Introduction: Endoscopic Assisted Inter Hemispheric Trans-Callosal Hemispherotomy: Preliminary Description Of A Novel Technique

Methods: Endoscopic assisted inter hemispheric trans-callosal hemispherotomy was performed in 5 children (April 2013-June 2014). The procedure consisted of the use of a small craniotomy (4 X 3 cm), just lateral to midline using a transverse skin incision. Following dural opening, the surgery was performed with the assistance of a rigid high-definition endoscope, 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 (3), Rasmussen’s (3), and hemimegalencephaly (3). 8 patients had a class I Engel and one patient had a class II outcome at a mean follow up of 13.2 months (range: 8-14 months). The mean blood loss was 80 cc and mean operating time was 210 minutes. There were no complications in this study.

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

Patient Care: reduce morbidity, blood loss, minimally invasive procedure

Learning Objectives: New minimally technique to perform hemisphertomy using endoscopic assistance

References: Chandra PS, Kurwale N, Garg A, Dwivedi R, Malviya SV, Tripathi M. Endoscopy-Assisted Interhemispheric Transcallosal Hemispherotomy: Preliminary Description of a Novel Technique. Neurosurgery. 2015 Feb 12. [Epub ahead of print] PubMed PMID: 25710106.