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Robert T. Buckley, Tiffany Morgan, Russell P. Saneto, Jason Barber, Richard G. Ellenbogen, and Jeffrey G. Ojemann

F unctional or disconnective hemispherectomy is a surgical procedure used in intractable, lateralized epilepsy. First conceived as an anatomical resection of the involved hemisphere, it demonstrated acceptable seizure control but was limited by postoperative complications, especially superficial cerebral hemosiderosis and hydrocephalus. 12 , 16 In response, Rasmussen developed the functional hemispherectomy, which aimed to provide a complete functional disconnection while minimizing resection of the cerebrum. 30 This trend of functional disconnection

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Alexandra D. Beier and James T. Rutka

T he treatment for intractable epilepsy has been evolving since Horsley performed the first surgery for epilepsy in 1886. 13 For catastrophic epilepsy, the entire removal of one hemisphere was advocated in 1938 by McKenzie. 2 Since then, several advances have brought the initially abandoned procedure back into favor for intractable hemispheric epilepsy. This article will highlight the recent developments and technical details of hemispherectomy. Historical Overview Initially, hemispherectomy was described and performed for tumor control. Both Dandy

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Ignacio Jusue-Torres, Vikram C. Prabhu, and G. Alexander Jones

and the editorial process. Stories, aphorisms, and axioms help us to understand everything from neurological disease to the history of our own field, and often lend some life to the otherwise two-dimensional forebears who reside in the pages of textbooks. In 1928, Walter Dandy published an account of 5 patients undergoing hemispherectomy for glioblastoma. Here, we set out to discern his motivation for this radical treatment and to place this in historical context in terms of the disease, as well as the technology available at the time. Because it is worthwhile, from

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Alexander G. Weil, Aria Fallah, Shelly Wang, George M. Ibrahim, Lior M. Elkaim, Prasanna Jayakar, Ian Miller, Sanjiv Bhatia, Toba N. Niazi, and John Ragheb

A lthough hemispherectomy is an effective treatment for children with intractable hemispheric epilepsy syndromes, up to 40% of patients go on to develop seizure recurrence. 22 The causes of seizure recurrence in these patients are incompletely understood. Traditionally, the ideal candidates for hemispherectomy have concordant unilateral findings on neuroimaging and electrophysiological studies. 12 , 16 , 19 , 22 , 24 , 26 , 27 However, whether the presence of bilateral preoperative MRI abnormalities is truly associated with a worse seizure outcome following

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Christopher C. Young, John R. Williams, Abdullah H. Feroze, Margaret McGrath, Ali C. Ravanpay, Richard G. Ellenbogen, Jeffrey G. Ojemann, and Jason S. Hauptman

F unctional hemispherectomy/hemispherotomy is a disconnection surgery that has undergone significant evolution. Today, when performed in high-volume epilepsy centers in appropriate patients, it is an effective procedure for the control of unilateral medically refractory epilepsy. Surgical modifications and improvements have resulted in excellent seizure outcome with low operative morbidity and mortality. In 1938, McKenzie presented the first report of anatomical hemispherectomy for the treatment of refractory epilepsy at the annual meeting of the American

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Jamal M. Taha, Kerry R. Crone, and Thomas S. Berger

ventricular shunting have been unsuccessful in controlling seizures and encephalopathic changes. 5, 7, 9 Although hemispherectomy has recently been advocated to treat holohemispheric hemimegaloencephaly, the experience is limited to a few case reports. To better define the role of hemispherectomy in treating holohemispheric hemimegaloencephaly, we present the cases of five infants diagnosed as having this condition. Their clinical course with or without surgical intervention is described and the results following the insertion of ventricular shunts, partial

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Christoph J. Griessenauer, Smeer Salam, Philipp Hendrix, Daxa M. Patel, R. Shane Tubbs, Jeffrey P. Blount, and Peter A. Winkler

H emispherectomy for the treatment of refractory epilepsy was first performed in the first half of the 20th century. 20 Anatomical hemispherectomy, the resection of an entire hemisphere frequently done in the 1950s and 1960s that was associated with high complication rates from hydrocephalus and superficial cerebral hemosiderosis, has been replaced with less invasive procedures that accomplish a functional equivalent by disconnection of the epileptogenic cortex of one hemisphere from the contralateral hemisphere and deeper brain structures or removal of

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Gregory G. Heuer, Douglas A. Hardesty, Kareem A. Zaghloul, Erin M. Simon Schwartz, A. Reghan Foley, and Phillip B. Storm

shunt placement. Epilepsy is found in up to 36–65% of patients with schizencephaly and is resistant to medical treatment in 9–38% of cases. 1 , 3 , 7 , 10 , 11 , 19 Usually, patients with epilepsy and schizencephaly can be treated with resection of either the schizencephalic cleft alone or the cleft and surrounding epileptogenic tissue. 15–17 , 20 The open-lip form of schizencephaly is associated with more numerous difficult-to-control seizures compared with the closed-lip variety. 19 Anatomic hemispherectomy for the treatment of medically intractable epilepsy

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Steven J. Schiff and Steven L. Weinstein

diffuse right hemisphere atrophy. Operations . The family consented to permit hemispherectomy but refused blood transfusion. Human recombinant erythropoietin was begun at a dose of 11,000 U subcutaneously every other day. The hemoglobin concentration and hematocrit rose from 9.5 gm/dl and 29.8% to 12.0 gm/dl and 37.3% over a period of 14 days. She was taken to the operating room where a functional hemispherectomy 20 was begun. The operation was terminated when the estimated blood loss of 400 cc appeared to place the patient at risk for transfusion in the

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Sandeep Sood, Eishi Asano, and Harry T. Chugani

N oninfectious fever occurs in more than one-half of children following hemispherectomy for intractable epilepsy. 2–5 Temperature elevation typically occurs during the first 4–12 days postoperatively and is generally believed to be related to an inflammatory response generated by tissue damage and the presence of blood and its degradation products in the ventricular or subarachnoid space, inducing an aseptic meningitis. Elevated temperatures often cause concern among family members and caregivers and lead to the empiric use of antibiotics and a battery of