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Neurology (Expert Forum)
Surgey
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Surgey
by Elisa-Landes, Oct 06, 1997 12:00AM
Re: Surgey
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Posted by CCF NEUROSURGERY MD on October 09, 1997 at 12:10:34:
In Reply to: Surgey posted by Elissa Landes on October 06, 1997 at 19:02:20:
: My name is Elissa Landes and I am a tenth grader at Holton-Arms. For my
term paper I wish to study the new procedure of removing half the brain.
If you know of it, can give me any information concernig reasons for the
surgery, the actual process, effects, anything at all would be an immense
help. Thank You.
_____________________________________
_____________________________________
Dear Elissa,
The procedure you are speaking of is called a hemispherectomy. It is performed
in selected cases of intractable epilepsy, or seizures. There are few
epilepsy centers in the country that do this kind of surgery. Patients are
typically young, less that about 7 years, and have seizures originating in
one side of the brain which is abnormal.
One such condition is hemimegalencephaly, where one side of the brain is
abnormally larger than the other. The abnormal brain tissue generates
seizures and a progressive motor deficit on the opposite side of the body.
The child, without surgery, would lose motor function on the other side of
the body and would suffer from impaired development of mental abilities.
The idea is that with surgery one can eliminate the input of the abnormal
brain and allow the remaining normal brain to assume routine functions.
It is possible in children under about 7 years because they are usually able
to transfer motor and other functions to the other side of the brain.
This is known as 'plasticity' in brain function, and often children with
these disorders will begin to transfer function to the other side before
surgery is done. In adults and children older than about 7 years, a
hemispherectomy would result in a permanent paralysis on the other side of the
body. The amazing plasticity of function in children is a subject of much
research today, though its mechanisms are poorly understood.
The surgery itself isn't quite as dramatic as it may seem. In years past,
neurosurgeons would remove the entire hemisphere of the brain. This, they
found, caused too many problems with bleeding and other postoperative
complications. The problem was that there was this big cavity left in the
head. Today the surgery has been modified in that a 'functional' hemispherectomy
is done. This means that the tracts that connect the abnormal hemisphere to
the normal hemisphere are severed at surgery. The actual brain tissue is
left behind but is functionally isolated from the rest of the brain.
The workup and surgery in such cases is only done at a few centers specializing
in epilepsy and epilepsy surgery. More information on hemispherectomies may
be found in a neurosurgery text at a medical library. A Medline search would
also find recent article regarding the procedure,its indications and recent
issues in research. Ask the librarian at a medical library to give you a hand.
Good luck with your term paper.
