Talk:Hemispherectomy

Not the most dangerous surgical procedure?

"Hemispherectomy is considered the most invasive surgical operation in use today, although not the most dangerous." In addition to lacking a citation, this statement seems rather dubious, in that it doesn't specify what the more dangerous diseases are. I would expect to see something like, "although it isn't as dangerous as <some set of operations> like operations x, y, and z." I'll tag it with a . Randomizer3 (talk) 23:13, 22 February 2015 (UTC)

"minimal changes in cognitive function overall"

This statement is sourced to the following:

http://onlinelibrary.wiley.com/doi/10.1111/j.0013-9580.2004.15303.x/abstract

Yet the concluding sentence of that abstract is "Regardless of etiology, most patients showed only moderate change in cognitive performance at follow-up."

"Moderate" is hardly equivalent to "minimal". I recommend the text in the current article be altered to the following: "Studies have found...only moderate changes in cognitive function overall."

Russell Richie (talk) 05:41, 19 January 2014 (UTC)

Fiction

I once read a science fiction book long ago in middle school which involved the main character landing alone on the moon to scout it out and receiving a hemispherectomy. The moon was divided up into caches of war computers and robots belonging to different countries there to fight out proxy, if unwitnessed, wars. Yes, quite the story :) it made an impression on my adolescent mind. I'd really like to find out the title or author again; I'm curious if anyone who happens on this page knows. Thanks Heaven's knight 06:52, 11 April 2007 (UTC)

Flaws

One major flaw that I'm unhappy with is the "is used to treat" part of the initial description. I know that I'm not being complete there, and there's some overlap, but I don't know enough about the field to be exact. If someone who does know something about neurosurgery can edit that, I'd be thrilled.

Beyond that, I think the only major flaw is the rather roughly handled references in the last paragraph. -Harmil 28 June 2005 13:27 (UTC)

Age and indications and neuroplasticity

Someone had listed the maximum age of surgery to be 5 years old. However, the article referenced later clearly states, "Mean age at surgery was 7.2 years." I am changing this to reflect that a hemispherectomy is almost always performed in children due to the concept of neuroplasticity.

In reference to neuroplasticity, a 2002 article seems to support the concept of reinforcement of already existing ipsilateral pathways as opposed to development of new pathways. --Kevin Dufendach 15:20, 13 October 2007 (UTC)

Ben Carson

What about Ben Carson. And I kinda wanted to know more that the actual surgery itself involved.

Fix

"It is reserved for cases which can't be managed with medication alone." Wow...that make it sound like hemispherectomies is performed whenever medications have a less than desirable effect. Hemispherectomy is a last ditch solution (and not a very good one) to treating extreme epilepsy. Fixed. Jumping cheese 04:38, 3 October 2007 (UTC)

fluid build up

the article states that hemispherectomies are rarely performed because fluid can build up pressuring the remaining hemisphere. Can someone explain why a surgeon couldn't simply place an object where the hemisphere was to stop this happening. 129.67.178.236 (talk) —Preceding comment was added at 20:55, 5 May 2008 (UTC)

The article states first: "Studies have found no significant long-term effects on memory, personality, or humor after the procedure[2], and minimal changes in cognitive function overall.[3]"

But then, the very next pair of sentences say the following: "Generally, the greater the intellectual capacity of the patient prior to surgery, the greater the decline in function. Most patients end up with mild to severe mental retardation, which is usually already present before surgery."

To me, this reads as contradictory. Furthermore, the "minimal effect" statement is well-sourced, whereas the "decline in function/mental retardation" statements are not.

I am not sufficiently expert on this subject to make any correction, but to me, this indicates that the "decline in function" sentencecs should be removed, as they are both unsourced and contradict the previous, well-sourced statement. Flewellyn (talk) 03:16, 24 August 2009 (UTC)

Three years on and this still confused me. 110.22.59.181 (talk) 17:37, 24 March 2012 (UTC)

I checked the talk page to see if anyone else was troubled by this contradictory statement. I think I've clarified this section, but feel free to revise if necessary (I'm by no means and expert on this subject).Apogalacticon (talk) 00:46, 2 November 2013 (UTC)

After a bit of digging, it looks like this text was added by 80.217.197.69 on Nov 4 2007 (https://en.wikipedia.org/w/index.php?title=Hemispherectomy&diff=169250436&oldid=165989590). The reference used does not appear to indicate this statement is true. It actually states that mental and psychomotor retardation was observed in 2 cases studied - children with hemimegalencephaly (an abnormally large hemisphere). Mental and psychomotor retardation was present after surgery in these patients Two children with a similar condition who were effectively treated with drugs (not surgery) did not appear to suffer from the same mental and psychomotor retardation. This would indicate that the surgery may have caused this decline in mental cognition, or the children who were not adequately treated by drugs suffered from a more severe condition. It is apparent that this level of cognitive decline may only occur in patients with hemimegalencephaly, and not all patients requiring a hemispherectomy.

Furthermore, this same source repeatedly notes that mental assessments of hemisphectomy patients are not usually made before surgery, so it is difficult to quantify the level of cognitive decline.

I am removing the contradictory text because: a) the note regarding retardation may only apply to a very small subset of patients b) the statement: the greater the intellectual capacity of the patient prior to surgery, the greater the decline in function is not found in the source - it is specifically stated that doctors are usually unable to accurately track cognitive decline due to poor assessments of patients prior to surgery.

Note: I do not have access to the full Bayard article (http://books.google.com/books?id=PQDRThq4UeMC&pg=PA229#v=onepage&q&f=false), specifically pages 238-239, so this issue may need to be revisited by an expert later. Apogalacticon (talk) 01:17, 2 November 2013 (UTC)

Redundancies

"Most patients end up with mild to severe mental retardation, which is usually already present before surgery." is functionally equivalent to "Some normally functioning patients end up with mild to severe mental retardation.", but without the obvious "Patients who are mentally retarded before are still mentally retarded after.". (Unregistered user: jlinkous05) — Preceding unsigned comment added by 174.103.247.104 (talk) 22:34, 1 March 2013 (UTC)