Advertisement

Neurosurgical Review

, Volume 29, Issue 2, pp 97–102 | Cite as

Hemispherectomy: a schematic review of the current techniques

  • Antonio Nogueira De Almeida
  • Raul MarinoJr.
  • Paulo Henrique Aguiar
  • Manoel Jacobsen Teixeira
Review

Abstract

Anatomical hemispherectomy has been used for the treatment of seizures since 1938. However, it was almost abandoned in the 1960s after reports of postoperative fatalities caused by hydrocephalus, hemosiderosis, and trivial head traumas. Despite serious complications, the remarkable improvement of patients encouraged authors to carry out modifications on anatomical hemispherectomy in order to lessen its morbidity while preserving its efficacy. The effort to improve the technique generated several original procedures. This paper reviews current techniques of hemispherectomy and proposes a classification scheme based on their surgical characteristics. Techniques of hemispherectomy were sorted into two major groups: (1) those that remove completely the cortex from the hemisphere and (2) those that associate partial cortical removal and disconnection. Group 1 was subdivided into two subgroups based on the integrity of the ventricular cavity and group 2 was subdivided into three subgroups depending on the amount and location of the corticectomy. Grouping similar techniques may allow a better understanding of the distinctive features of each one and creates the possibility of comparing data from different authors.

Keywords

Epilepsy surgery Hemispherectomy Hemispherotomy Hemidecortication Hemicorticectomy 

