Hemispherectomy

ABSTRACT

Hemispherectomy became a more widely accepted surgical treatment for intractable epilepsy, secondary to severe unilateral hemisphere damage. Basic concept of the hemispherectomy changed from hemispheric resection in anatomical hemispherectomy to a less tissue removal with disconnection of the rest of the hemisphere in the functional hemispherectomy, up to minimal tissue resection with maximal disconnection in the hemispherotomy. This change away from extended resections to predominant disconnection methods lead to reduction of the complications and at the same time maintained the favourable seizure freedom rate. In our current review, we review the hemispherectomy history and techniques in literature with details of our modified surgical technique of hemispherotomy. We also outline the indications, appropriate patient selection, and present our results in a large series of 74 patients who underwent hemispherotomy in our clinic between 1995 and 2006. In our clinical series, the 2-year follow-up shows that 72% of our patients [54 out of 74] had class I and II outcome according to Engel's classification system. No mortality occurred in the current series and postoperative complication was significantly lowered. Hemispherotomy represents an efficacious, technically simple and safe surgical treatment for the management of patients with medically intractable seizures