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If the damaged hemisphere can be removed before a child has developed right-or left-handedness or has learned to speak, so much the better. In such a case, the question of removing the dominant side does not arise. Says Hendrick: "The brain is very malleable in infants and hasn't established any habits, so there is a better chance of the function of the damaged areas being taken over by the undamaged areas. For instance, early damage might not affect normal speech development. But a child having a stroke later, say at six or seven, is in big trouble."
Tractor Driving. David Webster had the more slowly developing type of seizure from unexplained brain damage, beginning when he was ten months old. He was a trial to his foster parents at Thornhill, outside Toronto. Says Mrs. Willi Smith: "He had to take about nine pills a day and he still had a couple of attacks just about every day. Somebody always had to be with him on the stairs for fear he would slip. They have these attacks if they have the slightest little scare—like slipping on a polished floor. His behavior wasn't all that good, and the nuns at the convent school couldn't really teach him anything."
David had his hemispherectomy when he was 14. Mrs. Smith says: "You just wouldn't believe the difference after the operation. He used to look sort of vacant, but his whole face has changed. Only a year and a half after his operations, he's doing seventh-grade work. He still has a bit of trouble with his right hand, but he's learned to drive a tractor and he looks after his own cattle —20 head of steer—and he's learned to do his own bookkeeping."
In the rare and radical surgery that has wrought such changes, Dr. Hendrick cuts a trap door in the skull, removes the entire neocortex (new brain) and hippocampal area on one side (see diagram), stopping at the midbrain just above the hypothalamus. He puts nothing into the huge cavity that results, because it soon fills up with cerebrospinal fluid. The operation, he says, "is not exciting—it's terrifying, especially, on young babies. They don't have much blood anyway, and we have to get into an area that's all blood vessels. And you have to do a lot of talking to persuade parents to let you remove half of the brain of an infant who is only a few weeks old."
*In the vast majority of right-handed and in many left-handed people the left side of the brain is dominant, controlling most body movements and such faculties as speech and reading, while the right hemisphere is relatively inactive.