Hemispherectomy

As Hemispherectomy the neurosurgical removal of a brain is called in medicine. This is a rarely performed procedure for the treatment of severe cases of epilepsy.

Conditions for the implementation are that the disease is caused by large areas of a single brain that epileptic seizures are not treatable by medication and other measures, and that there is already a serious damage to the affected hemisphere or is anticipated in the course of the disease. The adverse consequences of such surgery include paralysis in all patients and in most cases, vision problems on the side of the body, which is the far side of the brain opposite ( contralateral).

An experimental hemispherectomy in a cat was first performed in 1888 by Friedrich Goltz. The first human application was made in 1928 by Walter Edward Dandy for treating located in the non - dominant hemisphere gliomas with diffuse Hirngewebsinfiltration. Ten years later, the procedure was used for the first time and after the end of World War II to a greater extent for the treatment of epilepsy or other disorders with epileptic symptoms. In the following years showed that the benefit in the treatment of brain tumors in relation to risks and long-term consequences was too low and thus not justified. For this reason, the hemispherectomy for this area of ​​neurosurgery plays no essential role more since the 1960s.

This method is used for treating severe treatment-resistant epilepsy, however, up to the present in epilepsy surgery is important. Since associated with severe attacks rare Rasmussen encephalitis remains strictly limited to one hemisphere of the brain, is often considered a hemispherectomy in this disease, with the possibility of severe permanent loss of function must be weighed against a seizure freedom in individual cases. Instead of an actual complete removal of the hemisphere ( anatomical hemispherectomy ) are performed increasingly less invasive procedures such as the removal of individual lobes of the cerebrum and the designated as callosotomy transection of the corpus callosum. Modern surgical procedures in which the left hemisphere, and is only functionally uncoupled from the rest of the brain are referred to as functional Hemispherectomy.

Also, patients with the Sturge -Weber syndrome suffer from epilepsy, which can not be treated causally. Treatment of the symptoms is also conceivable here by hemispherectomy.