Minimally-invasive endovascular occlusion therapy in two adults for seizures associated with congenital porencephalic cysts

Hemispherectomy is currently the surgical treatment of choice for intractable seizures associated with large, unilateral hemisphere porencephalic cysts and a neurologic deficit. We present an alternative minimally-invasive approach using permanent endovascular balloon occlusion in two patients who would otherwise have proceeded directly to hemispherectomy. Clinical, electroencephalogram (EEG), and neuroimaging findings implicated the damaged hemisphere as the source of the seizures in both cases. Under sedation, the distal internal carotid artery was embolized in the first patient and the middle cerebral artery in the second. A significant reduction in seizure frequency occurred postocclusion in both patients and one patient, to date, has not required hemispherectomy. This improvement was correlated with postocclusion EEG and neuroimaging changes. Permanent endovascular balloon occlusion may be a minimally-invasive alternative to resectional surgery or first stage procedure in this special group of patients. Application to a greater number of patients and long-term follow-up is required to demonstrate whether endovascular occlusion is a safe beneficial therapy for regional or focal epilepsies.

Key words: Epilepsy, Porencephalic cysts, Interventional neuroradiology, Endovascular therapy, Permanent balloon occlusion

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