Functional Hemispherotomy and Variants for Treatment of Epilepsy

Epilepsy is a network disease, where afferent and efferent fibers connected with the epileptogenic focus may be responsible for secondary spreading. Disconnective techniques for hemispheric epilepsy were developed to limit the risk of complications associated with the resection of large cerebral areas. Functional hemispherotomy and its variants represent surgical techniques for the treatment of hemispheric epilepsy, which can lead to seizure freedom and improved quality of life. Early surgery is necessary in children to prevent the negative impact on neuroplasticity and neurodevelopmental outcomes. A thorough understanding of the white matter anatomy is fundamental to successfully perform these procedures. The aim of this chapter is to describe the functional neuroanatomical landmarks and to detail the surgical steps to safely perform functional hemispherotomy.