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A hemispherectomy is a special brain surgery where doctors remove or disconnect the half of your brain that causes bad seizures. Before the surgery, the doctors do tests like brain scans and give you a short sleep test to find out exactly where the seizures start. During the surgery, they gently open the skull, do the procedure, and then put everything back in place carefully.
After surgery, you will stay in the hospital for a few days so doctors and nurses can watch how you’re doing. You’ll probably feel sleepy and need time to heal, but soon you'll begin therapy to help you learn to move, speak, and do everyday tasks again. Medicines that help control seizures will be adjusted over time. Many kids feel much better afterwards and can resume activities like attending school, playing with friends, and learning new things.
Hemispherectomy is a rare but life-changing neurosurgical procedure performed to treat severe, intractable epilepsy that originates from one cerebral hemisphere.It is typically used when seizures do not respond to medications and are caused by extensive damage or malformation in one side of the brain.The goal is to remove or disconnect the affected hemisphere to stop seizure activity, reduce neurological decline, and improve quality of life.
Consult a pediatric or adult epileptologist if you or your child has drug-resistant epilepsy, especially if seizures are frequent, disabling, or result in developmental regression.Early evaluation is critical if imaging (MRI, EEG, PET) shows unilateral cortical dysplasia, Rasmussen’s encephalitis, Sturge-Weber syndrome, or hemimegalencephaly.Surgery is considered when seizures are disabling and localized to one hemisphere, and other treatments have failed.
Preparation involves an extensive pre-surgical epilepsy evaluation, including:
- Video EEG monitoring to localize seizure origin
- MRI, PET, or MEG scans to assess brain structure and function
- Neuropsychological testing to evaluate cognitive and language baseline
- Multidisciplinary team discussion to ensure the patient is a surgical candidate
- Patients may also need blood work and a pre-anesthesia evaluation.
Hemispherectomy is done under general anesthesia and may take several forms:
- Anatomic Hemispherectomy: Physical removal of one hemisphere (rarely performed today)
- Functional Hemispherectomy: Disconnects the dysfunctional hemisphere while leaving most of it in place
- Hemidecortication or Hemispherotomy: Disconnection of cortical fibers and seizure pathways with minimal tissue removal
- A large craniotomy is performed, and the surgeon uses microsurgical tools to isolate or remove the affected hemisphere. Advanced intraoperative imaging and neuro-navigation are used for precision.
The surgery typically takes 6 to 12 hours, depending on the technique and extent of brain involvement.Postoperative ICU monitoring is usually required for 1–2 days, followed by a hospital stay of 7 to 14 days.Rehabilitation planning begins early in the recovery period.
- Hemiparesis or weakness on the opposite side (usually pre-existing and expected to remain)
- Hydrocephalus requiring a shunt
- Infection, bleeding, or stroke
- Visual field loss (hemianopia)
- Cognitive or behavioral changes
- Seizure recurrence (rare if seizure focus is fully remo Surgery is generally well-tolerated in children due to brain plasticity and the presence of already impaired function in the affected hemisphere.
- Seizure freedom in up to 85% of patients
- Improved developmental outcomes, especially in children
- Reduces reliance on anti-seizure medications
- Prevents further cognitive and neurological regression
- Improves overall quality of life, schooling, and social development
Recovery includes close neurological monitoring, followed by intensive rehabilitation for motor function, language, and adaptive skills.Most patients remain hospitalized for 1–2 weeks before transitioning to an inpatient or outpatient neuro-rehab facility.Physical, occupational, and speech therapy are key to maximizing long-term function. Educational support and caregiver training are also essential.
Hemispherectomy offers seizure freedom in 70–85% of patients and significant seizure reduction in over 90%.Younger patients often achieve better outcomes due to neuroplasticity, allowing the remaining hemisphere to adapt.Cognitive and developmental improvements are often seen within months to years post-surgery when combined with consistent rehabilitation.
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neuraxis Care and Research Center, India
Delhi, India
Neuraxis Care and Research Center are well-versed and established in Delhi, India (Kaushambi & South Delhi). It is known to be the leading center for Neuromodulation therapies. The main objective behind this specialized center is to capture all those minds who are thinking of neuromodulation therapies. It may come as a surprise, though, that 98% of Neuraxis patients improve with neuromodulation therapy and surgeries that are completely painless. The center has a team of experts that are well-known both nationally and globally in their fields of medicine and have treated thousands of patients all over the world. They've been dubbed "leaders" in the field of neurological conditions all across the world. The Neuraxis' objective is to provide superior clinical outcomes, compassionate patient care, education and research, and innovation to patients who require neurosurgical treatment.
