{
  "abstract": "Background Hemimegalencephaly (HME) is a rare, congenital brain malformation associated with drug-resistant seizures that are challenging to manage in young infants. Hemispheric surgery in infants <3 months of age carries increased risks of blood loss and complications due to the fragility of the immature brain parenchyma and cerebral vasculature. Transarterial embolization (TAE) has emerged from an adjunct to surgery to a potential alternative to hemispherectomy in a subset of HME patients.Objective To review the safety, efficacy, and evolution of TAE performed in infants <3 months of age with medically refractory seizures due to HME.Methods We retrospectively reviewed patient demographics, intraprocedural events, procedure-related complications, and epilepsy characteristics for all infants who underwent TAE between 2013 and 2024 at a single quaternary institution.Results Thirteen patients underwent a total of 41 embolizations, with a mean age of 45.5±26.8 (range 10–99) days at first embolization. Procedure-related complications included femoral arterial occlusion (n=2), symptomatic intracranial hemorrhage resulting in progressive hydrocephalus requiring cerebrospinal fluid shunting (n=1), and non-target embolization (n=2). One mortality occurred from multifocal intraparenchymal hemorrhages due to post-procedure coagulopathy. Two patients developed delayed contralateral ischemic injury. Engel Class I (free of disabling seizures) was achieved in 72.7% (8/11) of patients, with a mean follow-up age of 4.4±3.6 (range 1.3–11.0) years.Conclusions TAE is a potential alternative to hemispherectomy for refractory epilepsy due to HME in infants <3 months of age; however, technical and perioperative challenges remain important considerations. Optimizing patient selection and periprocedure care are critical factors to improve patient outcomes.",
  "authors": [
    {
      "affiliations": [
        "Radiology, Children’s National Hospital, Washington, District of Columbia, USA",
        "Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"
      ],
      "name": "Monica S Pearl"
    },
    {
      "affiliations": [
        "Neurology, Children’s National Hospital, Washington, District of Columbia, USA",
        "Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"
      ],
      "name": "Tayyba Anwar"
    },
    {
      "affiliations": [
        "Neurology, Children’s National Hospital, Washington, District of Columbia, USA"
      ],
      "name": "Shani Israel"
    },
    {
      "affiliations": [
        "Zickler Family Prenatal Pediatrics Institute, Children’s National Hospital, Washington, District of Columbia, USA"
      ],
      "name": "Lindsay Ruffini"
    },
    {
      "affiliations": [
        "Neonatology and Center for Research in Neuroscience, Children’s National Hospital, Washington, District of Columbia, USA",
        "Neonatology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"
      ],
      "name": "Panagiotis Kratimenos"
    },
    {
      "affiliations": [
        "Radiology, Children’s National Hospital, Washington, District of Columbia, USA",
        "Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"
      ],
      "name": "Kyle Spagnolo"
    },
    {
      "affiliations": [
        "Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA",
        "Neurogenetics and Developmental Pediatrics, Children’s National Hospital, Washington, District of Columbia, USA"
      ],
      "name": "Wei-Lang Chen"
    },
    {
      "affiliations": [
        "Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA",
        "Pediatric Neuropsychology, Children’s National Hospital, Washington, District of Columbia, USA"
      ],
      "name": "Madison Berl"
    },
    {
      "affiliations": [
        "Neurology, Children’s National Hospital, Washington, District of Columbia, USA",
        "Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"
      ],
      "name": "William D Gaillard"
    },
    {
      "affiliations": [
        "Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA",
        "Neonatology, Children’s National Hospital, Washington, District of Columbia, USA"
      ],
      "name": "Tammy N Tsuchida"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Children’s National Health System, Washington, District of Columbia, USA",
        "Neurosurgery and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"
      ],
      "name": "Chima Oluigbo"
    }
  ],
  "title": "Transarterial embolization for infants under 3 months of age with refractory seizures due to hemimegalencephaly: complication analysis and evolution of treatment strategy",
  "uid": "6275583e-1f0f-5417-860f-ae77f5a731b2"
}