Hemispherectomy is a neurosurgical procedure in which one cerebral hemisphere is functionally or anatomically disconnected from or removed from the rest of the brain. It is one of the most radical epilepsy surgery procedures and is used exclusively for the most severe, medically refractory epilepsies arising from a single, extensively damaged cerebral hemisphere.
Indication
Hemispherectomy is considered primarily for patients with severe focal epilepsy when the epileptogenic zone involves an entire hemisphere and the contralateral side is functionally largely preserved. Typical indications include[^1]:
Hemimegalencephaly
Extensive cortical dysplasias
Sturge-Weber syndrome with hemispheric involvement
Perinatal ischemic strokes
Severe traumatic brain injuries with hemispheric destruction
The operation is performed predominantly in childhood, as the neural plasticity of the immature brain enables better functional compensation for neurological deficits.