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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.
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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

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