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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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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

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Keith G. Davies, Robert E. Maxwell and Lyle A. French

T he operation of hemispherectomy, which is in essence cerebral hemidecortication, was introduced in the 1920's by Dandy 4 and L'Hermitte 17 in an attempt to improve treatment of gliomas of the nondominant cerebral hemisphere. However, the results, even with such a radical procedure, proved not to be curative. Williams and Scott 34 cite McKenzie's 1938 work as the first application of the procedure to the management of intractable seizures in infantile hemiplegia. It was not until 1950, when Krynauw 14 reported 12 cases with excellent short-term results

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Cristina V. Torres, Aria Fallah, George M. Ibrahim, Samuel Cheshier, Hiroshi Otsubo, Ayako Ochi, Sylvester Chuang, O. Carter Snead, Stephanie Holowka and James T. Rutka

H emispherectomy is a surgical procedure used to treat unilateral medication-resistant epilepsy in diffuse hemispheric conditions such as Sturge-Weber syndrome, cortical dysplasia, hemimegalencephaly, or Rasmussen encephalitis. 4 , 7–9 , 14 , 21 Described by Dandy in 1928, and first applied by McKenzie in 1938 to intractable epilepsy, hemispherectomy consists of a complete resection of a hemisphere. Multiple modified techniques, known as functional hemispherectomies, were subsequently developed to avoid potential complications related to the empty cavity

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Sandeep Mittal, Jean-Pierre Farmer, Bernard Rosenblatt, Frederick Andermann, José L. Montes and Jean-Guy Villemure

C erebral hemispherectomy remains one of the most successful surgical procedures used in the treatment of intractable epilepsy. McKenzie 7 was the first to propose hemispherectomy for the surgical management of a patient with seizures. Krynauw 6 performed hemispherectomies in 12 children with infantile hemiplegia and obtained positive results, including excellent seizure control and improved behavior. Subsequently, hemispherectomy gained widespread acceptance as a successful procedure for controlling refractory childhood epilepsy. Since then, several