Acta Neurochirurgica

, Volume 154, Issue 9, pp 1603–1612 | Cite as

Seizure outcome, functional outcome, and quality of life after hemispherectomy in adults

  • J. SchrammEmail author
  • D. Delev
  • J. Wagner
  • C. E. Elger
  • M. von Lehe
Clinical Article



Functional hemispherectomy is a well-established method in childhood epilepsy surgery with only a few reports on its application in adults.


We report on 27 patients (median age 30 years, range 19-55) with a follow-up of more than 1 year (median 124 months, range 13-234). Etiology was developmental in two (one schizencephaly, one hemimegalencephaly), acquired in 21 (two hemiatrophy, 17 porencephaly, two postencephalitic), and progressive in four (Rasmussen’s encephalitis).


At last available follow-up, 22 patients were seizure free (81 % ILAE class 1), one had auras (4 % ILAE class 2), one had no more than three seizures per year (4 % ILAE class 3). Thirty-seven percent were without antiepileptic drugs. Seventeen patients of 20 responding patients stated improved quality of life after surgery, one patient reported deterioration, and two patients reported no difference. Additionally, a self-rated postoperative functional status and changes compared to the pre-operative status was assessed. Six patients improved in gait, ten remained unchanged, and four deteriorated. Three patients improved in speech, none deteriorated. Hand function got worse five times, and in 15 cases remained unchanged. There was no mortality, one bone flap infection, and one subdural hematoma. Hydrocephalus was seen in three cases (12 %).


It is possible to achieve good seizure outcome results despite long-standing epilepsy across a variety of etiologies, comparable to epilepsy surgery in pediatric patients. Adult patients do not have to expect more problems with new deficits, appear to cope quite well, and mostly profit from surgery in several quality of life domains.


Hemispherectomy Epilepsy surgery Adult Seizure outcome Functional outcome 



We thank Professor H. Urbach for his long-term neuroradiological expertise and Prof. F. Rosenow, Marburg, for allowing us to include two cases where his team performed presurgical evaluation. We also wish to acknowledge the contribution of those colleagues who maintained the epilepsy surgery database in the past in the Department of Neurosurgery: H. Clusmann MD, T. Kral MD, E. Behrens MD. P. Süßmann and B. Harzheim helped with patient follow-up. Patient follow-up was funded as part of the transregional collaborative research consortium SFB-TR3 “Mesial temporal lobe epilepsies” of the Deutsche Forschungsgemeinschaft (DFG).

Conflicts of interest



  1. 1.
    Benbadis S, Vale F, Dubeau F, Duchowny M (2009) Huh? Hemispherectomy in adults?: an exercise in risk-benefit analysis. Epileptic Disord 11:258–259PubMedGoogle Scholar
  2. 2.
    Cukiert A, Cukiert CM, Argentoni M, Baise-Zung C, Forster CR, Mello VA, Burattini JA, Mariani PP (2009) Outcome after hemispherectomy in hemiplegic adult patients with refractory epilepsy associated with early middle cerebral artery infarcts. Epilepsia 50:1381–1384PubMedCrossRefGoogle Scholar
  3. 3.
    de Francisco J, Fernandez S, Carreno M, Rumia J, Donaire A, Maestro I, Bargallo N, Candela S, Pintor L, Boget T, Setoain X (2009) Successful functional hemispherectomy in adult patients with refractory epilepsy. Neurologia 24:9–14PubMedGoogle Scholar
  4. 4.
    Devlin AM, Cross JH, Harkness W, Chong WK, Harding B, Vargha-Khadem F, Neville BG (2003) Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain 126:556–566PubMedCrossRefGoogle Scholar
  5. 5.
    Gonzalez-Martinez JA, Gupta A, Kotagal P, Lachhwani D, Wyllie E, Luders HO, Bingaman WE (2005) Hemispherectomy for catastrophic epilepsy in infants. Epilepsia 46:1518–1525PubMedCrossRefGoogle Scholar
  6. 6.
    Jonas R, Nguyen S, Hu B, Asarnow RF, LoPresti C, Curtiss S, de Bode S, Yudovin S, Shields WD, Vinters HV, Mathern GW (2004) Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes. Neurology 62:1712–1721PubMedCrossRefGoogle Scholar
  7. 7.
    Kral T, Clusmann H, Urbach J, Schramm J, Elger CE, Kurthen M, Grunwald T (2002) Preoperative evaluation for epilepsy surgery (Bonn Algorithm). Zentralbl Neurochir 63:106–110PubMedCrossRefGoogle Scholar
  8. 8.
    McClelland S 3rd, Maxwell RE (2007) Hemispherectomy for intractable epilepsy in adults: the first reported series. Ann Neurol 61:372–376PubMedCrossRefGoogle Scholar
  9. 9.
    Schramm J, Behrens E, Entzian W (1995) Hemispherical deafferentation: an alternative to functional hemispherectomy. Neurosurgery 36:509–515, discussion 515-506PubMedCrossRefGoogle Scholar
  10. 10.
    Schramm J, Clusmann H (2008) The surgery of epilepsy. Neurosurgery 62(Suppl 2):463–481, discussionPubMedGoogle Scholar
  11. 11.
    Schramm J, Kral T, Clusmann H (2001) Transsylvian keyhole functional hemispherectomy. Neurosurgery 49:891–900, discussion 900-891PubMedGoogle Scholar
  12. 12.
    Steinhoff BJ, Staack AM, Bilic S, Kraus U, Schulze-Bonhage A, Zentner J (2009) Functional hemispherectomy in adults with intractable epilepsy syndromes: a report of 4 cases. Epileptic Disord 11:251–257PubMedGoogle Scholar
  13. 13.
    Villemure JG, Daniel RT (2006) Peri-insular hemispherotomy in paediatric epilepsy. Childs Nerv Syst 22:967–981PubMedCrossRefGoogle Scholar
  14. 14.
    Vining EP, Freeman JM, Pillas DJ, Uematsu S, Carson BS, Brandt J, Boatman D, Pulsifer MB, Zuckerberg A (1997) Why would you remove half a brain? The outcome of 58 children after hemispherectomy-the Johns Hopkins experience: 1968 to 1996. Pediatrics 100:163–171PubMedCrossRefGoogle Scholar
  15. 15.
    von Lehe M, Lutz M, Kral T, Schramm J, Elger CE, Clusmann H (2006) Correlation of health-related quality of life after surgery for mesial temporal lobe epilepsy with two seizure outcome scales. Epilepsy Behav 9:73–82CrossRefGoogle Scholar
  16. 16.
    Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, Sperling MR, Luders H, Pedley TA (2001) ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia 42:282–286PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • J. Schramm
    • 1
    Email author
  • D. Delev
    • 1
  • J. Wagner
    • 2
  • C. E. Elger
    • 2
  • M. von Lehe
    • 1
  1. 1.Department of Neurosurgery, Bonn University Medical CenterUniversity of BonnBonnGermany
  2. 2.Department of Epileptology, Bonn University Medical CenterUniversity of BonnBonnGermany

Personalised recommendations