The surgical procedure for severe, drug-resistant, unilateral hemispheric epilepsy
is challenging. Over the last decades the surgical landscape for hemispheric disconnection
procedures changed from anatomical hemispherectomy to functional hemispherotomy with
a reduction of complications and stable good seizure outcome. Here, a task force of
European epilepsy surgeons prepared, on behalf of the EANS Section for Functional
Neurosurgery, a consensus statement on different aspects of the hemispheric disconnection
procedure.To determine history, indication, timing, techniques, complications and
current practice in Europe for hemispheric disconnection procedures in drug-resistant
epilepsy.Relevant literature on the topic was collected by a literature search based
on the PRISMA 2020 guidelines.A comprehensive overview on the historical development
of hemispheric disconnection procedures for epilepsy is presented, while discussing
indications, timing, surgical techniques and complications. Current practice for this
procedure in European epilepsy surgery centers is provided. At present, our knowledge
of long-term seizure outcomes primarily stems from open surgical disconnection procedures.
Although minimal invasive surgical techniques in epilepsy are rapidly developing and
reported in case reports or small case series, long-term seizure outcome remain uncertain
and needs to be reported.This is the first paper presenting a European consensus statement
regarding history, indications, techniques and complications of hemispheric disconnection
procedures for different causes of chronic, drug-resistant epilepsy. Furthermore,
it serves as the pioneering document to report a comprehensive overview of the current
surgical practices regarding this type of surgery employed in renowned epilepsy surgery
centers across Europe.
