De Almeida Antonio Nogueira, Marino Raul, Aguiar Paulo Henrique, Jacobsen Teixeira Manoel
Departamento de Neurologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
Neurosurg Rev. 2006 Apr;29(2):97-102; discussion 102. doi: 10.1007/s10143-005-0011-7. Epub 2006 Feb 7.
Anatomical hemispherectomy has been used for the treatment of seizures since 1938. However, it was almost abandoned in the 1960s after reports of postoperative fatalities caused by hydrocephalus, hemosiderosis, and trivial head traumas. Despite serious complications, the remarkable improvement of patients encouraged authors to carry out modifications on anatomical hemispherectomy in order to lessen its morbidity while preserving its efficacy. The effort to improve the technique generated several original procedures. This paper reviews current techniques of hemispherectomy and proposes a classification scheme based on their surgical characteristics. Techniques of hemispherectomy were sorted into two major groups: (1) those that remove completely the cortex from the hemisphere and (2) those that associate partial cortical removal and disconnection. Group 1 was subdivided into two subgroups based on the integrity of the ventricular cavity and group 2 was subdivided into three subgroups depending on the amount and location of the corticectomy. Grouping similar techniques may allow a better understanding of the distinctive features of each one and creates the possibility of comparing data from different authors.
自1938年以来，解剖性大脑半球切除术一直用于治疗癫痫。然而，在20世纪60年代，有报告称该手术会导致脑积水、含铁血黄素沉积症和轻微头部创伤引起的术后死亡，因此该手术几乎被弃用。尽管存在严重并发症，但患者的显著改善促使作者对解剖性大脑半球切除术进行改良，以降低其发病率，同时保留其疗效。为改进该技术所做的努力产生了几种原创手术方法。本文回顾了当前大脑半球切除术的技术，并根据其手术特点提出了一种分类方案。大脑半球切除术技术分为两大类：（1）完全切除半球皮质的技术；（2）部分皮质切除与离断相结合的技术。第一组根据脑室腔的完整性分为两个亚组，第二组根据皮质切除术的范围和位置分为三个亚组。对相似技术进行分组可能有助于更好地理解每种技术的独特特征，并为比较不同作者的数据创造可能性。
