Which procedure is primarily limited to selected catastrophic infant and early childhood epilepsies?

Hemispherectomy is a surgical procedure that involves the removal or disconnection of one cerebral hemisphere of the brain. This procedure is primarily indicated in cases of severe, drug-resistant epilepsy that is localized to one hemisphere and is often seen in selected catastrophic infant and early childhood epilepsies, such as Rasmussen's encephalitis or hemimegalencephaly.

The rationale behind choosing hemispherectomy for these specific conditions is that the seizures often originate from one side of the brain and, in young children, removing or disconnecting the affected hemisphere can lead to significant improvements in seizure control and overall quality of life. The brain of infants and young children is more plastic, meaning that there is a greater potential for the brain to reorganize itself and adapt to the loss of one hemisphere.

This differentiates hemispherectomy from other surgical options like corpus callosotomy, subpial transection, and temporal lobectomy, which are used under different circumstances. Corpus callosotomy, for example, is typically performed to disrupt the spread of seizures between hemispheres rather than to remove a dysfunctional part of the brain. Subpial transection is used to cut connections within the cortex to help minimize seizures while preserving some function, and temporal lobectomy is more specific to temporal