• Vich Yindeedej, Takehiro Uda, Noritsugu Kunihiro, Ryoko Umaba, Masanari Takagawa, Jumpei Sugiyama, and Takeo Goto.
• Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan; Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
• World Neurosurg. 2024 Sep 1; 189: 475247-52.

AbstractHemispherotomy is a surgical procedure aimed at the treatment of hemispheric epilepsy. Hemispherotomy disconnects the commissural fibers, projecting fibers, and limbic system while preserving most of the brain parenchyma, unlike conventional hemispherectomy.1 Hemispherotomy is one of most complicated operations currently used in epilepsy surgery and requires a high-level understanding of the intrinsic neuroanatomy. Generally, 2 main techniques are applied in hemispherotomy: lateral hemispherotomy and vertical hemispherotomy.2,3 Vertical hemispherotomy was developed after the lateral technique. Despite a deeper, narrower surgical corridor, vertical hemispherotomy requires a smaller craniotomy and a shorter disconnection line and allows easier disconnection of the insula than the lateral approach.1 In performing vertical hemispherotomy, 2 options are available: the interhemispheric approach4 and the parasagittal approach.3 With the parasagittal approach, the lateral ventricle is opened and entered via superior frontal gyrus. To ease the surgery and minimize the operation time, we apply "partial superior frontal gyrus removal." This procedure is useful to widen a shallower surgical field while skipping the need for interhemispheric dissection. Total callosotomy is then performed via the lateral ventricle. To disconnect limbic system, we used the technique following the falx and tentorial edge as a landmark.5 Here, we present our surgical steps for parasagittal hemispherotomy in a 5-month-old girl diagnosed as hemimegalencephaly (Figures 1-8).Copyright © 2024 Elsevier Inc. All rights reserved.

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