Abstract
Cerebral Hemispherectomy (CH), is an advanced and rare surgical treatment to reduce or eliminate intractable seizures in children with Hemimegaencephaly (HME) and Cortical Dysplasia (CD). Aim of early surgical intervention is to have a seizure free patient.
Presenting a case of a 12 month, 12 kg child, with seizures from day 13 of birth in the form of small jerks lasting for 3 to 4 minutes multiple times a day and was prescribed a multidrug regimen of anticonvulsants since then. Brain MRI showed right megaloencephaly with dysplastic cortex of white matter. The patient was induced with standard intravenous induction, endotracheally intubated, and maintained on normocapneic volume controlled ventilation.
The duration of the surgery was approximately 9 hours. A blood loss of almost the patient’s entire blood volume was observed (80 ml/kg), with subsequent hypotension, fall in hemoglobin and metabolic disturbances accompanying massive blood loss. There were no intraoperative seizures. The patient was ventilated electively for 3 days postoperatively, with no postoperative complications and uneventful Pediatric Intensive Care Unit (PICU) stay.
Keywords: pediatric neurosurgery, intractable seizures, hemimegalencephaly, cortical dysplasia, cerebral hemispherotomy.
References
- Sridharan R and Murthy B N. Prevalence and pattern of epilepsy in India . Epilepsia 1999;40-631-636
- Engel J Jr, Surgery for seizures NEJM 1996,334(10):647-652.
- Anaesthesia and Epilepsy A, PerksS, Cheema and R Mohanraj, British Journal of Anaesthesia 108(4):562-71(2012)
- Cottrell and Young's Neuroanaesthesia, Chapter 17, Armin Schubert, Michelle Lotto, pages 299-304
- J Pediatr Neurosci.2015 Apr-Jun ;10(2):188-192 .Hemispherotomy in an infant with Hemimegalencephaly.Shilpa D Kulkarni, Chandrashekar E Deopujari ,Varsha A Patil, and Rafat J.Sayed.
- Dandy WE (1923) Removal of right cerebral hemisphere for certain tumors with hemiplegia. JAMA 90: 823-825
- Hemispherotomy and Functional Hemisheroctomy: Indications and Outcomes. Journal of Epilepsy research, 2018, Jun:8(1):1-5, Published online 2018 Jun30 , Ju–seong Kim, MD, Eun-Kyung Park, MD, and Dong Seok Kim, MD, PhD
- International journal of Surgery 36(2016)454-4549, Anaesthesia considerations in epilepsy surgery. Anita Shetty, Swarda Pardeshi, Viraj M Shah, Arti Kulkarni
- Essentials of Neuroanaesthesia and Neurointensive care, Chapter 19, Anaesthesia for epilepsy surgery, Martin Smith, pages 125-130.
- Anaesthesia and childhood epilepsy. Ahmed R. Barakat, MBBCh MSc FRCA MD, Su Mallory, BSc MB ChB FRCA. Continuing Education in Anaesthesia Critical Care & Pain, Volume 11, Issue 3, June 2011, Pages 93–98,https://doi.org/10.1093/bjaceaccp/mkr005 Published:18 April 2011.
- Brian JE Jr, Deshpande J K, McPerson R W: Management of cerebral hemispherotomy in children. J Clin Anaesth 2:91-95-1990
- Soriano SG, Bozza P: Anaesthesia for epilepsy surgery in children, ChildsNerv Syst 22;834-843,2006
- Essentials of Neuroanaesthesia and Neuro intensive care ,Chapter 36 237-240 ,Fluid management ,David Zygun
- Kotke WA, Templehoff R, Mdasheiff RM: Anaeshesia for epileptic patients and for epilepsy surgery. Cottrell JE, Smith DS, editors; Anaesthesia and Neurosurgery, St louis, 1994, Mosby, pp 495-524.
- Sinha PK, Neema P K, Manikandan S et al: Bradycardia and sinus arrest following saline irrigation of the brain during epilepsy surgery. J Neurosurg Anaesthesiol 16 :160-163 2004
- Zuckerberg AL, Tobin JR, Flisher I et al. The physiopathological consequences of cerebral hemispherectomy in children. Anaesthesiology 79: 1187, 1998(25)
- E. JAnaesth 22 (6)2014: Letter to the Editor: Anaesthetic management of a patient after functional hemispherectomy using Bilateral Bispectral index monitoring. Shinichiri Kira and Kentaro Okuda
- Anaesthetic considerations in epilepsy surgery. Gowri De Zylva, Ruwammali De Silva, CME LECTURE, Sri Lankan Journal of Anaesthesiology
- Sato K, Stamoto H, Yoshimoto T: Severe Bradycardia during epilepsy surgery .J Neurosurg Anaesthesiol 13 : 329 -332 -2001.
Corresponding Author
Dr Dipti Madan
Bombay Hospital Institute of Medical Sciences, 12 New Marine Lines, Mumbai- 400020