Brain and Spine (Jan 2024)
Functional hemispheric disconnection procedures for chronic epilepsy: history, indications, techniques, complications and current practice in Europe. A consensus statement on behalf of the EANS functional neurosurgery section
- Olaf E.M.G. Schijns,
- Daniel Delev,
- Marec von Lehe,
- Dirk van Roost,
- Karl Rössler,
- Tom Theys,
- Christian Auer,
- Thomas Blauwblomme,
- Marcelo Budke,
- Alexandre Rainha Campos,
- Santiago Candela Canto,
- Hans Clusmann,
- Christian Dorfer,
- Georg Dorfmüller,
- Arild Egge,
- Lorand Eröss,
- Sarah Ferrand-Sorbets,
- Flavio Giordano,
- Jürgen Honegger,
- Cihan Isler,
- Jugoslav Ivanovic,
- Thilo Kalbhenn,
- Atte Karppinen,
- Niklaus Krayenbühl,
- Rick H.G.J. van Lanen,
- Carlo E. Marras,
- Ioannis Mavridis,
- Daniel Nilsson,
- Julia Onken,
- Christian Raftopoulos,
- Jonathan Roth,
- Jordi Rumia,
- Thomas Sauvigny,
- Didier Scavarda,
- Karl Schaller,
- Christian Scheiwe,
- Sophie Schuind,
- Alexandra Seromenho-Santos,
- Kostas Fountas
Affiliations
- Olaf E.M.G. Schijns
- Corresponding author. Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; Academic Center for Epileptology, Maastricht University Medical Center and Kempenhaeghe, Maastricht-Heeze, the Netherlands; School for Mental Health and Neuroscience (MHeNs), University Maastricht (UM), Maastricht, the Netherlands
- Daniel Delev
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
- Marec von Lehe
- Department of Neurosurgery, Ruppiner Kliniken, Neuruppin, Germany
- Dirk van Roost
- Department of Neurosurgery, University Hospital Ghent, Ghent, Belgium
- Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Tom Theys
- Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
- Christian Auer
- Department of Neurosurgery, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
- Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Hôpital Necker, Université de Paris, Paris, France
- Marcelo Budke
- Department of Neurosurgery, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Alexandre Rainha Campos
- Department of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal
- Santiago Candela Canto
- Department of Neurosurgery, Hospital Sant Joan de Deu, Barcelona, Spain
- Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
- Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Georg Dorfmüller
- Department of Neurosurgery, Hopital Fondation Adolphe de Rothschild, Paris, France
- Arild Egge
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Lorand Eröss
- Department of Neurosurgery, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Sarah Ferrand-Sorbets
- Department of Neurosurgery, Hopital Fondation Adolphe de Rothschild, Paris, France
- Flavio Giordano
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, University of Florence, Italy
- Jürgen Honegger
- Department of Neurosurgery, University Hospital, Tübingen, Germany
- Cihan Isler
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
- Jugoslav Ivanovic
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Thilo Kalbhenn
- Department of Neurosurgery, Bielefeld University, Medical School, Bielefeld, Germany
- Atte Karppinen
- Department of Neurosurgery, University of Helsinki, Helsinki University hospital, Helsinki, Finland
- Niklaus Krayenbühl
- Department of Neurosurgery, Universitäts-Kinderspital Zürich-Eleonorenstiftung, Zürich, Switzerland
- Rick H.G.J. van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), University Maastricht (UM), Maastricht, the Netherlands
- Carlo E. Marras
- Department of Neurosurgery, Ospedale Pediatrico Bambino Gesu, Roma, Italy
- Ioannis Mavridis
- Department of Neurosurgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
- Daniel Nilsson
- Department of Neurosurgery, Sahlgrenska University hospital, Göteborg, Sweden
- Julia Onken
- Department of Neurosurgery, Charite University hospital, Berlin, Germany
- Christian Raftopoulos
- Department of Neurosurgery, Clinique Universitaires Saint Luc, Brussels, Belgium
- Jonathan Roth
- Department of Neurosurgery, Tel Aviv Sourasky medical center, Tel Aviv, Israel
- Jordi Rumia
- Department of Neurosurgery, Hospital Sant Joan de Deu, Barcelona, Spain
- Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Didier Scavarda
- Department of Neurosurgery, Hopital La Timone Enfants, Marseille, France
- Karl Schaller
- Department of Neurosurgery, Geneva University Medical Center, Geneva, Switzerland
- Christian Scheiwe
- Department of Neurosurgery, University hospital, Freiburg, Germany
- Sophie Schuind
- Department of Neurosurgery, Hopital Erasme, Brussels, Belgium
- Alexandra Seromenho-Santos
- Department of Neurosurgery, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Kostas Fountas
- Department of Neurosurgery, University of Thessaly Medical School, Larissa, Greece
- Journal volume & issue
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Vol. 4
p. 102754
Abstract
Introduction: The surgical procedure for severe, drug-resistant, unilateral hemispheric epilepsy is challenging. Over the last decades the surgical landscape for hemispheric disconnection procedures changed from anatomical hemispherectomy to functional hemispherotomy with a reduction of complications and stable good seizure outcome. Here, a task force of European epilepsy surgeons prepared, on behalf of the EANS Section for Functional Neurosurgery, a consensus statement on different aspects of the hemispheric disconnection procedure. Research question: To determine history, indication, timing, techniques, complications and current practice in Europe for hemispheric disconnection procedures in drug-resistant epilepsy. Material and methods: Relevant literature on the topic was collected by a literature search based on the PRISMA 2020 guidelines. Results: A comprehensive overview on the historical development of hemispheric disconnection procedures for epilepsy is presented, while discussing indications, timing, surgical techniques and complications. Current practice for this procedure in European epilepsy surgery centers is provided. At present, our knowledge of long-term seizure outcomes primarily stems from open surgical disconnection procedures. Although minimal invasive surgical techniques in epilepsy are rapidly developing and reported in case reports or small case series, long-term seizure outcome remain uncertain and needs to be reported. Discussion and conclusion: This is the first paper presenting a European consensus statement regarding history, indications, techniques and complications of hemispheric disconnection procedures for different causes of chronic, drug-resistant epilepsy. Furthermore, it serves as the pioneering document to report a comprehensive overview of the current surgical practices regarding this type of surgery employed in renowned epilepsy surgery centers across Europe.
