Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-02T21:49:48.716Z Has data issue: false hasContentIssue false
  • English
  • Français

Hemispherectomy for Seizures Revisited

Published online by Cambridge University Press:  18 September 2015

Theodore Rasmussen
Theodore Rasmussen*
Affiliation:
Montreal Neurological Institute and Hospital
*
Montreal Neurological Institute and Hospital, 3801 University St., Montreal, Quebec H3A 2B4.
Rights & Permissions [Opens in a new window]

Summary:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The serious, late complication of superficial cerebral hemosiderosis, which appears after several years in 1/4–1/3 of patients who have undergone hemispherectomy, has resulted in recent years in a considerable reluctance to carry out this operation despite the fact it has proved to be highly effective in patients with medically refractory seizures associated with hemiplegia. Preservation of a small portion of the hemisphere, usually the frontal or occipital pole, has proved to be effective in preventing this late complication, but at the cost of a significant reduction in the effectiveness of the operation in reducing the patients’ seizure tendency. Preserving the frontal and occipital poles but disconnecting them from the rest of the brain, resulting in a functional complete but anatomical subtotal hemispherectomy, retains the therapeutic effectiveness of a complete hemispherectomy while still protecting adequately against the serious late postoperative complication of superficial cerebral hemosiderosis and its associated neurologic deterioration, hydrocephalus and sometimes death.

Type
The 1982 Penfield Lecture
Information
Canadian Journal of Neurological Sciences , Volume 10 , Issue 2 , May 1983 , pp. 71 - 78
Copyright
Copyright © Canadian Neurological Sciences Federation 1983

References

Brett, E. (1969). Second thoughts on hemispherectomy in infantile hemiplegia. Develop. Med. Child Neurol. 11:374–376.Google ScholarPubMed
Carlson, J., Netley, C., Hendrick, E.B. and Pritchard, J.S. (1968). A reexamination of intellectual disabilities in hemispherectomized patients. Tr. Amer. Neurol. Assn. 93:198–201.Google Scholar
Dandy, W. (1928). Removal of right cerebral hemisphere for certain tumors with hemiplegia: preliminary report. J.A.M.A., 90:823–825.CrossRefGoogle Scholar
Falconer, M.A. and Wilson, P.J.E. (1969). Complications related to delayed hemorrhage after hemispherectomy. J. Neurosurg. 30:413–426.CrossRefGoogle ScholarPubMed
Gros, C. and Vlahovitch, B. (1955). L’hèmisphérectomie cérébrale. Imprimerie Causse, Graille et Castelnau. Montpellier, 113 pp.Google Scholar
Iwanowski, I. and Olszewski, J. (1960). The effects of subarachnoid injections of iron containing substances on the central nervous system. J. Neuropath, and Exper. Neurol. 19:433–448.CrossRefGoogle ScholarPubMed
Krynauw, R.A. (1950). Infantile hemiplegia treated by removing one cerebral hemisphere. J. Neurol. Neurosurg. Psychiat. 13:243–267.CrossRefGoogle ScholarPubMed
Laine, E. and Gros, C. (1956). L’hèmisphérectomie. Masson et Cie, Editeurs, Paris. 134 p.Google Scholar
Laine, E., Pruvet, P. et Osson, D. (1964). Résultats éloignés de l’hèmisphérectomie dans les cas d’hémiatrophie cérébrale infantile génératrice d’épilepsie. Neuro-Chirug. 10:507–522.Google Scholar
Lhermitte, J. (1928). L’ablation complète de l’hémisphère droit dans les cas de tumeur cérébrale localisée compliquée d’hémiplégie: la décérébration suprathalamique unilatérale chez l’homme. Encéphal. 23:314–323.Google Scholar
McKenzie, K.G. (1938). The present status of a patient who had the right cerebral hemisphere removed. Proc. Amer. Med. Assn, Chicago 111:168.Google Scholar
McKissock, W. (1953). Infantile hemiplegia. Proc. Royal Soc. Med. 46:431–434.CrossRefGoogle ScholarPubMed
Noetzel, H. (1940). Diffusion von Blutfarbstoff in der innerne Randzone und äusseren Oberfläche des Zentralnervensystems bei subarachnoidal Bluting. Arch. f. Psychiat. 111:129–138.CrossRefGoogle Scholar
Oppenheimer, D.R. and Griffith, H.B. (1966). Persistant intracranial bleeding as a complication of hemispherectomy. J. Neurol. Neurosurg. Psychiat. 29:229–240.CrossRefGoogle ScholarPubMed
Ransohoff, J.C. (1954). Hemispherectomy in the treatment of convulsive seizures associated with infantile hemiplegia. Res. Publ. Ass. Nerv. Ment. Dis. 34:176–195.Google Scholar
Rasmussen, T. (1973). Postoperative superficial hemosiderosis of the brain, its diagnosis, treatment and prevention. Trans. Am. Neur. Assn. 98:133–137.Google ScholarPubMed
Till, K. (1967). Hemispherectomy for infantile hemiplegia. Dev. Med. Child. Neurol. 9:773–774.CrossRefGoogle Scholar
Verity, C.M., Strauss, E.H., Moyes, P.O., Wada, J.A., Dunn, H.G., and Lapointe, J.S. (1982). Long term follow-up after cerebral hemispherectomy: neurophysiologic, radiologic and psychological findings. Neurology 32:629–639.CrossRefGoogle ScholarPubMed
White, H.H. (1961). Cerebral hemispherectomy in the treatment of infantile hemiplegia: review of the literature and report of 2 cases. Confinia neurol. 21:1–50.CrossRefGoogle Scholar
Wilson, P.J.E. (1970). Cerebral hemispherectomy for infantile hemiplegia. A report of 50 cases. Brain 147–180.CrossRefGoogle ScholarPubMed