Functional hemispherectomy for the treatment of intractable seizures

Hemispherectomy is the most successful operation for the control of seizures in a very select group of patients with infantile hemiplegia and intractable epilepsy. The efficacy of anatomical hemispherectomy has been offset to some degree by the fact that up to one third of those operated upon will subsequently develop obstructive hydrocephalus, and the so-called superficial subpial cerebral hemosiderosis, with potentially fatal complications. This review article details the operative technique of a modified `functional` hemispherectomy. In essence, the technique consists of removing the central (Rolandic) cortex and the temporal lobe of the affected hemisphere and leaving the remainder of the hemisphere intact, but neurogenically disconnected from the remaining brain.