Functional hemispherectomy variant a report of twenty one cases / Functional hemispherectomy variant a report of twenty one cases

RESUMEN

Objective and importance Although Rasmussen´s hemispherectomy is a proven effective technique, the reduction in surgical time and in blood volume los during its performance is crucial. This is achieved by means of the tecnichal variant intended to disconnect instead of to remove the temporal lobe. Clinical representation We present 21 children operated between 1997 and 2004 in whom a functional hemisfactory (FH) variant was performed. The clinical manifestations included the following crises hemianopsia, versive crises, abscences, CPC and tonic crises, with secondary generalization in some of the children. Intervention The proposed variant is a sort of combination of Rasmussen´s hemispherectomy and Delalande´s hemispherectomy, involving disconnection and isolation of the temporal lobe. This is achieved at cortical level by prolonging the incision of the mesial aspect of the occipital lobe by intraventricular route is extended towards the fornix to reach the free border of the cerebellar tentorium. The juncture of both incisions disconnects the neocortex from the temporal lobe, as well as the parahippocampal gyrus and the hippocampus itself. Since aprevious complete callosotomy, a temporal stem section and amigdala suction had been performed, the temporal lobe remains in situ, but nonfunctional. Conclusion: It is the autor conviction that Rasmussen´s hemipherectomy is a valid procedure given its proven efficacy. We believe that the proposed technical variant is particularly useful for neurosurgeons that are in training in the field of epilepsy surgery, as a priori stage to the use of more restricted disconnecting techniques