Abstract
Introduction
Anatomical hemispherectomy is frequently employed in the surgical management of pediatric patients with medically refractory epilepsy.
Materials and methods
In this chapter, we review the historical evolution of this surgical procedure, outline the indications and the criteria for selecting surgical candidates and describe the important pre-operative evaluation of the surgical candidates.
Discussion
We provide a detailed description of our surgical technique, anesthesiological considerations, and post-operative care plan. Ultimately we analyze the most common complications associated with this procedure.
Conclusion
Anatomical hemispherectomy performed in carefully selected pediatric patients with medically intractable epilepsy can be a safe and efficacious surgical procedure.
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References
Dandy WE (1928) Removal of right cerebral hemisphere for certain tumors with hemiplegia. JAMA 90:823–825
McKenzie KG (1938) The present status of a patient who had the right cerebral hemisphere removed. JAMA 111:168
Krynauw R (1950) Infantile hemiplegia treated by removing one cerebral hemisphere. J Neurol Neurosurg Psychiatry 13:243–267
Wilson PJE (1970) Cerebral hemispherectomy for infantile hemiplegia. A report of 50 cases. Brain 93:147–180
Oppenheimer DR, Griffith HB (1966) Persistent intracranial bleeding as a complication of hemispherectomy. J Neurol Neurosurg Psychiatry 29:229–240
Falconer MA, Wilson PJE (1969) Complications related to delayed hemorrhage after hemispherectomy. J Neurosurg 30:413–426
Rasmussen T (1973) Postoperative superficial hemosiderosis of the brain, its diagnosis, treatment and prevention. Trans Am Neurol Assoc 98:133–137
Rasmussen T (1983) Hemispherectomy for seizures revisited. Can J Neurol Sci 10:71–78
Goodman R (1986) Hemispherectomy and its alternatives in the treatment of intractable epilepsy in patients with infantile hemiplegia. Dev Med Child Neurol 28:251–258
Tinuper P, Anderman F, Villemure JG, Rasmussen TB, Quesey LF (1988) Functional hemispherectomy for treatment of epilepsy associated with hemiplegia: rationale, indications, results and comparison with callosotomy. Ann Neurol 24:27–34
Winston KR, Welch K, Adler JR, Erba G (1992) Cerebral hemicorticectomy for epilepsy. J Neurosurg 77:889–895
Smith SJM, Anderman F, Villemure JG, Rasmussen TB, Quesney LF (1991) Functional hemispherectomy: EEG findings, spiking from isolated brain postoperatively and prediction of outcome. Neurology 41:1790–1794
Schramm J, Behrens F, Entzian W (1995) Hemispherical deafferentation: an alternative to functional hemispherectomy. Neurosurgery 36:509–516
Villemure JG, Mascott CR (1995) Peri-insular hemispherotomy: surgical principles and anatomy. Neurosurgery 37:975–981
Kanev PM, Foley CM, Miles D (1997) Ultrasound-tailored functional hemispherectomy for surgical control of seizures in children. J Neurosurg 86:762–767
Shimizu H, Maehara T (2000) Modification of periinsular hemispherotomy and surgical results. Neurosurgery 47:367–373
Schramm J, Kral T, Clusmann H (2001) Transsylvian keyhole functional hemispherectomy. Neurosurgery 49:891–900
Delalande O, Fohlen M, Jalin C et al (2001) From hemispherectomy to hemispherotomy. In: Lunders HO, Comair YG (eds) Epilepsy surgery, 2nd edn. Lippincott, Williams and Wilkins, Philadelphia pp 741–746
Cook SW, Nguyen ST, Hu B, Yudovin S, Shields WD, Vinters HV, Van de Wiele BB, Harrison RE, Mathern GW (2004) Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients. J Neurosurg 100(2 Suppl Pediatrics):125–141
Smith JR, Fountas KN, Lee MR (2005) Hemispherotomy: description of surgical technique. Childs Nerv Syst 21:466–472
Piastra M, Pietrini D, Caresta E, Chiaretti A, Viola L, Costa F, Pusateri A, Polidori G, Di Rocco C (2004) Hemispherectomy in children: hematological issues. Childs Nerv Syst 20:453–458
