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Hemispherectomy is a surgical procedure where one cerebral hemisphere (half of the brain) is removed or disabled. This procedure is used to treat a variety of seizure disorders where the source of the epilepsy is localized to a broad area of a single hemisphere of the brain. It is solely reserved for extreme cases in which the seizures have not responded to medications and other less invasive surgeries.
What Is a Hemispherectomy ?
Hemispherectomy is performed in a number of different ways. One option is to "disconnect" or interrupt the communication between both sides of the brain. In that case, only a small section of the affected hemisphere needs to be removed. In the most radical hemispherectomy surgery, the entire hemisphere is removed. This is typically only done in children, whose growing brains can compensate for the loss of one hemisphere.
The use of cerebral hemispherectomy for seizure control implies that the seizure focus is lateralized, though diffusely localized to one hemisphere. In that respect, hemispherectomy may be considered as the most radical focal brain excision. The preoperative evaluation should establish as clearly as possible the degree of damage to the diseased hemisphere and the degree of integrity of the good hemisphere.
Purpose
Hemispherectomy is used to treat epilepsy when it cannot be sufficiently controlled by medications.The cerebral cortex is the wrinkled outer portion of the brain. It is divided into left and right hemispheres, which communicate with each other through a bundle of nerve fibers called the corpus callosum, located at the base of the hemispheres.
The seizures of epilepsy are due to unregulated electrical activity in the brain. This activity often begins in a discrete brain region called the focus of the seizure, and then spreads to other regions. Removing or disconnecting the focus from the rest of the brain can reduce seizure frequency and intensity.
In some people with epilepsy, there is no single focus. If there are multiple focal points within one hemisphere, or if the focus is undefined but restricted to one hemisphere, hemispherectomy may be indicated for treatment.
Removing an entire hemisphere of the brain is an effective treatment. The hemisphere that is removed is usually quite damaged by the effects of multiple seizures, and the other side of the brain has already assumed many of the functions of the damaged side. In addition, the brain has many "redundant systems," which allow healthy regions to make up for the loss of the damaged side.
Children who are candidates for hemispherectomy usually have significant impairments due to their epilepsy, including partial or complete paralysis and partial or complete loss of sensation on the side of the body opposite to the affected brain region.
Benefits of Hemispherectomy
Despite the potential risks, overall, about 85 percent of people who have a hemispherectomy show improvement in their seizures. As many as 60 percent no longer have any seizures.
After surgery, some people will stay on anti-seizure medications, though most of the time, they can eventually be reduced or discontinued. Many people also commonly need physical therapy following hemispherectomy to help restore some movement and functionality in the affected limbs and muscles.
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