Hemispherectomy

In medicine, a hemispherectomy is the neurosurgical removal of one half of the brain . It is a rarely done procedure used to treat the most severe cases of epilepsy , such as: B. in hemimegalencephaly .

execution

The prerequisites for implementation are that the disease is caused by large areas of a single hemisphere of the brain, that the epileptic seizures can not be treated with medication and other measures, and that serious damage to the affected hemisphere is already present or is foreseeable in the further course of the disease. The undesirable consequences of such an operation include paralysis in all patients and, in most cases, visual disturbances on the side of the body opposite the distal hemisphere of the brain ( contralateral : see also contralaterality of the forebrain ).

history

An experimental hemispherectomy in a dog was first performed by Friedrich Goltz in 1888 . It was first used in humans in 1928 by Walter Edward Dandy for the treatment of gliomas in the area of ​​the non-dominant hemisphere with diffuse brain tissue infiltration. Ten years later, the method was used for the first time and after the end of the Second World War to an increasing extent for the treatment of epilepsies and other diseases with epileptic symptoms. In the following years it became apparent that the benefit in the treatment of brain tumors in relation to the risks and long-term consequences was too low and therefore not justified. For this reason, hemispherectomy has not played an essential role in this area of ​​neurosurgery since the 1960s.

present

For the treatment of severe treatment-resistant epilepsies this method is, however, up to the present in the epilepsy surgery is important. Since the rare Rasmussen encephalitis associated with severe seizures is strictly limited to one cerebral hemisphere, a hemispherectomy is not infrequently considered in this disease, whereby the possibility of severe permanent functional failures must be weighed against freedom from seizures in individual cases. Instead of an actual complete removal of the hemisphere (anatomical hemispherectomy), less invasive procedures such as the removal of individual lobes of the cerebrum and the transection of the corpus callosum known as callosotomy are increasingly being performed. Modern surgical procedures in which the hemisphere is left in place and only functionally decoupled from the rest of the brain are called functional hemispherectomy.

Patients with Sturge-Weber syndrome also suffer from epilepsy, the cause of which cannot be treated. Treatment of the symptoms by hemispherectomy is also conceivable here.

Consequences for behavior

In 2019, Kliemann, Adolphs, Tyszka et al. in the journal Cell Reports their study “Intrinsic Functional Connectivity of the Brain in Adults with a Single Cerebral Hemisphere.” In it, the authors present six adults between the ages of 20 and 30 who had a hemispherectomy during their childhood. Compared to the norm (n = 1,482), those affected behaved "completely normally."

literature

• Annika Röcker: When one half of the brain works for two , brain and mind - website, November 19, 2019. Accessed January 25, 2020.
• KN Fountas, JR Smith, JS Robinson, G. Tamburrini, D. Pietrini, C. Di Rocco: Anatomical Hemispherectomy. In: Child's Nervous System. 22 (8) / 2006. Springer, pp. 982-991, ISSN  0256-7040

Individual evidence

1. ^ Dandy WE: Removal of right cerebral hemisphere for certain tumors with hemiplegia. J Am Med Assoc 90: 823-825, 1928
2. ^ McKenzie KG .: The present status of a patient who had the right cerebral hemisphere removed. In: JAMA . tape 111 , 1938, pp. 168-183 .
3. ↑ Krynauw RA .: Infantile hemiplegia Treated by removing one cerebral hemisphere. In: J Neurol Neurosurg Psychiatry . tape 13 , 1950, pp. 243-267 .
4. ↑ Tönnis W .: Unilateral cerebral removal in the treatment of epilepsy. In: Langenb Arch Chir . tape 279 , 1954, pp. 379-411 .
5. ^ De Almeida AN, Marino R Jr .: The early years of hemispherectomy. Pediatric Neurosurg. 2005; 41 (3): 137-40 PMID 15995330
6. ↑ Limbrick et al .: Hemispherotomy: efficacy and analysis of seizure recurrence. J Neurosurg Pediatr. 2009; 4 (4): 323-32. PMID 19795963
7. ^ Bien CG, Schramm J: Treatment of Rasmussen encephalitis half a century after its initial description: Promising prospects and a dilemma. Epilepsy Res. 2009 Jul 15. [Epub ahead of print] PMID 19615863
8. ↑ De Ribaupierre S, Delalande O .: Hemispherotomy and other disconnective techniques. In: Neurosurgical Focus . 2008 Sep; 25 (3): E14. PMID 18759615 (current review article) full text
9. ↑ Entry on hemispherectomy in Flexikon , a Wiki of the DocCheck company , accessed on November 27, 2015.
10. ↑ Kliemann, D., Adolphs, R., Tyszka, JM, Fischl, B., Yeo, B., Nair, R., ... Paul, LK (2019). Intrinsic Functional Connectivity of the Brain in Adults with a Single Cerebral Hemisphere. Cell reports, 29 (8), 2398-2407.e4. doi: 10.1016 / j.celrep.2019.10.067

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