Etiology associated with developing posthemispherectomy hydrocephalus after resection-disconnection procedures

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors sought to determine if clinical epilepsy variables, maximum daily temperature (Tmax), and blood and CSF findings were associated with the risk of developing hydrocephalus after first-time resection-disconnection hemispherectomy.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients who underwent cerebral hemispherectomy in whom a standardized perioperative protocol was used, including the use of ventriculostomies (n = 79), were classified into those who developed and those who did not develop hydrocephalus requiring CSF shunts. The authors compared these 2 groups for clinical variables, Tmax, and blood and CSF studies through postoperative Day 12.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In this cohort, 30% of the patients required CSF shunts, of which 8% developed late hydrocephalus up to 3 years posthemispherectomy. Multivariate analysis found that etiology was associated with developing posthemispherectomy hydrocephalus. Higher shunt rates were observed for patients with hemimegalencephaly (40%; n = 15) and a history of CNS infection (100%; n = 4) compared with cortical dysplasia (17%; n = 23) and Rasmussen encephalitis (17%; n = 12). In univariate analysis, other factors associated with developing hydrocephalus were elevated maximum daily temperatures, elevated white blood cell counts, decreased CSF protein, and increased CSF red blood cell counts.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The findings of the study indicate that etiology was the factor most strongly associated with developing posthemispherectomy hydrocephalus. These findings suggest that there are variable mechanisms for developing hydrocephalus after cerebral hemispherectomy depending on the procedure, and in resection-disconnection operations the mechanism may involve changes in CSF bulk flow that varies by histopathology.</jats:p></jats:sec>

National Trends and In-hospital Complication Rates in More Than 1600 Hemispherectomies From 1988 to 2010

“…5,[25][26][27] Meningitis developed in 10% of patients during their hospitalization, which was noted to be the second most common complication in our series, again consistent with the literature. 8,15,28,29 Given the lack of an ICD-9-CM code for aseptic meningitis, we could not ascertain the exact contribution of this common and expected complication to our observed overall rate of meningitis of 10%. In fact, patients often receive prolonged courses of prophylactic steroids postoperatively as a method to treat aseptic meningitis, which is believed to be caused by the large amount of tissue breakdown products and debris within the resection cavity irritating the meningeal layers of the brain after surgery.…”

Fevers and abnormal blood and cerebrospinal fluid studies after pediatric cerebral hemispherectomy: impact of etiology and age at surgery

“…These findings complement those of prior studies by our group showing a limited association of CNS and non-CNS infections with fevers and altered blood and CSF values in all types of pediatric epilepsy surgery cases, as well as an association between etiology and posthemispherectomy hydrocephalus requiring CSF shunts. 11,12 Taken together, these findings indicate that multiple clinical variables are associated with the development of fever and altered blood and CSF laboratory studies after cerebral hemispherectomy involving resection-disconnection procedures, including the underlying seizure etiology and age at surgery. For the practicing neurosurgeon, the best predictor of CNS Fig.…”

Trapped ipsilateral lateral ventricle: a delayed complication of hemispherotomy for Rasmussen’s encephalitis

“…In the case of functional hemispherectomy, aetiology seems to be the decisive factor than the inflammation induced by the surgery. One study found higher rates of hydrocephalus and shunting procedures in association with hemimegalencephaly and central nervous system infection and less in association with cortical dysplasia and Rasmussen’s encephalitis 10. This was explained by the varying CSF flow dynamics in association with the different aetiologies.…”