title: Cerebral hemispherectomy in infants and young children.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA. sean.flack@seattlechildrens.org
authors.forename: Sean
authors.initials: S
authors.lastname: Flack
authors.forename: Jeff
authors.initials: J
authors.lastname: Ojemann
authors.forename: Charles
authors.initials: C
authors.lastname: Haberkern
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002675:Child, Preschool; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D038421:Hemispherectomy / Q000009:adverse effects* / Q000379:methods; D006728:Hormones / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D006728:Hormones