Complex Neurosurgery

Introduction

 Two-thirds of children who undergo a hemispherectomy become seizure-free post surgery and 15-20% have a considerable reduction of seizures. This statistic seems hard to believe for a procedure that removes half of your brain, but it is completely true! Eric Kossoff, M.D,  A pediatric epileptologist at Johns Hopkins Children's Center who was the leader of the hemispherectomy study stated, "It's clear now that the quality of life of children with chronic, severe seizures greatly improves following hemispherectomy," he said. "In almost all cases, the children no longer depend on multiple medications, and post-operatively, most of the children are walking and running and living normal lives.” 

A hemispherectomy is a surgical procedure that removes or disconnects one of the two hemispheres of the brain and is usually performed on individuals who have neurological disorders that cause seizures on one side of the brain. The Hemispherectomy is considered a radical procedure, or a procedure that removes the entirety of affected cells, as well as some healthy tissue around it called the margin. Radical procedures may be the only treatment necessary, depending on the specific condition of the patient.

Intro to the Brain

The brain is the most complex organ in the human body. It allows us to create every thought, action, and memory in our lifetime. This mass of tissue weighs in at around 3 pounds, and contains around one hundred billion nerve cells, or neurons. The cerebral cortex is the outer layer of our brain that has a wrinkled appearance. It is critical to your ability to move, to understand what you see and hear, and to think. The cerebrum is divided into two halves called hemispheres. The two halves join at a large, deep sulcus (fold) that runs from the front to the back of the head. The right hemisphere controls the left side of the body, and the left half controls the right side of the body. The hemispherectomy removes one of the two hemispheres of the cerebrum in order to eliminate seizing and epileptic activities.

How patients are chosen for the procedure

Typically, young patients with harmful or deadly neurological disorders like epilepsy or spasms who have failed to see a change after medication or other treatments undergo this procedure. Chosen patients usually already have loss of function, including loss of dexterity or eyesight on one side of the body so that any additional loss of function due to the procedure will be minimal. Patients can only be chosen for a hemispherectomy as long as only one hemisphere of the cerebral cortex is affected. Diagnosis that can lead to hemispherectomies include (but are not limited to) hemispheric malformations, hemimegalencephaly (a rare genetic condition that causes part of the brain to be larger than the rest. It is associated with seizures and sometimes developmental delay), peri-natal strokes, Sturge-Weber Syndrome (a condition that affects the development of certain blood vessels, causing abnormalities in the brain, skin, and eyes from birth) and Rasmussen’s Encephalitis (a very rare, chronic inflammatory neurological disease that causes inflammation and seizures that result with permanent brain damage)

Into the Operating Room

There are two types of hemispherectomies: anatomic and functional. Doctors will have to decide which procedure to conduct in the operating room. 

An anatomic hemispherectomy removes the hemisphere of the brain that is affected. The deeper structures in the brain are left alone because they don't usually initiate seizures. This operation generally results in more blood loss, a longer operation, and an increased probability of developing postoperative hydrocephalus (buildup of excess fluid in the brain). This procedure is usually done in situations where there are seizures despite a previous attempt at a functional hemispherectomy.

A functional hemispherectomy is essentially an anatomic hemispherectomy where less of the brain is removed, but also, the diseased hemisphere of the brain is completely disconnected from the normal hemisphere of the brain. This procedure is just as successful at curing seizures and has benefits including a shorter operation, less blood loss, and less probability of developing hydrocephalus (excess brain or spinal fluid in the brain). This is why the functional hemispherectomy is the preferred operation for most surgeons.

Post-surgery recovery

Typical hospital stays after a hemispherectomy varies from patient to patient but after the procedure, the patient will most likely spend the first 3 or 4 days in the ICU (intensive care unit) before being moved to a regular room for a total of about a week. The patient will undergo physical therapy, speech therapy, and occupational therapy to help them perform daily functions. Inpatient rehabilitation facilities are common for patients to regain strength and function before returning home. Although the hemispherectomy is a complex procedure it is unlikely that any complications will occur after surgery. In fact, the hemispherectomy is one of the most successful procedures known to cure epilepsy. But yes, occasionally there are complications that may occur post operation including the need for a blood transfusion, aseptic meningitis (inflammation of the linings of the brain), fevers or infection, and hydrocephalus (excess brain and spinal fluid in the brain). 

Conclusion

If epilepsy is not treated, seizures may occur throughout a person's life. Seizures left unchecked and untreated properly can become more severe and occur more often. Fatal seizures may be caused by pauses in breathing (apnea). If pauses in breathing last too long, they can cut off the amount of oxygen in the blood to a life-threatening level. To prevent this from happening, someone who experiences a seizure should be examined by a medical professional who can test and possibly diagnose epilepsy. Never try to self-diagnose. The hemispherectomy procedure has changed many people's lives and will continue to make an impact on those who suffer from neurological disorders and allow them to live a normal and healthy life.

Works Cited

Brain Anatomy and How the Brain Works. (n.d.). Www.hopkinsmedicine.org. Retrieved February 28, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-of-the-brain#:~:text=The%20right%20hemisphere%20controls%20the

Hemispherectomy - Epilepsy Treatment - UCLA Health Pediatric Neurosurgery, Los Angeles, CA. (n.d.). Www.uclahealth.org. https://www.uclahealth.org/mattel/pediatric-neurosurgery/hemispherectomy#:~:text=A%20hemispherectomy%20is%20a%20radical

Whiteman, H. (2016, November 9). Five weird and wonderful surgical procedures. Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/314009#3