Hemispherectomy And Hemispherotomy Techniques In Pediatric Epilepsy Surgery

Hemispherectomy is one of the most effective surgical interventions in the management of children with unilateral multilobar or hemispheric epilepsy. Hemispherectomy, or resection of the entire hemisphere, was first performed by Dandy in 1928 and later McKenzie used the hemispherectomy technique for the first time to treat an epilepsy patient with infantile hemiplegia. Since the description of "anatomical hemispherectomy," many other variations and modifications of this procedure have been developed. Rasmussen developed "functional hemispherectomy" first and then next generation of neurosurgeons developed various "hemispherotomy" techniques to further reduce the resection volume. All of these modifications aimed gradual reduction in the amount of the resected brain tissue while still achieving complete disconnection of the entire hemisphere. All these hemispherectomy techniques provide very satisfactory seizure control with a relatively low complication rate in a very challenging pediatric patient population. The pathology appears to be the most significant determinant of outcome, and incomplete disconnection appears to be the most frequent reason for surgical failure.