Hemispherotomy, known for its efficacy in treating drug-resistant epilepsy linked to unilateral hemispheric pathology, stands out in the evolving field of epilepsy surgery (Alotaibi F, et al., Can J Neurol Sci 48(4):451–463, 2021 ; Cossu M, et al., J Neurosurg 136(6):1627–1637, 2022). This disconnection technique is favored over the more traditional hemispherectomy due to its lower complication rates. The debate between lateral and vertical approaches continues, underscored by a lack of extensive comparative studies, complicating surgical decision-making. This chapter delves into the vertical approach, exploring its historical development, surgical details, indications, and comparative review with other methods. The goal is to equip neurosurgeons with a thorough understanding of the effectiveness and safety of vertical hemispherotomy, aiding them in the complex arena of hemispheric surgery.