The first hemispherectomy for epilepsy, performed by Dr. Kenneth G. McKenzie in 1938, marked a groundbreaking moment in neurosurgery and epilepsy treatment. A Canadian neurosurgeon based at Toronto General Hospital, Dr. McKenzie is celebrated for his pioneering efforts in surgical approaches to intractable epilepsy. His landmark procedure paved the way for innovative surgical strategies that have since transformed the lives of countless individuals suffering from severe epileptic disorders.

The Case
The patient, a young girl suffering from severe intractable seizures due to Rasmussen's encephalitis (a rare inflammatory neurological disorder), had profound neurological impairments and was unresponsive to medical therapy. Dr. McKenzie, with his bold decision to perform the hemispherectomy, sought to alleviate her symptoms by removing the entire affected cerebral hemisphere. The procedure was revolutionary at the time, addressing epilepsy by targeting the structural brain abnormality responsible for the seizures.

The Procedure
The hemispherectomy involved the surgical resection of one hemisphere of the brain. This drastic approach was designed to halt the electrical disturbances responsible for the patient’s epileptic seizures. While the procedure entailed significant risks, including concerns about potential complications like hydrocephalus and contralateral motor deficits, it was justified by the patient’s devastating quality of life and lack of other viable treatment options.

Outcomes and Impact
Remarkably, the surgery was successful. The patient experienced a significant reduction in seizure frequency, demonstrating the potential of hemispherectomy as a treatment for epilepsy. Although neurological deficits such as hemiparesis were inevitable due to the nature of the surgery, the trade-off for seizure freedom was considered life-changing.

Dr. McKenzie's bold innovation inspired further refinements in hemispherectomy techniques over the decades. Today, the procedure is most commonly performed as a functional hemispherectomy, which involves disconnecting rather than completely removing the affected hemisphere. This minimizes complications while retaining the therapeutic benefits.

Legacy
Dr. K.G. McKenzie’s first hemispherectomy is remembered as a turning point in epilepsy surgery. His work demonstrated that even the most severe cases of epilepsy could be treated surgically, challenging the prevailing medical norms of his era. This milestone not only advanced the field of epilepsy surgery but also underscored the potential of neurosurgery to improve the lives of patients with debilitating neurological conditions.

As we reflect on this achievement, it is evident that Dr. McKenzie’s courage and vision laid the foundation for contemporary epilepsy surgery, leaving an enduring legacy in the history of medicine.