Transarterial embolization offers hope for infants with hemimegalencephaly
A new study from Children’s National Hospital reveals how a minimally invasive procedure is transforming care for infants with hemimegalencephaly and medically refractory seizures, offering seizure relief with fewer surgical risks.
Until recently, families of infants with hemimegalencephaly and medically refractory seizures had few treatment options, almost all involved major brain surgery such as hemispherectomy, to remove or disconnect the affected portion of the brain. These procedures, while sometimes effective, carry high risks in very young infants due to the fragility of their developing brains and invasive nature of the surgery.
Now, specialists from the Hemimegalencephaly Program at Children’s National Hospital have pioneered a minimally invasive alternative. Leveraging the combined expertise of a multidisciplinary team — spanning neurology, neurointerventional radiology, prenatal pediatrics, neonatology, neurogenetics and neurodevelopmental pediatrics, neuropsychology and neurosurgery — they have developed a technique that induces controlled, targeted strokes in the affected hemisphere using transarterial embolization (TAE). This approach mimics the effect of surgery by reducing seizure activity, without the need for open brain procedures.
This novel strategy is the focus of a new study led by Monica Pearl, MD, director of the Neurointerventional Radiology Program. The research represents the largest retrospective review of its kind, examining 41 TAE procedures performed over an 11-year span in 13 infants under three months of age.
The results are promising: 73% of patients achieved Engel Class I seizure outcomes at follow-up, suggesting that with careful technique and patient selection, TAE may provide meaningful seizure control with fewer perioperative risks than traditional surgery. The study also highlights the technical complexity of the procedure, early complications and the critical role of evolving protocols in ensuring patient safety.
Authors from Children’s National include Monica Pearl, MD, Tayyba Anwar, MD, Shani Israel, BS, Lindsay Ruffini, CPNP, CPNP-AC, CPNP-PC, Panagiotis Kratimenos, MD, PhD, Kyle Spagnolo, DO, Wei-Liang Chen, MD, Madison Berl, PhD, William D. Gaillard, MD, Tammy N. Tsuchida, MD, PhD and Chima Oluigbo, MD
To learn more about the clinical outcomes and evolving protocols behind this approach, you can read the full study, Transarterial embolization for infants under 3 months of age with refractory seizures due to hemimegalencephaly: complication analysis and evolution of treatment strategy, in the Journal of Neurointerventional Surgery.
