Cerebral hemispherectomy since its first application by Dandy(1928) until the past ten years, has been a radical procedure used only in patients with infiltrating gliomas of one cerebral hemisphere.
Krynauw(1950) arroused a new interest in the procedure by demonstrating that young patients with infantile hemiplegia associated with uncontrollable convulsions, temper tantrum, and mental deficiency, could be greatly benefited by removal of the atrophic cerebral hemisphere.
At present there are 114 hemispherectomies reported in the literature(43 for tumor and 71 for convulsion).
During the past three years the authors operated on 24 cases of cerebral paragonimiasis at the Seoul National University Hospital. In two of them, cerebral hemispherectomy was performed to control intractable convulsions caused by diffuse cerebral paragonimiasis and cerebral atrophy.
Case 1: K.C., a 21-year-old boy, was admitted on July 15, 1958 to the neurosurgical service with the chief complaints of focal and generalized convulsions, spastic hemiplegia, homonymous hemianopsia and mental deterioration. This patient had a history of meningeal symptoms from an unknown cause, at the age of 9years. Thereafter, dysesthesia and motor weakness in the left half of the body appeared and a-few years later generalized convulsions with sensory or, visual aura on the left side developed. These seizures have persisted despite anticonvulsant medication for ten years.
This patient had a typical spastic hemiplegia, hemihypesthesia, homonymous hemianopsia and central type facial palsy on the left side. Further examination revealed that the patient has had bilateral pulmonary paragonimiasis, diffuse calcified cerebral paragonimiasis, involving mainly the corona radiata, and severe cerebral atrophy on the right side.
The right cerebral hemispherectomy was performed preserving the thalamus and caudate nucleus on July 25, 1958. Following the operation his persistent seizures have completely disappeared without anticonvulsant, and the spastic hemiplegia, hemihypesthesia. and mental deterioration were improved compared to the pre-operative state.
Case 2:T.N., a 16-year-old boy, was admitted to the neurosurgical service with chief complaints of status epilepticus, motor aphasia and mental deterioration on April 21, 1961. This patient had a history of pulmonary paragonimiasis at the age of 10 years." About 4 years ago, he developed meningeal symptoms and thereafter focal or generalized convulsions with adversive phenomena to the right side appeared. This was associated with motor aphasia and mental deterioration. These seizures have persisted despite anticonvulsant medication and turned into a status epilepticus ´state when he was -admitted to the hospital. This patient, a right handed boy, had a typical motor aphasia and mental deterioration but no remarkable motor or sensory disturbance was found except for the slight ,homonymous hemianopsia on the right side. Further examination revealed that the patient has had bilateral pulmonary paragonimiasis and cerebral paragonimiasis which involved the entire temporal lobe and motor speech center, and there was moderate cerebral atrophy on the left side.
The left cerebral hemispherectomy was performed, preserving the thalamus and caudate nucleus on May 11, 1961. Following the operation, slight motor weakness and sensory disturbance appered on the right side, and the pre-operative mild homonymous hemianopsia became a complete one. But his motor aphasia completely recovered and his convulsions have been completely controlled with light anticonvulsant medication. His mental deterioration also improved.
Our conclusion is that in selected cases, cerebral hemispherectomy is worthwhile in teratment ´of intractable convulsive seizures caused by unilateral diffuse cerebral paragonimiasis.
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