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Minimizing blood loss in hemispherectomy for hemimegalencephaly in low-weight infants: technical note
Sandeep Sood1, Eishi Asano2, Aimee Luat2
1Pediatric Neurosurgery, Children's Hospital of Michigan, 3901 Beaubien, Second Floor, Detroit, MI, 48201, USA. ssood@med.wayne.edu.
Insights
Coagulating lenticulostriate arteries before hemispherotomy can significantly reduce blood loss in infants with hemimegalencephaly. This technique helps manage surgical bleeding in low-weight pediatric patients.
Area of Science:
- Neurosurgery
- Pediatric Epilepsy Surgery
- Anesthesiology
Background:
- Drug-resistant seizures in hemimegalencephaly present significant surgical and anesthesia challenges in neonates and infants.
- While early hemispherectomy can improve seizure control, low body weight and limited blood volume pose risks of prohibitive surgical blood loss.
Purpose of the Study:
- To evaluate the efficacy of early lenticulostriate artery coagulation in minimizing blood loss during hemispherotomy in low-weight infants.
Main Methods:
- Two infants underwent endoscope-assisted interhemispheric vertical hemispherotomy.
- Lenticulostriate arteries were coagulated at their origin from the middle cerebral artery to manage bleeding during lateral disconnection.
Main Results:
- Coagulation of the lenticulostriate arteries effectively reduced blood loss during the lateral dissection in both infants.
- The strategy was applied differently in the two cases, with one involving pre-emptive coagulation.
Conclusions:
- Early coagulation of lenticulostriate arteries is a valuable strategy for minimizing intraoperative blood loss in infants undergoing hemispherotomy.
- This technique is particularly beneficial for low-weight infants where surgical blood loss is a major concern.
Introduction:
Drug-resistant seizures due to hemimegalencephaly in neonates and infants are a unique surgical and anesthesia challenge. While early surgery in these patients may predict a better seizure control, a lower body weight, limited blood volume, and surgical blood loss may make hemispherectomy prohibitive.
Methods:
Two infants (weight, 8.7 kg and 3.7 kg) underwent interhemispheric vertical hemispherotomy with endoscope assistance. In the first case, during the lateral disconnection, excessive bleeding prompted the surgeon to coagulate the lenticulostriate arteries at the origin from the middle cerebral artery to reduce bleeding. In the second infant, the lenticulostriate arteries were coagulated before initiating the lateral disconnection.
Results:
In both infants, the blood loss from lateral dissection was reduced by coagulation of lenticulostriate arteries.
Conclusion:
The authors suggest that early coagulation of the lenticulostriate arteries is a useful strategy to minimize blood loss in low-weight infants undergoing hemispherotomy.
