Learn about functional hemispherectomy, a procedure used to treat seizures in people with epilepsy. The rationale for surgery is severing the white matter connection between the two hemispheres, i.e., functional discontinuation, and surgery is often performed in a staged manner. This surgery is generally reserved for children who experience seizures that originate from multiple sites in one hemisphere, usually the result of a condition present at birth or in early infancy. Such measures consequently are not optimal for differentiating between left-and right-sided lesions. Its utility is being explored in children with disabling “drop” attacks where the epileptogenic focus emanates from one hemisphere and spreads to the contralateral hemisphere. The long-term seizure-free rates after hemispherectomy remained stable at 63% at 5 years and beyond. We use cookies to help provide and enhance our service and tailor content and ads. The main indications for hemispherectomy are: severe intractable epilepsy associated with the congenital hemiplegia syndrome or as part of the hemiconvulsions–hemiplegia–epilepsy syndrome of Gastaut; in Rasmussen's syndrome; and in Sturge–Weber syndrome. This late complication, along with the significant frequency of operative mortality, the need for perioperative transfusion, and postoperative extracranial shunting, prompted Rasmussen to develop a modified technique to accomplish the same objective. studied 186 children who underwent hemispherectomy by a single surgeon , with the goal of assessing longitudinal outcome of seizure freedom rates by survival analysis, and predictors of seizure outcome by proportional hazard modeling. Modified surgical techniques have, however, been introduced (Adams, 1983; Rasmussen, 1987) which allow the operation to be carried out very successfully without, at least as yet, producing serious late sequelae. Nevertheless, the occurrence of late complications, such as hydrocephalus and superficial hemosiderosis, decreased the initial enthusiasm and restricted its clinical applications [11,12]. The best results are in children with diseases affecting only one hemisphere, Sturge-Weber syndrome (Kossoff et al, 2002), and Rasmussen encephalitis (Kossoff et al, 2003). By continuing you agree to the use of cookies. Access success rates for patients at Cleveland Clinic following hemispherectomy surgery. Hemimegalencephaly might increase morbidity and lower the success rate. In particular, the presence of bilateral PET abnormalities on preoperative screening correlated with seizure recurrence. However, despite clear efficacy in controlling seizures in 65–80% of the patients, there is no place for excessive optimism with regard to plasticity. So that, a greater resection cannot necessarily reduce the seizure frequency, however the morbidity may also be larger. These results indicate that ipsilateral and contralateral representations in the remaining hemisphere are topographically differentiated, with ipsilateral representations having a more anterior and lateral scalp distribution. View chapter Purchase book. Talk to a doctor. It may significantly improve your quality of life. Operative mortality range for modern cases series range from 2 to 7%.30, J. Eric Piña-Garza MD, Kaitlin C. James MD, in Fenichel's Clinical Pediatric Neurology (Eighth Edition), 2019. A hemispherectomy is when one side of the brain is surgically disconnected from the rest of the brain so that seizures that originate in that hemisphere have nowhere to go. This complication appeared to cause delayed morbidity and death in more than 20% of patients. Later studies have largely confirmed that the outcome of hemispherectomy is determined mostly by the presurgical condition and that no major positive cognitive change can be expected after surgery (Devlin et al., 2003; Pulsifer et al., 2004; Battaglia et al., 2006; Basheer et al., 2007; Lettori et al., 2008). This surgery is to make your seizures less severe: Corpus callosotomy – in this type of surgery, the connections between the 2 sides (hemispheres) of the brain are cut. Rates of superficial cerebral hemosiderosis and hydrocephalus along with perioperative mortality decreased significantly while seizure control rate was similar to those observed with anatomic hemispherectomy. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B012226870900589X, URL: https://www.sciencedirect.com/science/article/pii/B9780750611725500235, URL: https://www.sciencedirect.com/science/article/pii/B9780444528988000367, URL: https://www.sciencedirect.com/science/article/pii/B9780124814608500263, URL: https://www.sciencedirect.com/science/article/pii/B9780323509619000347, URL: https://www.sciencedirect.com/science/article/pii/B9780124170438000092, URL: https://www.sciencedirect.com/science/article/pii/B9781455723768000013, URL: https://www.sciencedirect.com/science/article/pii/B9780407003088500252, Encyclopedia of the Neurological Sciences, Principles and Practice of Restorative Neurology, Christoph Helmstaedter, Juri-Alexander Witt, in, Devlin et al., 2003; Pulsifer et al., 2004; Battaglia et al., 2006; Basheer et al., 2007; Lettori et al., 2008, Ammar Shaikhouni MD, PhD, ... Ali Rezai MD, in, Fenichel's Clinical Pediatric Neurology (Seventh