The postoperative course and management of 106 hemidecortications.
BACKGROUND
The excellent long-term outcome for most children undergoing hemispherectomy is well documented. However, the condition of these children in the immediate postoperative period is poorly described. The purpose of this study was to evaluate the short-term issues surrounding hemispherectomy and their management in a series of patients from our institution.


METHODS
106 hemispherectomies were performed at our institution from 1975 to 2001 (102 hemidecortications). Medical records were retrospectively examined for information regarding immediate postoperative problems and care.


RESULTS
Three children died in the immediate perioperative period, while 3 others had significant postoperative morbidity. 82% of these children had postoperative fevers (temperature >38.5 degrees C). Of these children, 62% had lumbar punctures. Ten cases had positive CSF growth, of which 6 cases were felt to have actual meningitis. Patients with CSF growth had a significantly longer prior duration of steroid therapy and higher maximum temperature peaks. CSF pleocytosis and an ill clinical appearance neared significance for prediction of CSF growth. Shunting was performed in 19% of all children and was associated with CSF growth.


CONCLUSIONS
Postoperative fevers are common after hemidecortication, but meningitis is not. Children with CSF growth tended to appear more ill and have higher temperature spikes and CSF pleocytosis. Shunting was related to CSF growth.
Kossoff
E H
EH
Department of Neurology and Pediatrics, The Pediatric Epilepsy Center, Johns Hopkins Medicla Institutions, Baltimore, Md, USA. ekossoff@jhmi.edu
Vining
E P G
EP
Pyzik
P L
PL
Kriegler
S
S
Min
K-S
KS
Carson
B S
BS
Avellino
A M
AM
Freeman
J M
JM
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005334:Fever / Q000209:etiology*; D038421:Hemispherectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000150:complications; D011184:Postoperative Period; D012189:Retrospective Studies; D013129:Spinal Puncture; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone