Tailored suprainsular partial hemispherotomy: A new functional disconnection technique for stroke-induced refractory epilepsy

Abstract

Objective: Hemispherotomy is currently the most frequently performed surgical option for refractory epilepsy associated with large perinatal or childhood ischemic events. Such an approach may lead to good seizure control, but it has inherent functional consequences linked to the disconnection of functional cortices. The authors report on 6 consecutive patients who presented with severe epilepsy associated with hemiplegia due to stroke and who benefitted from a new, stereoelectroencephalography-guided partial disconnection technique. Methods: The authors developed a new disconnection technique termed "tailored suprainsular partial hemispherotomy" (TSIPH). Disconnection always included premotor and motor cortex with variable anterior and posterior extent. Results: At a mean follow-up of 28 months, there were no deaths and no patient had hydrocephalus. Motor degradation was observed in all patients in the 2 weeks after surgery, but all patients completely recovered. The 6 patients were seizure free (Engel class IA) at the last follow-up. No neuropsychological aggravation was observed. Conclusions: TSIPH appears to be a conservative alternative to classic hemispherotomy, leading to favorable outcome in this series.