Notes

References

  1. 1.
    Adams CBT (1983) Hemispherectomy a modification. J Neurol Neurosurg Psychiat 46:617-619PubMedGoogle Scholar
  2. 2.
    Cabieses F, Jeri R, Landa R (1957) Fatal brain shift following hemispherectomy. J Neurosurg 14:74-91PubMedGoogle Scholar
  3. 3.
    Carson BS, Javedan SP, Freeman JM, Vining EG, Zuckerberg AL, Lauer JA, Guarnieri ML (1996) Hemispherectomy: a hemidecortication approach and review of 52 cases. J Neurosurg 84:903-911PubMedGoogle Scholar
  4. 4.
    Chugani HT, Jacobs B (1994) Metabolic recovery in caudate nucleus of children following cerebral hemispherectomy. Ann Neurol 36:794-797PubMedCrossRefGoogle Scholar
  5. 5.
    Comair YG (2001) The transsylvian functional hemispherectomy: patient selection and results. In: Lüders HO, Comair YG (eds) Epilepsy surgery, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 699-704Google Scholar
  6. 6.
    Cook SW, Nguyen ST, Hu B, Yudovin S, Shields WD, Vinters HV, Van de Wiele BM, Harrison RE, Mathern GW (2004) Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients. J Neurosurg Ped 100:125-141Google Scholar
  7. 7.
    Dandy WE (1928) Removal of right cerebral hemisphere for certain tumors with hemiplegia. Preliminary report. JAMA 90:823-825Google Scholar
  8. 8.
    Daniel RT, Villemure JG (2003) Hemispherotomy techniques. J Neurosurg 98:438-439 [Letter]PubMedGoogle Scholar
  9. 9.
    Danielpour M, von Koch CS, Ojemann SG, Peacock WJ (2001) Disconnective hemispherectomy. Pediatr Neurosurg 35:169-172PubMedCrossRefGoogle Scholar
  10. 10.
    Davies KG, Maxwell RE, French LA (1993) Hemispherectomy for intractable seizures: long-term results in 17 patients followed for up to 38 years. J Neurosurg 78:733-740PubMedGoogle Scholar
  11. 11.
    De Almeida AN, Marino R Jr (2005) The early years of hemispherectomy. Pediatr Neurosurg 41:137-140PubMedCrossRefGoogle Scholar
  12. 12.
    Delalande O, Pinard JM, Basdevant C (1992) Hemispherotomy: a new procedure for central disconnection. Epilepsia 33 (Suppl 3):99–100 [Abstract]Google Scholar
  13. 13.
    Delalande O, Fohlen M, Jalin C, Pinard JM (2001) From hemispherectomy to hemispherotomy. In: Lüders HO, Comair YG (eds) Epilepsy surgery, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 741–746Google Scholar
  14. 14.
    Devlin AM, Cross JH, Harkness W, Chong WK, Harding B, Vargha-Khadem F, Neville BGR (2003) Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain 126:556-566PubMedCrossRefGoogle Scholar
  15. 15.
    Di Rocco C, Iannelli A (2000) Hemimegalencephaly and intractable epilepsy: complications of hemispherectomy and their correlations with the surgical technique. A report on 15 cases. Pediatr Neurosurg 33:198-207PubMedCrossRefGoogle Scholar
  16. 16.
    Dunn LT, Miles JB, May PL (1995) Hemispherectomy for intractable seizures: a further modification and early experience. Br J Neurosurg 9:775-783PubMedCrossRefGoogle Scholar
  17. 17.
    Feindel W, Leblanc R, Villemure JG (1997) History of the surgical treatment of epilepsy. In: Greenblatt SH (ed) A history of neurosurgery. AANS, Illinois, pp 465-488Google Scholar
  18. 18.
    Gros C, Vlahovitch B (1951) Hemispherectomies: neurophysiological considerations. Rev Neurol 85:482-488PubMedGoogle Scholar
  19. 19.
    Gros C, Vlahovitch B (1960) Forme particulière d’engagement cérébrale aprés hémisphérectomie (le deplacement du tronc cérébrale dans les grandes encéphalopathies hémiatrophiantes). Neuro-Chirurgie 6:245-248PubMedGoogle Scholar
  20. 20.
    Hoffman HJ, Hendrick EB, Dennis M, Armstrong D (1979) Hemispherectomy for Sturge-Weber syndrome. Childs Brain 5:233-248PubMedGoogle Scholar
  21. 21.
    Ignelzi RJ, Bucy PC (1968) Cerebral hemidecortication in the treatment of infantile cerebral hemiatrophy. J Nerv Ment Dis 147:14-30PubMedCrossRefGoogle Scholar
  22. 22.
    Kanev PM, Foley CM, Miles D (1997) Ultrasound-tailored functional hemispherectomy for surgical control of seizures in children. J Neurosurg 86:762–767PubMedGoogle Scholar
  23. 23.
    Krynauw RA (1950) Infantile hemiplegia treated by removing one cerebral hemisphere. J Neurol Neurosurg Psychiat 13:243-267PubMedGoogle Scholar
  24. 24.
    Laine E, Pruvot P, Osson D (1964) Résultats éloignés de l’hemisphérectomie dans les cas d’hémiatrophie cérebralé infantile génératrice d’épilepsie. Neuro-Chirurgie 10:507-522PubMedGoogle Scholar
