Augmented reality-assisted hemispherotomy-technical note.

objectiveHemispherotomy is an effective surgical option for children with drug-resistant epilepsy originating from a single hemisphere. This paper details the first experience using a navigated augmented reality (AR) system to guide a vertical parasagittal hemispherotomy by Delalande. MATERIALS AND

methodsTwelve consecutive patients with a median age of 6.5 years (range 1 to 17 years) underwent the procedure between 2022 and 2023. The patient pathologies included Rasmussen encephalitis, congenital cortical malformations, post-stroke epilepsy, post-inflammatory changes, and Sturge-Weber syndrome, Two of the patients had previously undergone an incomplete disconnection surgery elsewhere. The preoperative evaluation included clinical examinations, video EEG monitoring, and MRI scans. All surgeries used AR guidance in the microscopes field of view established by the neuronavigation system (Brainlab, Germany).

resultsIntraoperative AR guidance enhanced the visualization of anatomical structures, which was particularly helpful in cases of congenital malformations where pathological brain tissue narrowed the surgical corridor. Two patients (16.7%) experienced complications: two required a ventriculoperitoneal shunt for postoperative hydrocephalus, and one of those developed a spontaneous hemorrhage in the disconnection cavity that resolved without further intervention. The median duration of follow-up among the participants was 20.5 months, ranging from 12 to 31 months. Epilepsy status was Engel Class IA in eight patients, three patients showed Engel Class IB, and one patient experienced Engel Class IC.

conclusionThe authors conclude that AR-guided hemispherotomy is a safe and effective technique that improves visualization of hidden structures, ensures control of full disconnection of the pathways, and helps avoid complications. The benefits should be further explored in larger studies involving larger groups.