Hemispherectomy

December 6, 2006 12:21 AM

Video of a hemispherectomy, a neurosurgical procedure to remove a hemisphere of the brain, on a 6-year-old girl with epilepsy. Previous post about the procedure. [Via Mind Hacks.]
posted by homunculus (31 comments total)

One video I'm sure I'm not going to watch... (off to CuteOverload!)
posted by Harald74 at 1:00 AM on December 6, 2006

The curious side of me wants to watch... but it's just not going to happen.
posted by a. at 1:16 AM on December 6, 2006

Whoa, lot's of squishy red stuff. Back button.
posted by chillmost at 1:25 AM on December 6, 2006

I guess this is effectively killing one half of her. Although from the look of the brain scan, it wasn't much of a half.
posted by A Thousand Baited Hooks at 1:36 AM on December 6, 2006

Huh. I thought severing the corpus callosum was sufficient in reducing epileptic seizures. I didn't know about hemispherectomy as a procedure. I'm guessing the latter is a more extreme way of trying to control seizures.

This is one of the things I found most interesting about neuroscience. That one can lead a normal life after the tissue connecting the two brain hemispheres has been severed is simply remarkable.
posted by slimepuppy at 1:41 AM on December 6, 2006

Best of the web! The blog is a great find as well.
posted by phrontist at 1:49 AM on December 6, 2006

Fascinatin'. Yeah, yeah, yeah, not for squeamish sissies but you can handle it.

Got through a full hour. All I can say is a mind is a terrible thing to baste.
posted by hal9k at 2:40 AM on December 6, 2006

Wonder if she'll ever use the expression "I've got half a mind to..."
posted by StickyCarpet at 2:54 AM on December 6, 2006

This is a shocker to me. Hemispherectomies were reserved for lethal epilepsy cases in the first (and second, occasionally) year of life--it allowed the brain to re-wire and re-map functions into undetermined areas. A six y.o. will lose a great deal of function, permanently.

Then again, if they're doing it, there must be good reasons. The survivors must have shown some faculty for adaptation and recapitulated development. I never thought such a radical procedure would be extended this way.
posted by toma at 3:18 AM on December 6, 2006

I've now watched half of the film. Thoroughly engaging and equally fascinating. This is great stuff.

<personal agenda> And if some people got their way, this kind of 'single link google video' post would not be allowed on MeFi. Ridiculous. </personal agenda>
posted by slimepuppy at 3:22 AM on December 6, 2006

toma: if you want an explanation to what happened with a previous patient after the operation, jump to 18:30 on the video and listen.

Some bulletpoints:

• Down to 1 medication with moderate dosage instead of the 10 she was on before.
• No further seizures.
• 'cognitively [she] is doing better in school than she had before [the operation].'
• 'Still has the motor weakness on one side. That's not changed. It's not any worse, but it's present as it was before.'

Quite incredible really that there (in that specific example) are no negative side effects. Or maybe they just don't want to worry their audience...
posted by slimepuppy at 3:46 AM on December 6, 2006

Brain plasticity is very strong in someone that young. If you did the same procedure on a 40-year-old, they would be severely affected. But it's possible for a six-year-old to remap everything onto the other side of her brain.
posted by jennyjenny at 3:51 AM on December 6, 2006

What I recall, jj, is neuroscientists (back when) saying that even three years old was far too late for the procedure. There was no hope for complete re-mapping. The reason (then): Brain plasticity marginalizes as pre-determined brain 'skill-maps' fill with experience. And if the intelligence is discarded, it's difficult to regenerate it in a pioneering, gerry-mandered fashion.

Thanks, sp--didn't get that far, will check it out.
posted by toma at 4:46 AM on December 6, 2006

ISTR reading about some little kid who'd had a hemispherectomy as a toddler -- this would've been late '60s to early '70s -- and was growing up normally, playing ball, riding a bike, swimming, getting OK grades in school etc. I vaguely remember that intractable epilepsy was dx'd there too. And wasn't there some really little kid that had hemispheric brain trauma and wound up developing normally?

Wish I had time to dig up more on this.
posted by pax digita at 4:58 AM on December 6, 2006

I think in cases like this they proceed because they've determined that the hemisphere they're removing isn't doing anything useful anyway; it's just sitting there causing seizures, and meanwhile the child has already wired around it as much as possible at a younger age.

At work, so can't watch the video. Maybe later...
posted by localroger at 5:24 AM on December 6, 2006

I'll be watching this later, I'm a sucker for surgery shows. I had a bit of personal experience, last year my 5 year old son had to undergo two rounds of brain surgery (thankfully he's doing great now).

