case_images: PMC10951757_01
case_images: MCA-Infarct: 4yrs old male, delayed motor development, refractory seizures for 18 months; hemiparesis left, able to walk. T2 weighted MRI transversal (left) and coronar (right): Perinatal MCA-infarction involving the pyramidal tract.
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case_images: Perinatal infarction (Fig. 1), or intracerebral bleeding leading to large hemispheric defects with numerous cysts, causing drug resistant-epilepsy is one of the classical indications for any type of hemispheric disconnection procedures.
case_images: Rasmussen encephalitis: 13yrs old male, epilepsia partialis continua left arm and progressive hemiparesis. FDG-PET/CT transversal (left) and T2 weighted MRI transversal (right): Hypometabolism and slight hemiatrophy of the right hemisphere.
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case_images: The neurological deterioration and the occurrence of epilepsy typically mark the beginning of the acute stage. This stage is also accompanied by a progressive unilateral hemispheric atrophy usually starting in the insular lobe, which can be diagnosed by MRI (Fig. 2).
case_images: Schematic drawings of the 2 hemispherotomy techniques. Each hemisphere shows a single technique with the left hemisphere (blue) representing the periinsular hemispherotomy and the right (green) representing the vertical parasagittal hemispherotomy.A: Coronal view. B and C: Axial views. (In order to have only 2 axial cuts, some structures are represented on the same schema even if they are anatomically at different levels).(with CR permission O.Delalande and JNS group).
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case_images: At the end of the disconnection, the ventricular access is closed with fibrin glue, following irrigation of the ventricular cavities with saline after meticulous hemostasis, to avoid subdural collection (Fig. 3 and 4). This technique uses the transventricular approach for the mesial hemispheric disconnection in the same manner as the keyhole transsylvian approach (Fig. 3)(see below).
case_images: Coronal (left) and sagittal (right) T1-weighted MR images of a vertical parasagittal hemispherotomy. (with CR permission O.Delalande and JNS group).
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case_images: At the end of the disconnection, the ventricular access is closed with fibrin glue, following irrigation of the ventricular cavities with saline after meticulous hemostasis, to avoid subdural collection (Fig. 3 and 4).