Kossoff EH, Vining EPG, Pillas DJ, Pyzik PL, Avellino AM, Carson BS, Freeman JM (2003) Hemispherectomy for intractable unihemispheric epilepsy. Etiology vs outcome. Neurology 61:887–890
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 126:556–566
Davies K, Maxwell RE, French LA (1993) Hemispherectomy for intractable seizures: long-term results in 17 patients followed for up to 38 years. J Neurosurg 78:733–740
Kossoff EH, Vining EP, Pyzik PL, Kriegler S, Min KS, Carson BS, Avellino AM, Freeman JM (2002) The postoperative course and management of 106 hemidecortications. Pediatr Neurosurg 37:298–303
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 12:376–384
Di Rocco C, Iannelli A (2000) Hemimegalencephaly and intractable epilepsy: complications of hemispherectomy and their correlations with surgical technique. A report on 15 cases. Pediatr Neurosurg 33:198–207
Constant I, Seeman R, Murat I (2005) Sevoflurane and epileptiform EEG changes. Paediatr Anaesth 15:266–274
Artru AA, Momota T (2000) Rate of CSF formation and resistance to reabsorption of CGS during sevoflurane or remifentanil in rabbits. J Neurosurg Anesthesiol 12:37–43
Di Rocco C (1996) Surgical treatment of hemimegalencephaly. In: Guerrini R (ed) Dysplasias of the cerebral cortex and epilepsy. Lippincott-Raven, Philadelphia, pp 295–304
Schramm J (2002) Hemispherectomy techniques. In: Bingaman WE (ed) Neurosurg Clin N Am 13:(1)113–134
Carmichael EA (1966) The current status of hemispherectomy for infantile hemiplegia. Clin Proc Child Hosp Dist Columbia 22(10):285–293
White HH (1961) Cerebral hemispherectomy in the treatment of infantile hemiplegia: review of the literature and report of two cases. Confin Neurol 21:1–50
Cabieses F, Jeri R, Landa R (1957) Fatal brain-stem shift following hemispherectomy. J Neurosurg 14(1):74–91
Montes JL, Farmer JP, Andermann F, Poulin C (2006) Hemispherectomy: medications, technical approaches, and results. In: Wyllie E, Gupta A, Lachhwani DK (eds) The treatment of epilepsy: principles & practice, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1111–1124
Dunn LT, Miles JB, May PL (1995) Hemispherectomy for intractable seizures: a further modification and early experience. Br J Neurosurg 9:775–783
Peacock WJ (1995) Hemispherectomy for the treatment of intractable seizures in childhood. In: Adelson PD, Black PM (eds) Neurosurg Clin N Am 6:(3)549–563
McKissock W (1953) Infantile hemiplegia. Proc R Soc Med 46(6):431–434
McKissock W (1954) The operative technique for cerebral hemispherectomy in the treatment of infantile hemiplegia. Zentralbl Neurochir 14(1–2):42–48
Rasmussen T (1988) Cerebral hemispherectomy: indications, methods, and results. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Grune & Stratton, New York, pp 1235–1241
Mathew NT, Abraham J, Chandy J (1970) Late complications of hemispherectomy: report of a case relieved by surgery. J Neurol Neurosurg Psychiatry 33:372–375
Strowitzki M, Kiefer M, Steudel WI (1994) Acute hydrocephalus as a late complication of hemipherectomy. Acta Neurochir (Wien) 131:253–259
Ransohoff J, Hess W (1973) [in the discussion of Rasmussen T. Postoperative superficial hemosiderosis of the brain, its diagnosis, treatment and prevention. Trans Am Neurol Assoc 98:133–137]
Sayers MP (1976) Shunt complications. Clin Neurosurg 23:393–400
Wester K, Hugdahl K, Asbjornsen A (1991) Dichotic listening during forced-attention in a patient with left hemispherectomy. Percept Mot Skills 72:151–159
Wroe S, Richens A, Compston A (1986) Bilateral ballistic movements occurring as a late complication of hemispherectomy and responding to sulpiride. J Neurol 233:315–316
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Fountas, K.N., Smith, J.R., Robinson, J.S. et al. Anatomical hemispherectomy. Childs Nerv Syst 22, 982–991 (2006). https://doi.org/10.1007/s00381-006-0135-2
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DOI: https://doi.org/10.1007/s00381-006-0135-2