Cerebral hemispherectomy in infants and young children
Sean Flack1, Jeff Ojemann, Charles Haberkern
1Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA. sean.flack@seattlechildrens.org
Insights
Functional hemispherectomy in young children with intractable seizures showed a decreased complication rate compared to previous reports. Improvements in surgical and anesthetic techniques appear to enhance outcomes for this epilepsy surgery.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Anesthesiology
Background:
- Hemispherectomy is a surgical option for children with intractable seizures.
- Infants and young children increasingly undergo this procedure for improved developmental outcomes.
- Previous hemispherectomy procedures were associated with significant perioperative complications.
Purpose of the Study:
- To determine the incidence of major complications associated with functional hemispherectomy in young children.
- To evaluate the safety and efficacy of newer surgical and anesthetic techniques for pediatric epilepsy surgery.
Main Methods:
- Retrospective chart review of children under 3 years old who underwent functional hemispherectomy.
- Study period covered 4 years at a single institution.
- Focus on identifying major cardiovascular, pulmonary, neurologic, and coagulopathic complications.
Main Results:
- Seven children were included in the study.
- No serious adverse events (cardiovascular, pulmonary, neurologic, coagulopathic) were observed.
- Perioperative blood loss was the most common complication; one patient required ICU readmission for diabetes insipidus.
- All patients survived, and most remained seizure-free post-surgery.
Conclusions:
- Functional hemispherectomy, utilizing improved techniques, may have a lower complication rate in infants and young children than previously reported.
- Advances in anesthesia and surgical approaches enhance the safety profile of this epilepsy surgery.
- The findings suggest a potential improvement in outcomes for pediatric patients undergoing hemispherectomy.
Background:
Children with seizure disorders unresponsive to medical management may undergo surgical disconnection of a cerebral hemisphere, or hemispherectomy, in order to reduce or eliminate seizures. Because early cessation of seizures is thought to improve developmental outcomes, infants and young children with intractable seizures are undergoing hemispherectomies with increasing frequency. Previously, these procedures have been noted to be accompanied by severe cardiovascular, pulmonary, neurologic and coagulopathic complications. Newer surgical techniques (i.e. 'functional' rather than 'anatomic' hemispherectomy) and improved anesthetic management may reduce the perioperative complication rate of this procedure. The aim of this case series was to determine the incidence of major complication of functional hemispherectomy in our institution.
Methods:
A retrospective chart review was conducted of all children <3 years of age undergoing functional hemispherectomies for intractable seizures over a 4-year period at our institution.
Results:
Seven children were identified. No serious cardiovascular, pulmonary, neurologic or coagulopathic adverse events occurred. Perioperative blood loss and its sequelae were the most common complication. Postoperative management was generally uncomplicated, although one patient required readmission to the ICU for treatment of diabetes insipidus. All children survived and, at latest follow-up, all but one remained seizure-free.
Conclusion:
This small case series suggests that improvements in anesthetic and surgical techniques may be associated with a decreased complication rate for infants and small children undergoing seizure surgery than previously reported.
