Hemispherectomy

Abstract

Hemispherectomy, or its variant hemispherotomy, is an effective surgical technique to treat patients with hemispheric epilepsy. This surgery removes or disconnects the affected hemisphere from the more appropriately functioning portions of the brain. Though hemispherectomy is a large surgery, in appropriately selected patients, it can be the best chance to achieve seizure freedom or significant reduction. Hemispherectomy should be considered for patients with disorders such as Rasmussen’s encephalitis, hemimegalencephaly, Sturge Weber or perinatal infarct, who have significant deficits in function arising from one hemisphere, with good function in the other hemisphere. Hemispherectomies have evolved from en bloc resection of the entire affected cerebral hemisphere in the days of Walter Dandy, to more minimally invasive disconnection procedures today. This chapter will discuss underlying patient syndromes that may lead to hemispheric epilepsy as well as several surgical options for hemispherectomy and hemispherotomy.