Radiology, Children's National Hospital, Washington, District of Columbia, USA
Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
J Neurointerv Surg. 2023 Dec 19;16(1):81-87. doi: 10.1136/jnis-2022-019049.
This case series describes the technical considerations and effectiveness of 'endovascular embolic hemispherectomy' for the treatment of medically intractable seizures in neonates and young infants with hemimegalencephaly (HME) and in whom surgical hemispherectomy is not a viable option.
This is a descriptive review of the endovascular technique used to treat consecutive pediatric patients with serial transarterial embolization for intractable seizures due to HME between 2018 and 2022. Clinical presentation, endovascular procedural details and complications, and efficacy were examined.
Three infants (13-day-old, 13-week-old and 15-day-old) with HME and intractable seizures underwent a total of 10 transarterial embolizations. Anticipated intraprocedural events included vasospasm and focal subarachnoid hemorrhage in all three infants, effectively controlled endovascularly, and non-target embolization in one infant. No infants had symptomatic intracranial hemorrhage or femoral artery occlusion. EEG background quiescence and seizure cessation was achieved after the final stage of embolization in all patients. All infants were discharged home from the neonatal ICU (median length of stay 36 days, range 27-74 days) and remain seizure-free to date (4 years, 9 months, and 8 months). None have developed hydrocephalus, required surgical hemispherectomy or other neurosurgical interventions.
Endovascular hemispherectomy can be safely used to provide definitive treatment of HME-related epilepsy in neonates and young infants when intraprocedural events are managed effectively. This less invasive novel approach should be considered a feasible early alternative to surgical hemispherectomy. Further studies are needed to enhance the safety profile and to assess long-term neurodevelopmental outcome and durability of freedom from seizures.
本病例系列描述了对于患有偏侧巨脑畸形（HME）且手术半球切除术不可行的药物难治性癫痫新生儿和婴儿，采用“血管内栓塞半球切除术”的技术考虑因素和有效性。
这是对 2018 年至 2022 年间连续因 HME 致药物难治性癫痫行序贯性动脉内栓塞治疗的儿科患者采用的血管内技术进行的描述性回顾。检查了临床表现、血管内手术细节和并发症以及疗效。
3 例 HME 伴药物难治性癫痫的婴儿（13 天大、13 周大和 15 天大）共进行了 10 次动脉内栓塞。所有 3 例婴儿均预期发生术中事件，包括血管痉挛和局灶性蛛网膜下腔出血，均经血管内有效控制，1 例婴儿发生非靶栓塞。无一例婴儿发生症状性颅内出血或股动脉闭塞。所有患者在最后阶段栓塞后均获得脑电图背景静止和癫痫停止。所有婴儿均从新生儿 ICU 出院（中位住院时间 36 天，范围 27-74 天），且至今仍无癫痫发作（4 年 9 个月和 8 个月）。无一例患者发生脑积水、需要行手术半球切除术或其他神经外科干预。
当术中事件得到有效处理时，血管内半球切除术可安全用于治疗新生儿和婴儿的 HME 相关癫痫。这种微创的新方法应被视为手术半球切除术的可行早期替代方法。需要进一步研究以增强安全性，并评估长期神经发育结局和无癫痫发作的持久性。
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