After a bit of a hassle, we were able to get a DVD of the surgery from the doctors, and it was amazing to watch. Fortunately, it was just a close up of the area being worked on; I could not have handled seeing any recognizable part of my son. We let him watch it, and he thought it was pretty cool being able to see his own brain.
posted by shinynewnick at 7:37 AM on December 6, 2006

I can imagine a conversation in a coffee shop in 2089:

"After they put in the chip my seizures went away completely. I'm so glad I didn't go with the nanobots, that's so much more invasive. It gives me the willies."

"Heh, you know, 80 years ago they didn't know where it was coming from so they would actually open up your skull like a ripe coconut and scoop out an entire half of your brain just to fix it."

"Ewww, oh gawd."

"Now THAT's invasive!"
posted by CynicalKnight at 7:57 AM on December 6, 2006

I've always wondered how they managed to keep things from rattling around in the skull after they removed half the brain.
posted by the jam at 8:12 AM on December 6, 2006

"via Mind Hacks" indeed.
posted by aliasless at 8:15 AM on December 6, 2006

I saw a 8-yr-old kid in a Neuroscience class who'd had an operation like this. He'd actually had a Hemispherotomy, in which they leave the brain to its devices via blood vessels but sever any other connections it has with the body or nervous system. He was fully mobile and speaking, with a little motor deficiency (a limp and some sagging) but fine motor was good (he was playing a game boy). This is a very useful, if extreme, kind of surgery, and these people will grow up to have quite normal lives, albeit with half a brain.
posted by BlackLeotardFront at 8:24 AM on December 6, 2006

I've always wondered how they managed to keep things from rattling around in the skull after they removed half the brain.

I'm too lazy to dig up a reference, but I remember seeing that they throw in a big ol' bag of saline to fill the gap.
posted by Popular Ethics at 8:41 AM on December 6, 2006

I remember seeing that they throw in a big ol' bag of saline to fill the gap.

The only thing that could top having part of your brain removed would be having a breast implant put in the fill up the empty space. Yowza.
posted by GuyZero at 8:57 AM on December 6, 2006

4:51
53:07
posted by airguitar at 9:19 AM on December 6, 2006

I bet Sylar has this video on a continuous loop.
posted by rosemere at 9:51 AM on December 6, 2006

The expression on the girl's face right as the video is loading was too amusing for me to continue.
posted by tehloki at 10:24 AM on December 6, 2006

CynicalKnight: Gotta say, I've been monocular all my life due to a congenital cataract that wasn't understood until I was old enough to explain that I couldn't see out of the bad eye. An ophthalmic surgeon told me once that they'd've had to catch that in the first six weeks or so have had a shot at fixing it well enough for my brain to have learned how to use the eye properly. Six friggin' weeks!

I wish there were nanobot brain surgery that could (re)wire the synapses for the visual field on that side so that I could get the bad eye fixed and then, in concert with some physical therapy, learn how to do stereo vision -- which sounds like a neat concept. I bet even when nanobots can do microneurosurgery, it'll be a lot longer yet before we understand how to map synapses thoroughly enough to know what to fix.
posted by pax digita at 12:28 PM on December 6, 2006

Pax, there was a New Yorker article a few months ago by Oliver Sacks about a woman learning stereo vision in middle age and how doctors were trying to understand how she'd done what they thought was impossible.
posted by rikschell at 12:43 PM on December 6, 2006

Reminds me of Scott Adams regaining his voice. All it took was the right trigger to remap the connections.
posted by jwells at 1:07 PM on December 6, 2006

jennyjenny: In the video, they say the procedure was performed on a man in his twenties with apparently good results. Perhaps if your brain is like this the damaged section has already been routed around by necessity, and removing does not do much further damage.
posted by alexei at 5:31 PM on December 6, 2006

pax, I've seen estimates (alas no cites) that as many as 10% of modern people don't have stereo vision, not because of a "hardware" defect but because they never learn it. I wish I could remember where I read that but it has always rung true to me.
posted by localroger at 7:37 PM on December 6, 2006

I think localroger and alexei are right about the damaged hemisphere already not doing much. It doesn't seem like she'll be losing any functions from such a drastic procedure. Plus, she's still fairly young, and the damage happened prenatally anyway, so it seems like there was a lot of rewiring already.

Amazing video, thanks!
posted by tickingclock at 8:28 PM on December 6, 2006