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Das N, Sharma A, Mann M, Gordillo A, Desai A, Serletis D, Moosa AN, Rammo R, Bingaman W. Postoperative shunt failure following hemispherectomy in pediatric patients with pre-existing hydrocephalus. Childs Nerv Syst 2024; 40:1507-1514. [PMID: 38273143 PMCID: PMC11026181 DOI: 10.1007/s00381-024-06295-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The risk of hydrocephalus following hemispherectomy for drug resistant epilepsy (DRE) remains high. Patients with pre-existing hydrocephalus pose a postoperative challenge, as maintaining existing shunt patency is necessary but lacks a clearly defined strategy. This study examines the incidence and predictors of shunt failure in pediatric hemispherectomy patients with pre-existing ventricular shunts. METHODS We performed a retrospective chart review at our center to identify pediatric patients diagnosed with DRE who were treated with ventricular shunt prior to their first hemispherectomy surgery. Demographic and perioperative data were obtained including shunt history, hydrocephalus etiology, epilepsy duration, surgical technique, and postoperative outcomes. Univariate analysis was performed using Fisher's exact test and Pearson correlation, with Bonferroni correction to a = 0.00625 and a = 0.01, respectively. RESULTS Five of nineteen (26.3%) patients identified with ventriculoperitoneal shunting prior to hemispherectomy experienced postoperative shunt malfunction. All 5 of these patients underwent at least 1 shunt revision prior to hemispherectomy, with a significant association between pre- and post-hemispherectomy shunt revisions. There was no significant association between post-hemispherectomy shunt failure and valve type, intraoperative shunt alteration, postoperative external ventricular drain placement, hemispherectomy revision, lateralization of shunt relative to resection, postoperative complications, or postoperative aseptic meningitis. There was no significant correlation between number of post-hemispherectomy shunt revisions and age at shunt placement, age at hemispherectomy, epilepsy duration, or shunt duration prior to hemispherectomy. CONCLUSIONS Earlier shunt revision surgery may portend a subsequent need for shunt revision following hemispherectomy. These findings may guide neurosurgeons in counseling patients with pre-existing ventricular shunts prior to hemispherectomy surgery.
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Affiliation(s)
- Nikita Das
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Akshay Sharma
- Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland, OH, USA.
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Michael Mann
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Alan Gordillo
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ansh Desai
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Demitre Serletis
- Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland, OH, USA
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Ahsan N Moosa
- Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland, OH, USA
| | - Richard Rammo
- Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland, OH, USA
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - William Bingaman
- Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland, OH, USA
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
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Al-Juhani A, Imran M, Aljaili ZK, Alzhrani MM, Alsalman RA, Ahmed M, Ali DK, Fallatah MI, Yousuf HM, Dajani LM. Beyond the Pump: A Narrative Study Exploring Heart Memory. Cureus 2024; 16:e59385. [PMID: 38694651 PMCID: PMC11061817 DOI: 10.7759/cureus.59385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/04/2024] Open
Abstract
The field of organ transplantation, particularly heart transplantation, has brought to light interesting phenomena challenging traditional understandings of memory, identity, and consciousness. Studies indicate that heart transplant recipients may exhibit preferences, emotions, and memories resembling those of the donors, suggesting a form of memory storage within the transplanted organ. Mechanisms proposed for this memory transfer include cellular memory, epigenetic modifications, and energetic interactions. Moreover, the heart's intricate neural network, often referred to as the "heart brain," communicates bidirectionally with the brain and other organs, supporting the concept of heart-brain connection and its role in memory and personality. Additionally, observations from hemispherectomy procedures highlight the brain's remarkable plasticity and functional preservation beyond expectations, further underscoring the complex interplay between the brain, body, and identity. However, ethical and philosophical questions regarding the implications of these findings, including the definition of death and the nature of personal identity, remain unresolved. Further interdisciplinary research is needed to unravel the intricacies of memory transfer, neuroplasticity, and organ integration, offering insights into both organ transplantation and broader aspects of neuroscience and human identity. Understanding these complexities holds promise for enhancing patient care in organ transplantation and deepens our understanding of fundamental aspects of human experience and existence.
