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Endoscope-assisted (with robotic guidance and using a hybrid technique) interhemispheric transcallosal hemispherotomy: a comparative study with open hemispherotomy to evaluate efficacy, complications, and outcome.
Chandra, P Sarat; Subianto, Heri; Bajaj, Jitin; Girishan, Shabari; Doddamani, Ramesh; Ramanujam, Bhargavi; Chouhan, Mahendra Singh; Garg, Ajay; Tripathi, Madhavi; Bal, Chandrasekhar S; Sarkar, Chitra; Dwivedi, Rekha; Sapra, Savita; Tripathi, Manjari.
Affiliation
  • Chandra PS; Departments of1Neurosurgery.
  • Subianto H; 3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and.
  • Bajaj J; Departments of1Neurosurgery.
  • Girishan S; 3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and.
  • Doddamani R; Departments of1Neurosurgery.
  • Ramanujam B; 3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and.
  • Chouhan MS; Departments of1Neurosurgery.
  • Garg A; 3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and.
  • Tripathi M; Departments of1Neurosurgery.
  • Bal CS; 2Neurology.
  • Sarkar C; 3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and.
  • Dwivedi R; 4Department of Neurosurgery, Shalby Multi-Speciality Hospital, Ahmedabad, India.
  • Sapra S; 5Neuroradiology.
  • Tripathi M; 6Nuclear Medicine.
J Neurosurg Pediatr ; 23(2): 187-197, 2018 11 09.
Article in En | MEDLINE | ID: mdl-30497135
ABSTRACT
OBJECTIVEEndoscope-assisted hemispherotomy (EH) has emerged as a good alternative option for hemispheric pathologies with drug-resistant epilepsy.METHODSThis was a prospective observational study. Parameters measured included primary outcome measures (frequency, severity of seizures) and secondary outcomes (cognition, behavior, and quality of life). Blood loss, operating time, complications, and hospital stay were also taken into account. A comparison was made between the open hemispherotomy (OH) and endoscopic techniques performed by the senior author.RESULTSOf 59 cases (42 males), 27 underwent OH (8 periinsular, the rest vertical) and 32 received EH. The mean age was 8.65 ± 5.41 years (EH 8.6 ± 5.3 years; OH 8.6 ± 5.7 years). Seizure frequency per day was 7 ± 5.9 (EH 7.3 ± 4.6; OH 15.0 ± 6.2). Duration of disease (years since first episode) was 3.92 ± 1.24 years (EH 5.2 ± 4.3; OH 5.8 ± 4.5 years). Number of antiepileptic drugs per patient was 3.9 ± 1.2 (EH 4.2 ± 1.2; OH 3.8 ± 0.98). Values for the foregoing variables are expressed as the mean ± SD. Pathologies included the following postinfarct encephalomalacia in 19 (EH 11); Rasmussen's syndrome in 14 (EH 7); hemimegalencephaly in 12 (EH 7); hemispheric cortical dysplasia in 7 (EH 4); postencephalitis sequelae in 6 (EH 2); and Sturge-Weber syndrome in 1 (EH 1). The mean follow-up was 40.16 ± 17.3 months. Thirty-nine of 49 (79.6%) had favorable outcomes (International League Against Epilepsy class I and II) in EH the total was 19/23 (82.6%) and in OH it was 20/26 (76.9%). There was no difference in the primary outcome between EH and OH (p = 0.15). Significant improvement was seen in the behavioral/quality of life performance, but not in IQ scores in both EH and OH (p < 0.01, no intergroup difference). Blood loss (p = 0.02) and hospital stay (p = 0.049) were less in EH.CONCLUSIONSEH was as effective as the open procedure in terms of primary and secondary outcomes. It also resulted in less blood loss and a shorter postoperative hospital stay.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Corpus Callosum / Hemispherectomy / Robotic Surgical Procedures / Drug Resistant Epilepsy Type of study: Guideline / Observational_studies / Prognostic_studies Aspects: Patient_preference Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Language: En Journal: J Neurosurg Pediatr Journal subject: NEUROCIRURGIA / PEDIATRIA Year: 2018 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Corpus Callosum / Hemispherectomy / Robotic Surgical Procedures / Drug Resistant Epilepsy Type of study: Guideline / Observational_studies / Prognostic_studies Aspects: Patient_preference Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Language: En Journal: J Neurosurg Pediatr Journal subject: NEUROCIRURGIA / PEDIATRIA Year: 2018 Document type: Article