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Hemispherectomy procedures in children: haematological issues
M Piastra1, D Pietrini, E Caresta
1Paediatric Intensive Care Unit, Catholic University Medical School, 00168 Rome, Italy. xoct01@yahoo.it
Insights
Excessive blood loss during hemispherectomy surgery significantly impacts children's blood clotting. Newer surgical methods may reduce these risks, even in young patients undergoing epilepsy surgery.
Area of Science:
- Pediatric Neurosurgery
- Hematology
- Pediatric Intensive Care
Background:
- Excessive perioperative hemorrhage and hemodynamic instability are known risks of hemispherectomy.
- Understanding the impact on hematological and coagulative patterns is crucial, especially in pediatric patients.
Purpose of the Study:
- To analyze the effects of hemispherectomy on hematological and coagulative parameters in children.
- To investigate these effects specifically in younger patients undergoing the procedure.
Main Methods:
- Retrospective analysis of 18 children undergoing hemispherectomy (anatomical or functional) between 1993-2003.
- Comparison with a historical cohort of 13 children operated on before 1992.
- Focus on patients with hemimegalencephaly (HME) and other epileptogenic lesions.
Main Results:
- Significant influence of blood loss and transfusions on hematologic/coagulative status observed.
- A strong correlation found between estimated red cell volume (ERCV) loss and hemostatic impairment.
- Analysis highlights the hematological changes post-hemispherectomy.
Conclusions:
- Blood loss and transfusions profoundly affect children's hematologic and coagulative status after hemispherectomy.
- Estimated red cell volume loss is strictly correlated with hemostatic impairment.
- Modern surgical techniques show promise in reducing blood loss and associated risks, even in younger pediatric patients.
Objects:
In literature, excessive perioperative haemorrhage and related haemodynamic instability have been described as major risk factors in hemispherectomy. In this report we analyse the impact of neurosurgical operation on both the haematological and coagulative patterns of these children, especially focusing on younger patients.
Methods:
From 1993 to 2003, 18 consecutive children suffering from intractable epilepsia and treated by hemispherectomy were admitted to the Pediatric Intensive Care Unit (PICU) of Catholic University Medical School, Policlinico Gemelli, Rome. Eight children had an entire hemisphere removed (anatomical hemispherectomy), whereas the remaining 10 underwent disconnective procedures (functional hemispherectomy) or cerebral cortex ablations (e.g. hemicorticectomy). Eleven out of these 18 children underwent hemispherectomy because of hemimegalencephaly (HME): their mean age was 14.5 months (range 3-56 months); non-HME patients underwent surgery for epileptogenic lesions involving the cerebral hemisphere to a great extent or diffusely. Data have been compared with an historical cohort of 13 children operated on before 1992 at the same institution comparable for age, aetiology of epilepsy and the modalities of surgical operation.
Conclusions:
Blood losses and haemotransfusions showed a profound influence on the haematologic/coagulative status of the children operated upon. A strict correlation was demonstrated between estimated red cell volume (ERCV) loss and haemostatic impairment in this series. Recent surgical techniques appear to reduce blood losses and related haemocoagulative risks even in younger patients.