The center primarily provides treatment for the following conditions- Movement disorders, Memory disorders, Epilepsy disorders, and OCD. The major service provided at the center is Deep Brain Stimulation and performed in more than 1000 cases, to to-date. Other Neuromodulation therapies conducted at the hospital are Spinal Cord Stimulation, Vagus Nerve Stimulation, Peripheral Nerve Stimulation, Intrathecal Baclofen Pump, and Sacral Nerve Stimulation.
Teamwork, mentoring, cooperation, sharing of expertise, and empowerment is embraced at the center.
Tel Aviv Sourasky Medical Center -Ichilov Hospital
Tel Aviv, Israel
Tel Aviv Sourasky Medical Center -Ichilov Hospital located in Tel-Aviv, Israel is accredited by JCI. Also listed below are some of the most prominent infrastructural details:
- The center possesses high end infratsructure with latest technologies which are upbgraded on a regular basis.
- There are 60 departments in Tel Aviv Sourasky Medical Center
- The center has as many as 6 institutions:
- Ichilov General Hospital
- Ted Arison Medical Tower
- Dana-Dwek Children's Hospital
- Sammy Ofer Heart & Brain Building
- Adams Health Science & Rehabilitation Building (in the planning stage)
- Lis Maternity and Women's Hospital
- Patient Care Numbers (annual) are as follows:
- 400,000 patients
- 36,000 surgeries
- 220,000 ER visits
- 12,000 births
- The bed capacity of the center is 1300.
- Good success rates during treatment for the majority of conditions.
Saudi German Hospital
Cairo, Egypt
- Saudi German Hospital, Cairo, is a leading tertiary care hospital in Egypt, delivering comprehensive, patient-centric healthcare across a wide spectrum of medical and surgical specialities.
- As part of the Saudi German Hospitals Group, the hospital combines international clinical standards with advanced medical technology to provide high-quality diagnosis, treatment, and long-term care.
- The hospital is internationally accredited and recognised for excellence in patient safety, clinical outcomes, and service quality. With access to global expertise through the Mayo Clinic Care Network, Saudi German Hospital Cairo offers multidisciplinary care supported by evidence-based practices and collaborative medical decision-making.
- Backed by highly skilled medical professionals, modern infrastructure, and a strong commitment to innovation, SGH Cairo serves both local and international patients seeking advanced medical treatments, complex procedures, and personalised care in a trusted tertiary healthcare setting.
Saudi German Hospital
Alexandria, Egypt
- Saudi German Hospital Alexandria is a modern tertiary care hospital delivering comprehensive, patient-centric healthcare across multiple medical specialities.
- Backed by the Saudi German Hospitals Group’s regional expertise and international accreditations, the hospital offers advanced diagnostics, evidence-based treatments, and high clinical safety standards.
- With state-of-the-art technology, experienced multidisciplinary teams, and strong global partnerships, it provides reliable, high-quality care to both local and international patients.
Jaslok Hospital & Research Center
Mumbai, India
- Jaslok Hospital & Research Centre, Mumbai, is a 350-bed super-speciality tertiary care hospital, established in 1973 and among India’s most respected private trust hospitals.
- Located on Peddar Road in South Mumbai, overlooking the Arabian Sea, it serves as a major referral centre for Mumbai, Maharashtra, and patients from across India and abroad.
- The hospital offers comprehensive care across 50+ specialities and nearly 20 multidisciplinary speciality clinics, addressing complex and advanced medical conditions.
- Supported by 300+ senior consultants and 200 resident doctors, ensuring high standards of expertise and round-the-clock patient care.
- Equipped with 75 ICU beds, advanced critical care units, modular operation theatres, and state-of-the-art diagnostic and imaging facilities.
- Recognised as a leading centre of excellence in Critical Care, Cardiac Sciences, Neurosciences, Oncosciences, Renal Sciences, Gastroenterology, and Assisted Reproduction.