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Affiliation(s)
| | | | - Zeyad K Aljaili
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | | | - Marwah Ahmed
- College of Medicine, Batterjee Medical College, Jeddah, SAU
| | - Dana K Ali
- College of Medicine, King Khalid University, Abha, SAU
| | - Mutaz I Fallatah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Hamad M Yousuf
- College of Medicine, Batterjee Medical College, Jeddah, SAU
| | - Leena M Dajani
- College of Medicine, Arabian Gulf University, Manama, BHR
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Ariwodo O, Nordli DR, Ranalli NJ, Beier AD. Tandem pediatric neurosurgery: treatment of synostosis and intractable epilepsy. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23379. [PMID: 37956426 PMCID: PMC10651393 DOI: 10.3171/case23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Hemispherectomy is a surgical procedure reserved for hemispheric intractable epilepsy. Sagittal craniosynostosis is a congenital disorder treated with open or endoscope-assisted approaches for synostosis correction. These procedures are not commonly performed in the same setting. OBSERVATIONS In this report, the authors present a 6-month-old female with sagittal craniosynostosis, hemimegalencephaly, and intractable epilepsy who underwent a left hemispherotomy with open sagittal synostosis correction followed by cranial molding orthosis therapy. LESSONS The report highlights the technical nuances of the procedure, but also discusses the possible genetic disorder responsible for both conditions, megalencephaly-capillary malformation syndrome.
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Affiliation(s)
- Ogechukwu Ariwodo
- 1Philadelphia Colleges of Osteopathic Medicine South Georgia, Moultrie, Georgia
| | - Douglas R Nordli
- 2Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida; and
| | - Nathan J Ranalli
- 3Division of Pediatric Neurosurgery, University of Florida Health Science Center, Jacksonville, Florida
| | - Alexandra D Beier
- 3Division of Pediatric Neurosurgery, University of Florida Health Science Center, Jacksonville, Florida
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Mashael AK, Maryam H, Ayesha RR. Correlation between Hemispherectomy and Hemiparesis in Drug Resistant Epilepsy. J Epilepsy Res 2021; 11:32-38. [PMID: 34395221 PMCID: PMC8357556 DOI: 10.14581/jer.21005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background and Purpose Refractory epilepsy is when seizures are unresponsive to two or more medications. Hemispherectomy, one of the treatment options, is the complete removal or functional disconnection of a cerebral hemisphere. Hemiparesis, a symptom of epilepsy, is defined as weakness of one side of the body. Patients with refractory epilepsy, who experience extreme seizure frequency, are subjected to hemispherectomy. This study focuses on finding the correlation between hemispherectomy and hemiparesis, discovering a pattern in its severity levels before and after surgery. Methods Data was collected from 59 epileptic patients suffering from refractory epilepsy, who underwent hemispherectomy, at the King Faisal Specialist Hospital and Research Centre, from 1998 to 2014. Each patient was monitored over a period of 1-year post-surgery. In this study, we wanted to further explore the correlation between hemispherectomy and hemiparesis. Results Upon analyzing the sample size, the level of hemiparesis pre and post hemispherectomy remained the same for 32 patients, of which 13 patients had mild levels pre-surgery and 19 patients had moderate to severe levels pre-surgery. However, 20 of the patients who had moderate to severe levels of hemiparesis before the surgery had either no hemiparesis or a mild level after surgery, which signified an improvement in their severity level. On the other hand, seven of the patients went from having no hemiparesis before the surgery to having moderate or severe levels of hemiparesis post-surgery. Although the results were clinically significant, they were not statistically significant as the p-value obtained was 0.31. Conclusions After analyzing the results, it can be concluded that hemispherectomy does decrease the severity of hemiparesis in an epileptic patient, thereby improving his/her quality of life drastically.
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Affiliation(s)
- Al Khateeb Mashael
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Haris Maryam
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
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de Haan EHF, Corballis PM, Hillyard SA, Marzi CA, Seth A, Lamme VAF, Volz L, Fabri M, Schechter E, Bayne T, Corballis M, Pinto Y. Split-Brain: What We Know Now and Why This is Important for Understanding Consciousness. Neuropsychol Rev 2020; 30:224-233. [PMID: 32399946 PMCID: PMC7305066 DOI: 10.1007/s11065-020-09439-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
Recently, the discussion regarding the consequences of cutting the corpus callosum (“split-brain”) has regained momentum (Corballis, Corballis, Berlucchi, & Marzi, Brain, 141(6), e46, 2018; Pinto et al., Brain, 140(5), 1231–1237, 2017a; Pinto, Lamme, & de Haan, Brain, 140(11), e68, 2017; Volz & Gazzaniga, Brain, 140(7), 2051–2060, 2017; Volz, Hillyard, Miller, & Gazzaniga, Brain, 141(3), e15, 2018). This collective review paper aims to summarize the empirical common ground, to delineate the different interpretations, and to identify the remaining questions. In short, callosotomy leads to a broad breakdown of functional integration ranging from perception to attention. However, the breakdown is not absolute as several processes, such as action control, seem to remain unified. Disagreement exists about the responsible mechanisms for this remaining unity. The main issue concerns the first-person perspective of a split-brain patient. Does a split-brain harbor a split consciousness or is consciousness unified? The current consensus is that the body of evidence is insufficient to answer this question, and different suggestions are made with respect to how future studies might address this paucity. In addition, it is suggested that the answers might not be a simple yes or no but that intermediate conceptualizations need to be considered.
