Annual Meeting Abstracts: View

  • (Abst. 1.225), 2019
  • Staged Transarterial Hemispheric Embolization: An Innovative and Effective Treatment Option for Intractable Seizures in Newborns with Hemimegalencephaly
  • Authors: Taeun Chang, Children's National Medical Center; Monica S. Pearl, John Hopkins University; Chima Oluigbo, Children's National Medical Center; Panagiotis Kratimenos, Children's National Medical Center; Gilbert Vezina, Children's National Medical Center; William D. Gaillard, Children's National Medical Center; Tammy N. Tsuchida, Children's National Medical Center
  • Content:

    Rationale: Management of the newborn with intractable seizures due to hemimegalencephaly is challenging. Unrelenting seizures and the multiple anti-seizure medications used impairs the development of the immature brain. Anatomic or functional hemispherectomy is the established treatment for intractable seizures in patients with hemimegalencephaly. Delays in surgical treatment appear to be linked to worse developmental outcomes. However, in infants < 3 months of age, surgery can be life threatening from intraoperative blood loss. We present our experience with five newborns with hemimegalencephaly and intractable seizures who underwent staged transarterial glue embolization. Methods: A multidisciplinary team including a Level 4 Pediatric Epilepsy Program, Level 4 Neonatal ICU, Neonatal Neurocritical Care Service, and an Interventional Neuroradiology Program instituted a staged transarterial glue embolization as the best approach in five newborns presenting with hemimegalencephaly and intractable seizures between 2013-2018. The region of highest seizure burden was selected for initial and subsequent embolization. During and between embolization, seizure control was maximized with continuous EEG monitoring. Neuroprotective measures to minimize cerebral edema, intracranial bleeding, and vasospasm were established. Results: One boy and four girls (6-51 days old) with hemimegalencephaly and intractable seizures underwent 1-3 staged transarterial glue embolizations (per stage a mean of 3 embolizations, range 1-5). Seizure burden improved with each stage; complete seizure resolution was achieved in all four survivors. Two patients experienced vascular micro-perforation (1 asymptomatic, 1 fatality from an arteriovenous fistula hemorrhage). Three were subsequently treated with anatomic (2) or functional (1) hemispherectomy when seizures re-emerged from brain remnants. All survivors remain seizure-controlled on 2-3 anti-seizure medications. Both newborns who received anatomic hemispherectomy developed hydrocephalus requiring ventriculo-peritoneal shunt placement. Conclusions: Staged transarterial hemispheric embolization for hemimegalencephaly is an effective alternate treatment option for the management of intractable seizures in newborns. Long-term, neurodevelopmental outcome assessments are underway. Funding: No funding