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
Brain and Spine, vol. 4, pp. 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.
Authors 38
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Olaf E. M. G. Schijns corresponding
Maastricht University Medical Centre · Maastricht University · Kempenhaeghe
Affiliation as printed
Academic Center for Epileptology, Maastricht University Medical Center and Kempenhaeghe, Maastricht-Heeze, the Netherlands
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
School for Mental Health and Neuroscience (MHeNs), University Maastricht (UM), Maastricht, the Netherlands
School for Mental Health and Neuroscience (MHeNS), University Maastricht (UM), Maastricht, the Netherlands
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
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Affiliation as printed
Department of Neurosurgery, Ruppiner Kliniken, Neuruppin, Germany
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Affiliation as printed
Department of Neurosurgery, University Hospital Ghent, Ghent, Belgium
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Affiliation as printed
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Universitair Ziekenhuis Leuven
Affiliation as printed
Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
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Johannes Kepler University of Linz · Kepler Universitätsklinikum
Affiliation as printed
Department of Neurosurgery, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
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Hôpital Necker-Enfants Malades · Université Paris Cité
Affiliation as printed
Department of Pediatric Neurosurgery, Hôpital Necker, Université de Paris, Paris, France
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Hospital Infantil Universitario Niño Jesús
Affiliation as printed
Department of Neurosurgery, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Affiliation as printed
Department of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal
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Hospital Sant Joan de Déu Barcelona
Affiliation as printed
Department of Neurosurgery, Hospital Sant Joan de Deu, Barcelona, Spain
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
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Affiliation as printed
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Affiliation as printed
Department of Neurosurgery, Hopital Fondation Adolphe de Rothschild, Paris, France
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Affiliation as printed
Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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National Institute of Menthal Health, Neurology and Neurosurgery - Nyírő Gyula Hospital
Affiliation as printed
Department of Neurosurgery, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
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Affiliation as printed
Department of Neurosurgery, Hopital Fondation Adolphe de Rothschild, Paris, France
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Meyer Children's Hospital · University of Florence
Affiliation as printed
Department of Neurosurgery, Meyer Children's Hospital IRCCS, University of Florence, Italy
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Affiliation as printed
Department of Neurosurgery, University Hospital, Tübingen, Germany
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Istanbul University-Cerrahpaşa · Istanbul University
Affiliation as printed
Department of Neurosurgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Affiliation as printed
Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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Affiliation as printed
Department of Neurosurgery, Bielefeld University, Medical School, Bielefeld, Germany
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University of Helsinki · Helsinki University Hospital
Affiliation as printed
Department of Neurosurgery, University of Helsinki, Helsinki University hospital, Helsinki, Finland
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University Children's Hospital Zurich
Affiliation as printed
Department of Neurosurgery, Universitäts-Kinderspital Zürich-Eleonorenstiftung, Zürich, Switzerland
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
School for Mental Health and Neuroscience (MHeNs), University Maastricht (UM), Maastricht, the Netherlands
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Bambino Gesù Children's Hospital
Affiliation as printed
Department of Neurosurgery, Ospedale Pediatrico Bambino Gesu, Roma, Italy
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University Hospital of Alexandroupolis
Affiliation as printed
Department of Neurosurgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Neurosurgery, Charite University hospital, Berlin, Germany
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Cliniques Universitaires Saint-Luc · Medical University of Vienna
Affiliation as printed
Department of Neurosurgery, Clinique Universitaires Saint Luc, Brussels, Belgium
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Tel Aviv Sourasky Medical Center
Affiliation as printed
Department of Neurosurgery, Tel Aviv Sourasky medical center, Tel Aviv, Israel
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Hospital Sant Joan de Déu Barcelona
Affiliation as printed
Department of Neurosurgery, Hospital Sant Joan de Deu, Barcelona, Spain
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Hôpital Necker-Enfants Malades · Université Paris Cité · University Medical Center Hamburg-Eppendorf
Affiliation as printed
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Pediatric Neurosurgery, Hôpital Necker, Université de Paris, Paris, France
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Affiliation as printed
Department of Neurosurgery, Hopital La Timone Enfants, Marseille, France
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University of Geneva · University Hospital of Geneva · Medical University of Vienna
Affiliation as printed
Department of Neurosurgery, Geneva University Medical Center, Geneva, Switzerland
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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University Medical Center Freiburg · Medical University of Vienna
Affiliation as printed
Department of Neurosurgery, University hospital, Freiburg, Germany
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Affiliation as printed
Department of Neurosurgery, Hopital Erasme, Brussels, Belgium
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Hospital de Egas Moniz · Hospital de Santa Cruz · Centro Hospitalar de Lisboa Ocidental
Affiliation as printed
Department of Neurosurgery, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Affiliation as printed
Department of Neurosurgery, University of Thessaly Medical School, Larissa, Greece
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