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Case report
peer-reviewed

Diffusion Tensor Imaging in an Infant Undergoing Functional Hemispherectomy: A Surgical Aid



Abstract

Hemispherectomy is a highly effective treatment option for children with severe, unilateral, medically refractory epilepsy. Many patients undergoing hemispherectomy are younger patients with dysmorphic brains, making accomplishing a complete disconnection challenging due to anatomic distortion, even with the aid of intraoperative navigation. Diffusion tensor imaging (DTI) has been proposed as a valuable imaging adjunct perioperatively to help guide surgeons intraoperatively, as well as for post-surgical evaluation and confirmation of complete hemispheric disconnection. We present a case of an infant with Otoharra syndrome and hemimegencephaly who underwent a functional hemispherectomy for treatment of severe, refractory seizures. We demonstrate how DTI was utilized both pre-, intra-, and postoperatively to help plan, guide, and confirm surgical disconnection. The application of exquisite DTI for this child led to her being seizure-free, which is a life-changing event with long-lasting benefits and will become even more critical as we now perform these disconnection procedures with a more minimally invasive approach.



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Case report
peer-reviewed

Diffusion Tensor Imaging in an Infant Undergoing Functional Hemispherectomy: A Surgical Aid


Author Information

Allen L. Ho Corresponding Author

Department of Neurosurgery, Stanford University School of Medicine

Arjun V. Pendharkar

Department of Neurosurgery, Stanford University School of Medicine

Eric S. Sussman

Department of Neurosurgery, Stanford University School of Medicine

May Casazza

Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital

Gerald A. Grant

Department of Neurosurgery, Stanford University School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Diffusion Tensor Imaging in an Infant Undergoing Functional Hemispherectomy: A Surgical Aid


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Case report
peer-reviewed

Diffusion Tensor Imaging in an Infant Undergoing Functional Hemispherectomy: A Surgical Aid

Allen L. Ho">Allen L. Ho , Arjun V. Pendharkar">Arjun V. Pendharkar, Eric S. Sussman">Eric S. Sussman, May Casazza">May Casazza, Gerald A. Grant">Gerald A. Grant

  • Author Information
    Allen L. Ho Corresponding Author

    Department of Neurosurgery, Stanford University School of Medicine

    Arjun V. Pendharkar

    Department of Neurosurgery, Stanford University School of Medicine

    Eric S. Sussman

    Department of Neurosurgery, Stanford University School of Medicine

    May Casazza

    Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital

    Gerald A. Grant

    Department of Neurosurgery, Stanford University School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 18, 2017

    DOI

    10.7759/cureus.1697

    Cite this article as:

    Ho A L, Pendharkar A V, Sussman E S, et al. (September 18, 2017) Diffusion Tensor Imaging in an Infant Undergoing Functional Hemispherectomy: A Surgical Aid. Cureus 9(9): e1697. doi:10.7759/cureus.1697

    Publication history

    Received by Cureus: August 03, 2017
    Peer review began: August 21, 2017
    Peer review concluded: September 13, 2017
    Published: September 18, 2017

    Copyright

    © Copyright 2017
    Ho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Hemispherectomy is a highly effective treatment option for children with severe, unilateral, medically refractory epilepsy. Many patients undergoing hemispherectomy are younger patients with dysmorphic brains, making accomplishing a complete disconnection challenging due to anatomic distortion, even with the aid of intraoperative navigation. Diffusion tensor imaging (DTI) has been proposed as a valuable imaging adjunct perioperatively to help guide surgeons intraoperatively, as well as for post-surgical evaluation and confirmation of complete hemispheric disconnection. We present a case of an infant with Otoharra syndrome and hemimegencephaly who underwent a functional hemispherectomy for treatment of severe, refractory seizures. We demonstrate how DTI was utilized both pre-, intra-, and postoperatively to help plan, guide, and confirm surgical disconnection. The application of exquisite DTI for this child led to her being seizure-free, which is a life-changing event with long-lasting benefits and will become even more critical as we now perform these disconnection procedures with a more minimally invasive approach.



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Allen L. Ho, M.D., Resident Physician

Department of Neurosurgery, Stanford University School of Medicine

For correspondence:
allenlho@gmail.com

Arjun V. Pendharkar, M.D., Resident Physician

Department of Neurosurgery, Stanford University School of Medicine

Eric S. Sussman

Department of Neurosurgery, Stanford University School of Medicine

May Casazza

Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital

Gerald A. Grant

Department of Neurosurgery, Stanford University School of Medicine

Allen L. Ho, M.D., Resident Physician

Department of Neurosurgery, Stanford University School of Medicine

For correspondence:
allenlho@gmail.com

Arjun V. Pendharkar, M.D., Resident Physician

Department of Neurosurgery, Stanford University School of Medicine

Eric S. Sussman

Department of Neurosurgery, Stanford University School of Medicine

May Casazza

Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital

Gerald A. Grant

Department of Neurosurgery, Stanford University School of Medicine