Does your little one have frequent seizures? You must be very worried because you can't control them despite all the medication they give you. Sometimes, doctors talk about a major surgery called 'Hemispherectomy' in such a situation. It's normal to feel very scared when you hear this name. Because this means removing half of the brain. But don't worry, today we will talk about this very simply, in a way that you can understand.
Simply put, what is Hemispherectomy?
Hemispherectomy is the surgical removal of all or part of a child's brain (one side) or severing its connection to the rest of the brain. "Hemi" means "half." This is a very rare, very specialized surgery.
This is mainly done for children with epilepsy that cannot be controlled by medication. In such children, one side of the brain is completely abnormal, and that side is the one that causes the seizures. So the goal of this surgery is to stop the seizures by removing or disconnecting that diseased part.
There are two main types of this surgery.
There are two main methods for performing this surgery. Doctors will choose the most appropriate method based on your child's condition.
| Type of surgery | Simply put... |
|---|---|
| Functional (Disconnective) Hemispherectomy | This method involves removing a small part of the diseased side of the brain, completely severing the connection between that side and the healthy side. This does not remove a large part of the brain. Therefore, the risk of complications is low. This method is usually tried first. |
| Anatomic Hemispherectomy | In this procedure, the surgeon removes all four major lobes of the brain (frontal, parietal, temporal, and occipital lobes) on the affected side. This procedure is only used if the seizure is not controlled after functional surgery. There is a slightly higher risk of complications, such as excessive bleeding. |
The important thing is that the success of both methods is the same. Both methods have a good ability to stop the fit.
What kind of children need this surgery?
This surgery is not done for every child who has a fit. It is done in very special cases. If your child has the following symptoms or conditions, your doctor may consider this surgery:
- Having fits (epilepsy) that cannot be controlled with medication .
- Weakness on one side of the body. For example, not being able to use one arm as well as the other.
- Loss of peripheral vision.
- An MRI scan of the brain shows an abnormality on only one side of the brain.
- The frequent fits can cause developmental delay in the child's growth and development .
Conditions that can cause these symptoms:
- Malformations of Cortical Development: Certain defects that occur during the development of the brain's cortex.
- Perinatal Infarction (Stroke): A stroke that occurs in the womb or after birth.
- Hemimegalencephaly: One side of the brain is abnormally larger than the other.
- Sturge-Weber Syndrome: A condition in which blood vessels grow abnormally. These can also occur in the brain.
- Rasmussen's Encephalitis: A condition that affects only one side of the brain and causes fits due to inflammation.
What happens before and during the surgery?
Preparing your child for such a major surgery can be a big challenge for you, but the doctors and nurses at the hospital will help you by explaining everything.
Before surgery
The day before the surgery, you will be asked to stop eating and drinking after a certain time. You will be given clear instructions on what medications your child is taking, which ones should be stopped, and which ones should be continued. You may have some hair cut or removed completely on the side of your child's head where the surgery will be performed.
During surgery
The child is given general anesthesia , which makes them completely asleep and pain-free. The surgery takes about 5 hours, sometimes longer. The surgeon will mainly follow these steps:
1. Removing a small part of the skull (this is called a `Craniotomy`).
2. Removing or completely removing part of the tissue on the diseased side of the brain.
3. Cutting the fibers that connect the two sides of the brain (corpus callosum). (This is called `Corpus Callosotomy`).
4. The removed part of the skull is replaced and the skin is sewn shut.
What happens after the surgery? And what are the results?
After the surgery, the child is admitted to the Intensive Care Unit (ICU) and monitored very closely. After two to three days, they are transferred to a regular ward.
The good news is that the results of this surgery are very good. Studies have shown that between 66% and 80% of children who undergo the surgery become completely free of fits. Many other children also experience a significant reduction in the frequency of fits.
A team of specialists is working to help the child recover.
- Physical Therapy: Helps you walk, run, and maintain balance.
- Occupational Therapy: Teaches you how to do daily tasks like eating and dressing yourself.
- Speech Therapy: Helps overcome difficulties in speaking and expressing ideas.
Aren't there risks and complications?
As with any major surgery, there are risks and complications that can occur, but these are very rare.
| Type of complication | Description |
|---|---|
| Possible complications before | It can occur during or shortly after surgery. For example, excessive blood loss, infections, and hypothermia. |
| Possible complications later | The main one is a condition called Hydrocephalus . This is the accumulation of water inside the brain. The chance of this occurring during functional surgery is less than 5%. If this happens, a small tube called a 'shunt' has to be inserted to remove the water. |
When you need to talk to the doctor urgently
After you go home from the hospital, you should pay close attention to your child. If you notice any of the following symptoms, call your doctor immediately or take your child to the Emergency Department (ETU) of the nearest hospital.
- Showing signs of infection, such as fever , swelling, redness, or pus from the surgical wound.
- Frequent vomiting , severe headaches , and behavioral changes (these may be signs of a condition called Hydrocephalus).
- Recurrence of a seizure.
Making this decision about surgery is not an easy one for parents. It is a big burden. But remember, a doctor will only recommend such a surgery if he is absolutely certain that there are no other options and that it will greatly benefit the child's life.
Take-Home Message
- Hemispherectomy is a highly successful surgical procedure for children with severe epilepsy that cannot be controlled by medication.
- The likelihood that the fit will stop completely or be significantly reduced with this surgery is very high.
- The remaining healthy side of the child's brain begins to take over many of the functions of the removed side over time. This is an amazing thing!
- Physical, occupational, and speech therapy (rehabilitation) after surgery is essential for the child's recovery.
- Feel free to discuss any questions or concerns you have with your doctor. They are always ready to help you.
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