Background: Hemispheric disconnection represents a challenging and major epilepsy surgical procedure. This procedure in experienced hands offers excellent results in terms of seizure outcomes, especially for hemispheric pathologies such as Rasmussen's encephalitis, hemispheric dysplasias, hemimegalencephaly. The technique of hemispherotomy has witnessed various modifications over the years, beginning from anatomical hemispherectomy to the current era of minimally invasive functional hemispheric disconnections.
Objective: This study aimed to describe the technique of performing endoscopic vertical hemispherotomy using interhemispheric corridor developed by the senior author.
Materials and Methods: A 12-year-old girl with seizure onset at the age of 10 years presented with an aura of fear and nausea followed by tonic deviation of eyes to the right and blinking with speech arrest. There were tonic–clonic movements of the right-sided limbs along with ictal spitting and occasional deviation of the angle of mouth to the right. The patient had loss of awareness for the event along with postictal confusion lasting few minutes.
Results: Video electroencephalography (VEEG) revealed left parietocentral and left temporal localization. Serial magnetic resonance imaging (MRI) brain over 3 years revealed progressive left hemispheric changes suggestive of Rasmussen's encephalitis. The patient underwent left-sided endoscopic hemispherotomy. At 2 years follow-up, the patient is seizure-free (ILAE [International League Against Epilepsy] Class 1).
Conclusion: Endoscopic hemispherotomy using the interhemispheric approach is an elegant, minimally invasive, reproducible, safe, and efficacious technique.


中文翻译：

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非萎缩性拉斯穆森脑病的内镜下半球切开术


背景：半球断开代表了一种具有挑战性和主要的癫痫外科手术。这种由经验丰富的人进行的手术在癫痫发作方面提供了出色的结果，特别是对于半球病变，例如拉斯穆森脑炎、半球发育不良、半巨脑畸形。多年来，半球切开术见证了各种修改，从解剖半球切除术到当前微创功能性半球断开的时代。
目的：本研究旨在描述使用资深作者开发的半球间通道进行内窥镜垂直半球切开术的技术。
材料和方法：一名 12 岁女孩在 10 岁时开始癫痫发作，出现恐惧和恶心的先兆，随后眼睛强直地向右偏斜并眨眼并伴有言语停止。右侧肢体出现强直-阵挛运动，伴随发作期吐痰和偶尔嘴角向右偏移。患者对该事件失去意识，并伴有持续几分钟的发作后意识模糊。
结果：视频脑电图 (VEEG) 显示左侧顶中央和左侧颞叶定位。连续 3 年的脑部磁共振成像 (MRI) 显示提示拉斯穆森脑炎的进行性左半球变化。患者接受了左侧内镜下半球切开术。在 2 年的随访中，患者无癫痫发作（ILAE [国际抗癫痫联盟] 1 级）。
结论：内窥镜半球切开术使用大脑半球间入路是一种优雅、微创、可重复、安全和有效的技术。