Hemispherotomy: description of surgical technique

Abstract

Hemispherectomy constitutes an established surgical method in the management of patients with medically intractable epilepsy, secondary to severe unilateral hemisphere damage. The well-established association of the anatomical hemispherectomy initially described with severe complications such as late hydrocephalus has led to the development of less resective and more disconnecting procedures. All these technical variations of hemispherotomy carry less favorable outcomes compared with anatomic hemispherectomy, but significantly fewer complications. In our current communication, we outline the indications and the surgical technique of hemispherotomy and report our experience of the clinical application of this surgical procedure. In our clinical series, the 5-year follow-up shows that 66.6% of our patients (6 out of 9) had class I outcome according to Engel's classification system, 22.2% (2 out of 9) class II outcome, while 11.1% (1 out of 9) had class III outcome. No mortality occurred in the current series and operative blood loss was significantly lowered. Hemispherotomy represents a less efficacious technique compared with anatomic hemispherectomy, but is a safe and technically simple surgical alternative for the management of patients with medically intractable seizures.