min. There were no complications in this study.

Conclusion: The present study describes a pilot novel technique and the feasibility of performing a minimally invasive endoscopic assisted hemispherotomy.