Edition). In recent years, several newer approaches have been developed with the goal of achieving complete hemispheric disconnection (hemispherotomy) with minimal cortical resection. A hemispherectomy is a neurosurgical procedure that involves the removal of one of the cerebral hemispheres. Make an Appointment or Find a Location ; Interested in epilepsy services in Florida? The anatomy suggests that the normal ipsilateral representation has become more influential in these patients and has likely contributed to the recovery. Meanwhile, about 10-20% significantly improve their quality of life. Morbidity rates following functional hemispherectomy are markedly lower, ranging anywhere from 11% to 35% (6,7). In the large UCLA series of 141 cases, the overall rate of seizure-free outcome with hemispherectomy was 83% for cases after 1997 and 66% for cases from 1986-1997. It is still for many people who have drug resistant epilepsy. Reported rates of seizure free outcome range from 60 to 90% in case series.30,32,33,34,35 The most common complications are hydrocephalus (2–33% of cases) and superficial cerebral hemosiderosis (0–30%).30 Those complications are more common in cases when anatomic hemispherectomy is performed. Hemispherectomy is performed in a number of different ways. Need appointment or locations information for services in Cleveland and nearby suburbs? Historical Overview Initially, hemispherectomy was described and per­ formed for tumor control. Hemispherectomy was described independently in 1928 by Dandy and L’Hermitte (Rasmussen, 1983) as a radical treatment for malignant glioma of one hemisphere, but with a failure to offer improvements in survival or quality of life compared with more conservative treatments. On the other hand, family counseling for functional outcome remains difficult … Hemispherectomy is most often considered in children, whose brains are better able to adapt to the loss of brain matter than adults. Because of these complications, less radical alternatives are generally preferred. Despite the potential risks, overall, about 85 percent of people who have a hemispherectomy show improvement in their seizures. The success rate of hemispherectomy in this study is comparable to prior published work. In a hemispherectomy, the doctor removes an entire hemisphere -- or half of your brain. 6). Hemispherectomy By: Barry Mortimer Hemispherectomy's are usually done only in hospitals that have neurosurgeons. There is also a small group of patients in whom the pathology is ill understood but results in a progressive illness in early childhood with severe focal fits accompanied by hemiparesis: the focal epilepsy is sufficiently severe to produce with epilepsia partialis continua an effective hemiplegia. The immediate results were good. One option is to “disconnect” or interrupt the communication between both sides of the brain. Motor functions seem to improve, but attention and memory generally appear to be deficient after surgery (Jambaque et al., 2001). Sometimes, the surgeon removes the left hemisphere. Currently, the functional hemispherectomy replaces the traditional one. Aaron's Story. Hemispherectomy is the treatment of ultimate rationale in the presence of severe catastrophic epilepsies that are confined to one hemisphere (mostly Rasmussen's encephalitis, Sturge–Weber syndrome, hemimegalencephaly). (1991). Walter Dandy first introduced hemispherectomy as a treatment for hemispheric glioma and over the next few decades it gained attention as a resection technique for intractable hemispheric epilepsy. In addition many of these children have a gross personality disorder, usually in the form of extreme aggression (Wilson, 1970). Overall, 23% of 57 patients successfully attended a regular school, 21% of 33 patients older than 20 years were employed on a low level, and less than half of the patients (42%) were rated as being able to lead an independent life – 15% have or had a partner ( Buddewig et al., 2009 ). There was an even disease were seizure free or only had “minor events.” lower success rate for anatomical hemispherectomy after Since for this type of epilepsy surgery for patients with a 2 years compared to hemispherotomy (83 % versus 59 % history of drug-resistant epilepsy in combination with a seizure free) [7]. The literature on childhood aphasia, hemispherectomy, and recovery of function has been reviewed by a number of authors (e.g., Aram & Eisele, 1992; Aram & Whitaker, 1988; Hiscock & Kinsbourne, 1994; Kinsbourne & Hiscock, 1987; Satz & Bullard-Bates, 1981; Spreen, Risser, & Edgell, 1995; Woods & Teuber, 1978). Reported seizure freedom rates after hemispherectomy vary from 52% to 80%, and multiple seizure outcome indicators have been identified, providing valuable information to counsel families about seizure outcome (Kossoff et al., 2003; Jonas et al., 2004; Delalande et al., 2007; Hallbook et al., 2010; Moosa et al., 2013). This study indicated that patients operated early (at age < 7 years) had the best seizure outcome, that patients who had surgery between ages 7 and 16 had the best preoperative to postoperative cognitive and behavioral change, and that the best overall psychosocial outcome was observed in the group operated after age 16 