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Background: Hemispheric disconnection represents a challenging and major epilepsy surgical procedure. This procedure in experienced hands offers excellent results in terms of seizure outcomes, especially for hemispheric pathologies such as Rasmussen's encephalitis, hemispheric dysplasias, hemimegalencephaly. The technique of hemispherotomy has witnessed various modifications over the years, beginning from anatomical hemispherectomy to the current era of minimally invasive functional hemispheric disconnections., Objective: This study aimed to describe the technique of performing endoscopic vertical hemispherotomy using interhemispheric corridor developed by the senior author., Materials and Methods: A 12-year-old girl with seizure onset at the age of 10 years presented with an aura of fear and nausea followed by tonic deviation of eyes to the right and blinking with speech arrest. There were tonic-clonic movements of the right-sided limbs along with ictal spitting and occasional deviation of the angle of mouth to the right. The patient had loss of awareness for the event along with postictal confusion lasting few minutes., Results: Video electroencephalography (VEEG) revealed left parietocentral and left temporal localization. Serial magnetic resonance imaging (MRI) brain over 3 years revealed progressive left hemispheric changes suggestive of Rasmussen's encephalitis. The patient underwent left-sided endoscopic hemispherotomy. At 2 years follow-up, the patient is seizure-free (ILAE [International League Against Epilepsy] Class 1)., Conclusion: Endoscopic hemispherotomy using the interhemispheric approach is an elegant, minimally invasive, reproducible, safe, and efficacious technique., Competing Interests: None

Epilepsy surgery currently offers the best treatment for patients with drug-refractory epilepsy (DRE). Resective surgery, in the presence of a well-localized epileptogenic focus, remains the best modality towards achieving seizure freedom. However, localization of the focus may not be possible in all the cases of DRE, despite comprehensive epilepsy workup. Neuromodulation techniques such as vagal nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS) may be a good alternative in these cases. This article intends to provide an overview of VNS in the management of DRE, including indications, comprehensive preoperative workup, exemplified by case illustrations and outcomes by reviewing the evidence available in the literature., Competing Interests: None

Vagal nerve stimulation (VNS) is US Food and Drug Administration approved treatment for drug refractory epilepsy and major depression. In vivo research showed that VNS has anti-inflammatory properties and has a role in inflammatory conditions such as inflammatory bowel disease, rheumatoid arthritis, sepsis, lung and bowel injuries, and in patients with head injury. It is also shown that VNS can restore the homeostasis between the sympathetic and parasympathetic systems. This property is made use of in heart failure, angina, and peripheral arterial disease. Cluster headache and migraine are the other conditions. In this review, we describe the indications along with the mechanisms in various clinical conditions other than epilepsy and the associated outcomes. [ABSTRACT FROM AUTHOR]

Vagal nerve stimulation (VNS) is a proven effective modality of treatment for drug refractory epilepsy and major depression. Recently, the indications have been expanded to various other non-neural indications. The key to a successful surgery includes identification of the vagus nerve and proper application of the device. Meticulous dissection and proper handling of the nerve leads to maximizing therapeutic effect and minimizing complications. In the current article, we describe the technical aspects of performing VNS, focusing on the anatomical variants and intraoperative adjuncts to identify the vagus nerve accurately. [ABSTRACT FROM AUTHOR]

Background: Vagal nerve stimulation (VNS) is a form of neuromodulation for patients with drug-refractory epilepsy (DRE), in whom extensive preoperative evaluation fails to localize the epileptogenic zone. VNS is often compared to Corpus callosotomy (CC) in terms of both indications and efficacy. However, VNS represents a less invasive and less morbid procedure compared to CC and is the preferred procedure in majority of patients with DRE.Objective: The aim of this study was to present the surgical technique and nuances involved in the implantation of vagal nerve stimulator.Procedure: A 16-year-old boy suffering from DRE, with bilateral seizure onset on evaluation, for 12 years, underwent left vagal nerve stimulator placement. The VNS device has a lead and a pulse generator, the lead has coils to be wrapped around the vagus nerve and the pulse generator is placed in a subcutaneous pocket in the infraclavicular region (demonstrated in the video).Results: The patient is relieved of the disabling drop attacks along with improved cognitive functions at 1 year follow up.Conclusions: In carefully selected patients, VNS is a safe and effective procedure to alleviate seizures, in cases otherwise morbidly affected due to drug refractory epilepsy. [ABSTRACT FROM AUTHOR]