- A prominent research and academic institution, conducting clinical trials and recognised by the National Board of Examinations (NBE) in 22 specialities.
- Strong emphasis on quality, patient safety, and evidence-based care, with continuous monitoring of clinical and operational outcomes to meet international healthcare standards.
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+99Process Involved for Hemispherectomy
- Preoperative: Evaluation using EEG, MRI, neuropsychological, and sometimes Wada tests; medication adjustments; education for family preparation.
- Intraoperative: Performed under general anaesthesia with either anatomical removal or functional disconnection techniques, guided by intraoperative monitoring (e.g., electrocorticography).
- Postoperative: ICU monitoring (2–3 days), wound and drain management, continuation of antiepileptic medications, and imaging to detect complications like bleeding or hydrocephalus.
- Rehabilitation: Early initiation of physical, occupational, and speech therapy, often starting within days with ongoing follow-up to regain motor skills, speech, and functional independence.
- Hemimegalencephaly: one side of the brain becomes abnormally large and causes frequent, hard-to-control seizures. Surgery disconnects or removes the affected half and usually stops the seizures.
- Extensive cortical dysplasia: developmental abnormalities in the brain’s cortex (like polymicrogyria) that cause severe, resistant epilepsy. Hemispherectomy disconnects the malfunctioning region.
- Perinatal stroke or encephalomalacia: damage from early-life stroke or brain injury often leads to persistent, localised seizures. Removing or isolating the damaged hemisphere effectively controls them.
- Rasmussen’s encephalitis is a rare, progressive condition characterised by a slow-growing inflammation that affects one side of the brain, resulting in seizures, weakness, and loss of function. Surgery halts the disease’s effects.
- Sturge–Weber syndrome: a congenital vascular brain disorder that causes drug-resistant seizures on one side; hemispherectomy can eliminate the seizure focus and preserve development.
- Hemiconvulsion–hemiplegia–epilepsy syndrome starts with prolonged convulsions on one side, leading to paralysis and ongoing seizures. Surgery is a key option when medications fail.
- Traumatic brain injury or porencephalic cyst: severe injury or resulting cysts in one hemisphere may lead to uncontrollable epilepsy; surgery disconnects the faulty tissue
- Preoperative assessment: Comprehensive evaluations (EEG, MRI, neuropsychological testing, sometimes Wada/MEG) determine seizure origins and assess whether the healthy hemisphere can support vital functions. Patients and families receive education about procedure expectations and medication adjustments.
- Craniotomy and exposure: Under general anaesthesia, a neurosurgeon makes a scalp incision and removes a portion of the skull to expose the diseased hemisphere.
- Hemisection or hemisphere removal
Based on specific needs, the surgeon either disconnects brain connections (functional hemispherectomy or hemispherotomy), including the corpus callosum and key white matter tracts, or removes large parts of the diseased hemisphere (anatomical hemispherectomy). - Hemostasis and cleaning: After disconnection or resection, the surgeon controls bleeding, irrigates the cavity with saline, and ensures any exposed brain tissue is cleaned and secured.
- Watertight dural repair, bone flap replacement, and layered scalp closure—all in one step: a finely sutured dura (often reinforced with graft), precise reattachment of the skull flap using screws or plates, and sequential closure of scalp layers (muscle, fascia, galea, skin) with a drain or dressing to reduce bleeding and swellin
- Immediate postoperative care: Patients usually spend 1–3 days in the ICU with close monitoring, followed by a hospital stay of around 5–7 days with neurological checks and early imaging to detect complications.
- Rehabilitation and recovery: Rehabilitation begins within days, with physical, occupational, and speech therapy to promote motor and cognitive recovery. Antiepileptic drugs are continued and tapered gradually. Long-term follow-up supports developmental progress and seizure monitoring.
- Hemispherotomy
- Callosotomy
- Hemidecortication
- Lesionectomy
- Lobectomy
- Resection
- High likelihood of stopping or significantly reducing seizures, with about 66–83 per cent of patients becoming seizure‑free.
- Prevents further brain damage by halting ongoing seizure activity.
- Enables the remaining hemisphere to reorganise functions like speech and movement, especially in young patients.
- Improves independence, mobility, daily function, and quality of life in most children.
- Stabilises or even enhances cognitive development, including language and memory, with many showing no decline over long-term follow-up.
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