years. The amplitudes of MEPs evoked by magnetic stimulation (expressed as percentage of the alpha-motoneuron pool) are indicated. In these patients the neuropsychologically most relevant question is the degree to which the contralateral nonaffected hemisphere will take over functions of the affected hemisphere. Motor functions seem to improve, but attention and memory generally appear to be deficient after surgery (Jambaque et al., 2001). Hemispherectomy Last updated: January 18, 2020 ANATOMICAL HEMISPHERECTOMY ... success rate of 50% after functional HE has failed). From: Handbook of Clinical Neurology, 2013, Robert R. Goodman, in Encyclopedia of the Neurological Sciences, 2002. Hemimegalencephaly might increase morbidity and lower the success rate. A hemispherectomy is brain surgery that involves the removal of one half of the brain to reduce or prevent seizures. What is hemispherectomy? They excluded 3 patients due to loss of follow-up and 13 due to emergence of non-epileptic paroxysmal events. performed in children who have severe and intractable seizure disorders Under these circumstances such radical operation often has a good result and is entirely justified. The original procedure consisted of removing the cortex of one hemisphere along with a variable portion of the underlying basal ganglia. Although anatomical hemispherectomy provided a high success rate in terms of seizure control, a late complication, superficial cerebral hemosiderosis, was recognized in the late 1960s. There is little change in the severity of the already established hemiparesis. From: Handbook of Clinical Neurology, 2012, Robert R. Goodman, in Encyclopedia of the Neurological Sciences, 2002. Later studies have largely confirmed that the outcome of hemispherectomy is determined mostly by the presurgical condition and that no major positive cognitive change can be expected after surgery (Devlin et al., 2003; Pulsifer et al., 2004; Battaglia et al., 2006; Basheer et al., 2007; Lettori et al., 2008). Hemispherectomy is a relatively rare type of epilepsy surgery. This study newly identifies important predictors of surgery success or failure. The procedure fell out of favor due to its high perioperative mortality in addition to its serious long-term complications of superficial cerebral hemosiderosis and hydrocephalus. What to Expect Before Functional Hemispherectomy Surgery The use of hemispherectomy, or more correctly hemidecortication, is exclusively for children with intractable epilepsy and hemiplegia. hemispherectomy. performed per year in the United States is likely less than 100. 1999, Martínez-González et al. Meaning 3/4 Description Hemispherectomy may be "anatomic" or "functional." Hemispherectomy not only stops the epilepsy in 75–80%, it usually also produces a marked improvement of behaviour and some gain of cognitive ability. The resulting cavity communicated with the third ventricle and developed a subdural membrane lining. This procedure is relatively rare, and can have surprising rates of success and recovery. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Treatment Outcomes; Appointments. In that case, only a small section of the affected hemisphere needs to be removed. The success rate is much higher than in the past. The Montreal-type hemispherectomy is a modified procedure with removal of most of the damaged hemisphere but with portions of the frontal and occipital lobes left in place, but disconnected from the other hemisphere and brainstem. Access success rates for patients at Cleveland Clinic following hemispherectomy surgery. Although functional cerebral plasticity extends into puberty, Bayard and Lassonde reported in a review of studies published between 1972 and 1997 (Jambaque et al., 2001) that postoperative IQ was not related to age at surgery and that even in early surgery the right hemisphere clearly could not take over all linguistic features normally carried out by the left hemisphere. Apparently, functional hemispherectomies have a 75% success rate in stopping these seizures which is great for 3 out of 4 people. Functional hemispherectomy, popularly known as corpus callosectomy, is widely gaining momentum in most centers. However, late complications of hemorrhage, hydrocephalus, and hemosiderosis occurred in up to 35% of children and were sometimes fatal. The success of hemispherectomy depends on the underlying pathology, with excellent outcomes and seizure freedom rates approaching 75%–85% for pathologies such as Rasmussen’s encephalitis and focal infarcts, but with a poorer outcome for patients with hemi-megalencephaly.17 Another surgical technique, cerebral hemidecortication, was developed with the hope of obtaining the same goal while avoiding superficial cerebral hemosiderosis. View chapter Purchase book. If they do, they usually have a lot fewer than before, and will need to carry on taking their epilepsy medicine. About 85% to 90% of patients undergoing hemispherectomy experience arrest of their seizures, accompanied in most cases by dramatic improvement in function, including further cognitive development. Similar findings were obtained by Benecke et al. Brain surgery for epilepsy has a high success rate. 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