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Affiliation(s)
- Edward H F de Haan
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Paul M Corballis
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Steven A Hillyard
- School of Health Sciences, University of California Dan Diego, La Jolla, CA, USA
| | - Carlo A Marzi
- School of Medicine and Surgery, University of Verona, Verona, Italy
| | - Anil Seth
- Sackler Centre for Consciousness Science, Sussex University, Brighton, UK
| | - Victor A F Lamme
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Lukas Volz
- Klinik für Neurologie, Universitätsklinikum Köln, Kerpener Str, 62, Köln, Germany
| | - Mara Fabri
- Dipartimento di Medicina Sperimentale e Clinica, Via Tronto 10/A, 60020, Ancona, Italy
| | | | - Tim Bayne
- Department of Philosophy, Monash University, Melbourne, Australia
| | | | - Yair Pinto
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Anatomical hemispherectomy revisited-outcome, blood loss, hydrocephalus, and absence of chronic hemosiderosis. Childs Nerv Syst 2019; 35:1341-1349. [PMID: 31243582 DOI: 10.1007/s00381-019-04256-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate microsurgical trans-sylvian trans-ventricular anatomical hemispherectomy with regard to seizure outcome, risk of hydrocephalus, blood loss, and risk of chronic hemosiderosis in patients with intractable seizures selected for surgery using current preoperative assessment techniques. METHODS Out of 86 patients who underwent hemispherectomy between February 2000 and April 2019, by a single surgeon, at a tertiary care referral center, 77 patients (ages 0.2-20 years; 40 females) who had an anatomical hemispherectomy were analyzed. Five of these were 'palliative' surgeries. One-stage anatomical hemispherectomy was performed in 55 children, two-stage anatomical hemispherectomy after extraoperative intracranial monitoring in 16, and six hemispherectomies were done following failed previous resection. Mean follow-up duration was 5.7 years (range 1-16.84 years). Forty-six patients had postoperative MRI scans. RESULTS Ninety percent of children with non-palliative hemispherectomy achieved ILAE Class-1 outcome. Twenty-seven patients were no longer taking anticonvulsant medications. Surgical failures (n = 4) included one patient with previous meningoencephalitis, one with anti-GAD antibody encephalitis, one with idiopathic neonatal thalamic hemorrhage, and one with extensive tuberous sclerosis. There were no failures among patients with malformations of cortical development. Estimated average blood loss during surgery was 387 ml. Ten (21%) children developed hydrocephalus and required a shunt following one-stage hemispherectomy, whereas 10 (50%) patients developed hydrocephalus among those who had extraoperative intracranial monitoring. Only 20% of the shunts malfunctioned in the first year. Early malfunctions were related to the valve and later to fracture disconnection of the shunt. One patent had a traumatic subdural hematoma. None of the patients developed clinical signs of chronic 'superficial cerebral hemosiderosis' nor was there evidence of radiologically persistent chronic hemosiderosis in patients who had postoperative MRI imaging. CONCLUSION Surgical results of anatomical hemispherectomy are excellent in carefully selected cases. Post-operative complications of hydrocephalus and intraoperative blood loss are comparable to those reported for hemispheric disconnective surgery (hemispherotomy). The rate of shunt malfunction was less than that reported for patients with hydrocephalus of other etiologies Absence of chronic 'superficial hemosiderosis', even on long-term follow-up, suggests that anatomical hemispherectomy should be revisited as a viable option in patients with intractable seizures and altered anatomy such as in malformations of cortical development, a group that has a reported high rate of seizure recurrence related to incomplete disconnection following hemispheric disconnective surgery.
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