Dr. Ramesh Doddamani Podcast

This video presents the technique of endoscopic hemispherotomy for the management of non-atrophic Rasmussen’s encephalopathy, a rare, progressive inflammatory neurological disorder characterized by medically refractory focal epilepsy, progressive neurological deficits, and unilateral hemispheric dysfunction.

Rasmussen’s encephalopathy typically presents in childhood with focal seizures or epilepsia partialis continua that are resistant to antiseizure medications. In selected cases where seizures remain uncontrolled, hemispherotomy — a functional disconnection of the affected cerebral hemisphere — is the definitive surgical treatment.

Unlike traditional open hemispherotomy approaches, this procedure utilizes a minimally invasive endoscopic keyhole technique, allowing precise disconnection with reduced blood loss, smaller craniotomy, and improved visualization of deep anatomical structures.

The video highlights:

• Preoperative clinical and radiological evaluation
• Indications for hemispherotomy in non-atrophic disease
• Interhemispheric endoscopic approach
• Corpus callosotomy and perisylvian disconnection
• Disconnection of frontobasal fibers and temporal stem
• Insular and posterior disconnection techniques
• Preservation of critical vascular structures
• Intraoperative anatomical landmarks
• Postoperative imaging confirming complete hemispheric disconnection

Endoscopic hemispherotomy aims to interrupt the epileptogenic network while minimizing surgical morbidity. This approach is particularly valuable in non-atrophic Rasmussen’s encephalopathy where traditional anatomical landmarks may still be preserved.

Postoperatively, patients often demonstrate significant seizure reduction or seizure freedom, improved quality of life, and stabilization of neurological decline.

This video illustrates the evolution of epilepsy surgery toward precision, minimally invasive disconnection techniques and provides important technical nuances for neurosurgeons managing complex pediatric epilepsy cases.