Minimal invasive vertical hemispherotomy in a 2.5-month-old infant with hemispheric Sturge-Weber Syndrome and recurrent status epilepticus using neuronavigation and augmented reality support

Abstract

Hemispherotomy in infants under the age of 3 months is considered a high-risk procedure and is not routinely performed. A 2.5-month-old female infant weighing 5.1 kg successfully underwent a right vertical hemispherotomy after developing status epilepticus due to a right hemispheric Sturge-Weber meningo-angiomatosis. The surgical technique involved skull fixation at the skull base using kid pins to facilitate image-guided surgery with neuronavigation and augmented reality within the eyepiece of the microscope employing the vertical hemispherotomy technique. The surgical course was uneventful, with moderate blood loss (100 mL of red blood cells, 90 mL of fresh frozen plasma, and 150 mg of tranexamic acid transfused). The surgery duration was within 2 h. Postoperatively, seizures ceased immediately, and the infant experienced rapid developmental and neurological progress, remaining seizure-free for 8 months after surgery (Engel 1a) now.