  25. 25.
    Machado AGG, Shoji A, Ballester G, Marino R Jr (2003) Motor area after hemispherectomy: the hemispheres as potentially independent motor brains. Epilepsia 44:500-506PubMedCrossRefGoogle Scholar
  26. 26.
    Marino R Jr, Machado AGG, Timo-Iaria C (2001) Functional recovery after combined cerebral and cerebellar hemispherectomy in the rat. Stereotactic Funct Neurosurg 76:83-93CrossRefGoogle Scholar
  27. 27.
    McKissock W (1954) The operative technique for cerebral hemispherectomy in the treatment of infantile hemiplegia. Zbl Neurochir 14:42-48Google Scholar
  28. 28.
    Morino M, Shimizu H, Ohata K, Tanaka K, Hara M (2002) Anatomical analysis of different hemispherotomy procedures based on dissection of cadaveric brains. J Neurosurg 97:423-431PubMedCrossRefGoogle Scholar
  29. 29.
    Obrador AS (1951) Hemisferectomia en el tratamiento de las convulsiones de la hemiplejía infantil por hemiatrofia cerebral. Arch Neuropsichiat. (São Paulo) 9:191-197Google Scholar
  30. 30.
    Oppenheimer DR, Griffith HB (1966) Persistent intracranial bleeding as a complication of hemipherectomy. J Neurol Neurosurg Psychiat 29:229-240PubMedCrossRefGoogle Scholar
  31. 31.
    Peacock WJ, Wehby-Grant MC, Shields WD, Shewmon DA, Chugani HT, Sankar R, Vinters HV (1996) Hemispherectomy for intractable seizures in children: a report of 58 cases. Childs Nerv Syst 12:376-384PubMedCrossRefGoogle Scholar
  32. 32.
    Rasmussen T (1983) Hemispherectomy for seizures revisited. Can J Neurol Sci 10:71-78PubMedGoogle Scholar
  33. 33.
    Schiff SJ, Weinstein SL (1993) Use of recombinant human erythropoietin to avoid blood transfusion in a Jehovah’s Witness requiring hemispherectomy. Case report. J Neurosurg 79:600-602PubMedGoogle Scholar
  34. 34.
    Schramm J, Behrens E, Entzian W (1995) Hemispherical deafferentation: an alternative to functional hemispherectomy. Neurosurgery 36:509-516PubMedCrossRefGoogle Scholar
  35. 35.
    Schramm J, Kral T, Clusmann H (2001) Transsylvian keyhole functional hemispherectomy. Neurosurgery 49:891-901PubMedCrossRefGoogle Scholar
  36. 36.
    Schramm J (2002) Hemispherectomy techniques. Neurosurg Clin N Am 13:113-134PubMedCrossRefGoogle Scholar
  37. 37.
    Shimizu H, Maehara T (2000) Modification of peri-insular hemispherotomy and surgical results. Neurosurgery 47:367-373PubMedCrossRefGoogle Scholar
  38. 38.
    Smith JR, Fountas KN, Lee MR (2005) Hemispherotomy: description of surgical technique. Childs Nerv Syst 21:466-472PubMedCrossRefGoogle Scholar
  39. 39.
    Taha JM, Crone KR, Berger TS (1994) The role of hemispherectomy in the treatment of holohemispheric hemimegalencephaly. J Neurosurg 81:37-42PubMedGoogle Scholar
  40. 40.
    Ulrich J, Isler W, Vasslli L (1965) L’effet d’hémorrhagies leptoméningees répétiées sur le système neveux (la sidérose marginale du système nerveux central). Rev Neurol 112:466-471PubMedGoogle Scholar
  41. 41.
    Villemure JG, Mascott CR (1995) Peri-insular hemispherotomy: surgical principles and anatomy. Neurosurgery 37:975-981PubMedCrossRefGoogle Scholar
  42. 42.
    Villemure JG (2001) Functional hemispherectomy: evolution of techniques and results in 65 cases. In: Lüders HO, Comair YG (eds). Epilepsy surgery, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 733–739Google Scholar
  43. 43.
    Wen HT, Rhoton AL Jr, Marino R Jr. (2004) Anatomical landmarks for hemispherotomy and their clinical application. J Neurosurg 101:747-755PubMedCrossRefGoogle Scholar
  44. 44.
    White HH (1961) Cerebral hemispherectomy in the treatment of infantile hemiplegia. Review of literature and report of 2 cases. Cofin Neurol 21:1-50Google Scholar
  45. 45.
    Wilson PJE (1970) Cerebral hemispherectomy for infantile hemiplegia. A report of 50 cases. Brain 93:147-180PubMedCrossRefGoogle Scholar
  46. 46.
    Winston KR, Welch K, Adler JR, Erba G (1992) Cerebral Hemicorticectomy for epilepsy. J Neurosurg 77:889-895PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Antonio Nogueira De Almeida
    • 1
    • 2
  • Raul MarinoJr.
    • 1
  • Paulo Henrique Aguiar
    • 1
  • Manoel Jacobsen Teixeira
    • 1
  1. 1.Departamento de Neurologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
  2. 2.Instituto Neurológico de São PauloSão PauloBrazil

Personalised recommendations