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Updated: Aug 13, 2025

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Surgical Strategy for Hemispherotomy.

Takeshi Matsuo1, So Fujimoto1

  • 1Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital.

Neurologia Medico-Chirurgica
|January 22, 2023
PubMed
Summary
This summary is machine-generated.

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Hemispherotomy offers a radical solution for severe epilepsy by disconnecting one brain hemisphere. This invasive surgery, with lateral and vertical approaches, aims to control seizures and improve development.

Area of Science:

  • Neurosurgery
  • Epileptology
  • Neurology

Background:

  • Hemispherotomy is a radical epilepsy surgery for widespread unilateral epileptogenic zones.
  • It targets developmental, acquired, and progressive neurological diseases.
  • Two primary surgical approaches exist: lateral and vertical.

Purpose of the Study:

  • To detail the indications and surgical approaches for hemispherotomy.
  • To compare the advantages and disadvantages of lateral versus vertical hemispherotomy.
  • To highlight the potential benefits and risks of this invasive epilepsy surgery.

Main Methods:

  • Review of lateral and vertical hemispherotomy techniques.
  • Discussion of anatomical considerations and lesion types (atrophic vs. hypertrophic).
Keywords:
epilepsy surgeryfunctional hemispherectomyhemispherotomylateral approachvertical approach

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  • Emphasis on understanding neural fiber pathways for surgical planning.

    • Main Results:

    • Lateral approach offers a wide surgical field, easier access to the lateral ventricle, and is suited for atrophic lesions.
    • Vertical approach reduces bleeding and operating time, with easier 3D anatomical understanding, suitable for hypertrophic lesions.
    • Both approaches aim to suppress seizures and potentially improve psychomotor development.

    Conclusions:

    • Hemispherotomy is a highly effective but invasive treatment for drug-resistant epilepsy with unilateral hemispheric involvement.
    • Careful consideration of indications and precise understanding of neuroanatomy are crucial for successful outcomes.
    • The choice between lateral and vertical approaches depends on lesion characteristics and surgical goals.