Factors of morbidity in hemispherectomies: surgical technique x pathology.
OBJECTIVE
The objective of this paper is to evaluate factors of surgical morbidity from different techniques of hemispherectomy with emphasis on causative pathology.


METHODS
Thirty patients underwent hemispherectomy in our institution from 1987 to 2003, two presented with Sturge-Weber Syndrome (SWS), sixteen with Rasmussen's Syndrome (RS), eight with established hemispheric lesions (EHL), and four with cortical development malformations (CDM). Six surgeons operated on three patients using anatomical hemispherectomies (AH), 11 patients using functional hemispherectomy (FH), and 16 patients employing hemispherotomy (HT). Surgical technique and causative pathology were studied independently as factors of morbidity in hemispherectomy.


RESULTS
Overall mean surgical time was 11:50+/-3:20 h and increased proportionately in pathologies with larger hemispheres. Blood transfusion was particularly influenced by the approach adopted by our team of anesthesiologists, independently of technique or pathology. Pathology was the most important factor related to hydrocephalus as two out of four patients with CDM needed ventriculoperitoneal shunt whilst none with EHL or SWS. Four patients undergoing HT and one FH presented residual bridges connecting the hemispheres, three were reoperated and are seizure free. Two patients with CDM did not improve their seizures worthwhile with surgery and other two (one with RS and other with CDM) were waiting a second procedure due to incomplete inter-hemispheric disconnection. Five patients presented infection and one died after developing meningoencephalitis.


CONCLUSIONS
Hemispherectomies are procedures where pathology and surgical technique interact narrowly. Therefore, in order to study surgical morbidity or outcome, both pathology and technique have to be analyzed independently.
de Almeida
Antonio Nogueira
AN
Departamento de Neurologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. almeidaan@globo.com
Marino
Raul
R
Marie
Suely Kazuo
SK
Aguiar
Paulo Henrique
PH
Teixeira
Manoel Jacobsen
MJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D008297:Male; D008590:Meningoencephalitis / Q000209:etiology; D018579:Patient Selection; D019106:Postoperative Hemorrhage; D013997:Time Factors; D017287:Ventriculoperitoneal Shunt