The first known hemispherectomy was performed on a dog in 1888 by German physiologist Friedrich Goltz. In humans, neurosurgeon Walter Dandy pioneered the operation at Johns Hopkins University in 1923 on a brain tumor patient. (That man lived for more than three years before ultimately succumbing to cancer.) The procedure is among the most drastic kinds of brain surgery—"You can't take more than half. If you take the whole thing, you've got a problem," Johns Hopkins neurologist John Freeman quips.
One side effect Canadian neurosurgeon Kenneth McKenzie reported in 1938 after a hemispherectomy on a 16-year-old girl who suffered a stroke was that her seizures stopped. Nowadays, the surgery is performed on patients who suffer dozens of seizures every day that resist all medication, and which are due to conditions that mostly afflict one hemisphere. "These disorders are often progressive and damage the rest of the brain if not treated," University of California, Los Angeles, neurosurgeon Gary Mathern says. Freeman concurs: "Hemispherectomy is something that one only does when the alternatives are worse."
Anatomical hemispherectomies involve the removal of the entire hemisphere, whereas functional hemispherectomies only take out parts of a hemisphere, as well as severing the corpus callosum, the fiber bundle that connects the two halves of the brain. The evacuated cavity is left empty, filling with cerebrospinal fluid in a day or so.
The strength of anatomical hemispherectomies, a specialty of Hopkins, lies in the fact that "leaving even a little bit of brain behind can lead seizures to return," Freeman says. On the other hand, functional hemispherectomies, which U.C.L.A. surgeons usually perform, lead to less blood loss. "Our patients are usually under two years of age, so they have less blood to lose," Mathern says. Most Hopkins hemispherectomy patients are five to 10 years old.
Neurosurgeons have performed the operation on children as young as three months old. Astonishingly, memory and personality develop normally. A recent study found that 86 percent of the 111 children who underwent hemispherectomy at Hopkins between 1975 and 2001 are either seizure-free or have nondisabling seizures that do not require medication. The patients who still suffer seizures usually have congenital defects or developmental abnormalities, where brain damage is often not confined to just one hemisphere, Freeman explains.
Another study found that children that underwent hemispherectomies often improved academically once their seizures stopped. "One was champion bowler of her class, one was chess champion of his state, and others are in college doing very nicely," Freeman says.
Of course, the operation has its downside: "You can walk, run—some dance or skip—but you lose use of the hand opposite of the hemisphere that was removed. You have little function in that arm and vision on that side is lost," Freeman says.
Remarkably, few other impacts are seen. If the left side of the brain is taken out, "most people have problems with their speech, but it used to be thought that if you took that side out after age two, you'd never talk again, and we've proven that untrue," Freeman says. "The younger a person is when they undergo hemispherectomy, the less disability you have in talking. Where on the right side of the brain speech is transferred to and what it displaces is something nobody has really worked out."
Mathern and his colleagues have recently conducted the first functional magnetic resonance imaging study into hemispherectomy patients, investigating how their brain changes with physical rehabilitation. Probing how the remaining cerebral hemispheres of these patients acquire language, sensory, motor and other functions "could shed a great deal of light on the brain's plasticity, or ability to change," Freeman notes. Still, having half a brain—and therefore only the use of one hand and half a field of vision in each eye—is a condition most would prefer to avoid.