When epilepsy is caused by a problem with one half of the brain, such as Rasmussen’s encephalitis,
a type of epilepsy surgery called a hemispherectomy could reduce or eliminate seizures. This surgery disconnects half of the brain so the abnormal side of the brain can no longer affect the normal side. Duke is among a small number of U.S. centers that offer a hemispherectomy for children with severe seizures that are not controlled with medication. Our team of experts work together to ensure you or your child experiences the best possible outcome.
A hemispherectomy, also known as a functional hemispherectomy, is a surgery that severs the connections from one side of the brain (called a hemisphere) to the other. This disconnection prevents seizure activity from spreading from one half of the brain to the other.
Watch a medical animation of a functional hemispherectomy.
Duke Children's Hospital & Health Center provides expert care in a child- and family-friendly environment.
Although hemispherectomies can benefit some adults, this surgery is typically performed and is most successful in young children.
Underlying congenital conditions are often responsible for half of the brain developing abnormally, leading to epileptic seizures. Common examples include:
Children born with these conditions should be treated quickly. However, symptoms may not appear until children are older.
Another reason why hemispherectomy is more successful in children is because each seizure a person experiences makes it more likely that additional seizures will occur. This increases the chance that seizures will originate outside of the abnormal part of the brain, which makes epilepsy more difficult to treat.
A hemispherectomy eliminates one half of the brain’s function. Many ideal candidates for a hemispherectomy already have functional limitations (for example, weakness on the side of the body opposite to the brain hemisphere where seizures begin) due to an underlying condition. Because children’s brains are adaptable (doctors call this “neuroplasticity”), they can often transfer function from the abnormal side of the brain to the normal side of the brain over time, before and/or after surgery.
Before recommending a hemispherectomy, expert epileptologists and neurosurgeons perform extensive testing to determine what functions, if any, may be affected.
Children and adults undergo a thorough surgical evaluation before hemispherectomy is recommended. Learn more about:
After receiving anesthesia, a neurosurgeon makes a question-mark-shaped incision on the side of the head. A small section of the skull is removed to allow access to the brain. Next, surgeons use specialized tools to disconnect the left or right hemispheres of the brain. Finally, surgeons replace the piece of skull that was removed and close the incision with dissolvable stiches. The procedure usually takes about five hours. Surgeons may leave behind an external ventricular drain -- this temporary tube helps drain excess fluid and monitor pressure inside the skull for several days or longer after surgery.
Minimally Invasive Approach
Some young children may be eligible for a minimally invasive approach to a hemispherectomy that utilizes endovascular (through the blood vessels) techniques.
After surgery, the average hospital stay is between 7 to 10 days. You or your child may undergo a CT scan or an MRI to document how the brain looks after surgery. Children may need to stay in the intensive care unit (ICU) until the ventricular drain is removed.
Depending on age and change in function compared to before surgery, doctors may recommend inpatient rehabilitation for four to six weeks or intensive outpatient speech, physical, and occupational therapy. Follow-up appointments take place at two weeks after surgery and again at three months. After this, you or your child may start weaning off certain epilepsy medications.
As a Level 4 Pediatric Epilepsy Center, Duke Health provides the highest level of diagnosis, medical, and surgical treatments for children with epilepsy. It's one reason why Duke Children’s is nationally ranked in pediatric neurology and neurosurgery by U.S. News & World Report for 2025-2026.
