Hemispherotomy for Epilepsy: The Procedure Evolution and Outcome

Abstract

Hemispherectomy is a unique epilepsy surgery procedure that has undergone significant modification and evolution since Dandy’s early description. This procedure is mainly indicated to treat early childhood and infancy medically intractable epilepsy. Various epileptic syndromes have been treated with this procedure, including hemimegalencephaly (HME), Rasmussen’s encephalitis, Sturge–Weber syndrome (SWS), perinatal stroke, and hemispheric cortical dysplasia. In terms of seizure reduction, hemispherectomy remains one of the most successful epilepsy surgery procedures. The modification of this procedure over many years has resulted in lower mortality and morbidity rates. HME might increase morbidity and lower the success rate. Future studies should identify the predictors of outcomes based on the pathology and the type of hemispherectomy. Here, based on a literature review, we discuss the evolution of hemispherectomy techniques and their outcomes and complications.

Pediatric awake epilepsy surgery: Intraoperative language mapping utilizing digital video gaming and electrocorticography

“…Specialized cortical area for language has been identified in the cortex prenatally, suggested by the asymmetry of anatomical language cortices in both hemispheres [19] . Language transformation has been seen after hemispheric disconnection surgery, however, reflecting the degree of language cortical plasticity during early childhood brain development [20] , [21] . During tumor surgeries, Sanai and colleagues identified different language-associated cortical areas around the primary expressive speech area [6] .…”

Commentary: Midline Brain Shift After Hemispheric Surgery: Natural History, Clinical Significance, and Association With Cerebrospinal Fluid Diversion

“…The surgical approach to hemispheric epilepsy has evolved from primarily respective strategies to greater implementation of disconnective techniques, stemming partially from the significant rate of delayed complications—including hydrocephalus and superficial cerebral hemosiderosis—with traditional, anatomic hemispherectomies. 9 Correspondingly, hydrocephalus and shunting rates have declined from 30% to 52%, as reported with anatomic hemispherectomies, to 12%–20% with functional hemispherectomies, and to 2%–8% with hemispherotomies. 4,7,8,10,11,14,15 This decline in need for CSF diversion is believed to be directly related to extent of tissue resection.…”

“…[3][4][5][6] Hydrocephalus is a well-recognized and frequent consequence posthemispherectomy. 4,[7][8][9][10] Often, this is associated with midline brain shift (MLBS), although the limited number of reports curtails an accurate assessment of its incidence, natural history, and symptomatology. 11,12 In this study, the authors fill a void in the literature with their experience of MLBS after hemispheric surgery and its association with shunting as well as clinical symptoms.…”

Vertical Hemispherotomy: Contribution of Advanced Three-Dimensional Modeling for Presurgical Planning and Training

“…Hemispheric disconnection has been demonstrated to be an effective treatment in many drug-resistant encephalopathies with unilateral involvement [1][2][3][4]. Starting with the removal of the whole hemisphere (hemispherectomy), subsequent techniques have been proposed, ai-ming to progressively reduce the rate of brain tissue removal in favor of a more conservative strategy based on the isolation of the affected hemisphere from the rest of the brain (hemispherotomy) [5][6][7][8][9].…”