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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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+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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