Objective To investigate the surgical outcome of medically intractable hemispheric epilepsy and the clinical effect of functional hemispherectomy (HF) versus hemispherotomy (H).Methods A retrospective analysis was performed for the clinical data of 25 patients with medically intractable hemispheric epilepsy who underwent surgical treatment in our department from 2005 to 2017.According to the surgical procedure,these patients were divided into FH group with 15 patients and H group with 10 patients.The time of operation,intraoperative blood loss,perioperative complications,postoperative epilepsy control,and neurological function were retrospectively analyzed.Results The postoperative follow-up lasted for 1-12 years,and the mean follow-up time was 5.28±2.91 years.Two patients were lost to follow-up,and among the other patients,19(82.60%) had an Engel Ia outcome,3(13.04%) had an Engel Id outcome,and 1(4.36%) had an Engel Ⅱa outcome.There was no significant difference in the control rate of epilepsy between the FH group and the H group (P >0.05).Compared with the H group,the FH group had a significantly longer time of operation and significantly higher intraoperative blood loss (P <0.05).Conclusions FH is an effective surgical procedure for the treatment of medically intractable hemispheric epilepsy and allows for a high epilepsy-free rate after surgery,and some patients may achieve improvements in neurological function.Hemispherotomy is an effective minimally invasive surgical procedure and holds promise for clinical application.