Cerebral hemispherectomy for seizures with hemiplegia
Theodore Rasmussen, MD
Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada H3A2B4
Jean-Guy Villemure, MD
CEREBRAL hemispherectomy has an interesting history, starting in 1928 when Dandy at Johns Hopkins1 and L’Hermitte2 in France independently introduced the operation in an effort to cure patients with malignant gliomas of the cerebral hemisphere. Experience soon showed, however, that neither prolongation of life nor palliation was any more effectively achieved than with more conservative surgical and medical tactics. Cerebral hemispherectomy for brain tumors has rarely been performed since the late 1930s and 1940s.
The procedure was revived, however, as a result of the 1950 report by the South African neurosurgeon Krynauw on cerebral hemispherectomy carried out in 12 patients with infantile hemiplegia and severe, medically refractory seizures.3 His impressive results in reducing seizure tendency in this small, highly selected patient population were quickly verified in neurosurgical centers in various parts of the world.4–24 Although the operation was applicable only to a tiny fraction of the overall population of patients with seizure disorders, by 1961 reports on nearly 300 cases had been published,25 and by 1972 the number of cases reported had risen to 400.26 Most centers reported essentially similar results, with a complete or nearly complete reduction of seizure tendency occurring in 80% to 85% of the patients. Severe behavioral disturbances, which often occur in this patient population, were also markedly lessened in nearly as high a proportion of cases.27–31
ANATOMICALLY COMPLETE HEMISPHERECTOMY
The first hemispherectomy at the Montreal Neurological Institute (MNI) was carried out by Penfield in 1952. By 1968 the series consisted of 29 patients.. . .