Abstracts

Rationale: Epilepsy is a neurological disorder characterized by seizures. Hemispherectomy is a neurosurgical procedure used to treat cases of severe intractable epilepsy. There are two types of hemispherectomy. In an anatomic hemispherectomy, a large amount of brain mass is removed whereas the functional technique involves removed a smaller amount of the affected area and disconnecting the brain tissue. The postoperative results of hemispherectomy may include improvement or deterioration in behavior, cognitive function, motor function, speech function, and seizure frequency. There is little to no data available on postoperative headaches in pediatric hemispherectomy patients. Our objective was to determine whether pediatric posthemispherectomy headaches are a significant negative outcome for this type of surgery. This data can potentially lead to better, quicker treatment and alleviation of pain and suffering for future hemispherectomy patients. Methods: We reviewed 74 pediatric hemispherectomy patients from the last 5 years at the Cleveland Clinic. 14 patients were excluded because they were too young to respond or did not respond to our letter, leaving 60 eligible participants. The medical records of the remaining 60 patients were reviewed and followed up with a letter and a subsequent 10-minute phone questionnaire asking about patients’ postoperative headache symptoms. IRB approval was obtained. Results: 60 of the 74 patients were contacted and 22 (36.7%) completed the questionnaire. 38 patients could not be reached or refused to participate. Of the remaining 22 patients, 11 were male (50%) and 11 were female (50 %). The median age at surgery was 6.5 years old. The most common types of hemispherectomy were left functional (50.0%) and right functional (31.8%). Among 22, 9 (39.1%) had headaches prior to surgery, and 7 (31.8%) reported having a family history of headaches. 19 of 22 patients (86.4%) had headaches after the surgery, while 10 of 22 (45.5%) had headaches that began only after the surgery! Of the other 9 patients that had preoperative headaches, 6 (66.6%) reported an increase in frequency and intensity of headache after the surgery while 2 (22.2%) reported no change and 1 (11.1%) reported a decrease. The p-values obtained were not statistically significant due to the small sample size and more data is needed to confirm these findings. Conclusions: The study showed that a majority of hemispherectomy patients reported the presence of headaches after their surgery! It is a significant postoperative concern. Most of those that had headaches before their surgery had an increase in headaches afterward! The most common type of headache reported was non-migrainous headache. We recommend that hemispherectomy patients should be queried preoperatively, followed closely postoperatively, and questioned regarding the presence of headache. Patients should be assessed and treated quickly to decrease prolonged pain and suffering and increase function. Further, prospective studies are needed to establish the true frequency of this condition. Funding: No funding