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Case series
Definitive treatment of seizures due to hemimegalencephaly in neonates and young infants by transarterial embolization: technical considerations for ‘endovascular embolic hemispherectomy’
  1. Monica S Pearl1,2,
  2. Tammy N Tsuchida3,4,
  3. Chima Oluigbo4,5,
  4. Panagiotis Kratimenos6,7,
  5. Tayyba Anwar3,4,
  6. Youssef Kousa3,4,
  7. William D Gaillard3,4,
  8. Taeun Chang3,4
  1. 1Radiology, Children's National Hospital, Washington, District of Columbia, USA
  2. 2Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  3. 3Neurology, Children's National Hospital, Washington, District of Columbia, USA
  4. 4Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  5. 5Department of Neurosurgery, Children's National Health System, Washington, District of Columbia, USA
  6. 6Neonatology, Children's National Hospital, Washington, District of Columbia, USA
  7. 7Neonatology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  1. Correspondence to Dr Monica S Pearl, Radiology, Children's National Hospital, Washington, DC 20010, USA; mspearl{at}childrensnational.org

Abstract

Background 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.

Methods 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.

Results 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.

Conclusion 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.

  • Embolic
  • Intervention
  • Pediatrics
  • Stroke
  • Technique

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Footnotes

  • Deceased Taeun Chang deceased on 18 June 2022

  • Contributors All authors participated in the concept, revision, and final approval of the manuscript. MSP drafted the manuscript and prepared the figures.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.