Postoperative Hemispherectomy Management and Outcome: A Review of 100 Cases.
Abstract number :
2.294
Submission category :
Year :
2001
Submission ID :
684
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
E.P. Vining, MD, Neurology, Johns Hopkins Hospital, Baltimore, MD; E.H. Kossoff, MD, Neurology, Johns Hopkins Hospital, Baltimore, MD; P.L. Pyzik, RN, Neurology, Johns Hopkins Hospital, Baltimore, MD; K-S. Min, MD, Neurology, Seoul, Democratic Peoples Rep
RATIONALE: The excellent long-term outcome for hemispherectomy is well documented. However, the immediate postoperative period is poorly described and there is much variation in management. Our objective was to determine the incidence of postoperative complications and fevers, identify predictive factors for complications and outcome, and create a protocol for future postoperative care.
METHODS: 100 hemispherectomies have been performed at our institution from 1968 to 2001. Indications have included predominantly Rasmussen[scquote]s syndrome, developmental dysplasias, vascular injuries, and Sturge Weber syndrome. Medical records were retrospectively examined for information regarding the immediate postoperative care. One chart was not available for review.
RESULTS: 3 children died in the immediate perioperative period. Complications occurred in 32% of patients, and there was no difference between the preoperative diagnoses. 81% had postoperative fevers (temperature [gt] 38.5[degree]C). Of these children, 2/3 had lumbar punctures done, but only 10 cases (17%) had positive CSF growth. Organisms included S. epidermidis, S. viridans, S. aureus, and E. cloacae. Patients with meningitis had higher maximum temperature peaks (39.9[degree]C vs. 39.4[degree]C, p=0.01) and had higher CSF pleocytosis (WBC 1564 vs. 486/hpf, p=0.05). 80% of meningitic patients had clinical symptoms in addition to fever (e.g. headache, lethargy, confusion) compared to half of those with sterile CSF. There was no mortality from meningitis. Shunting occurred in 15 patients and was significantly increased in the meningitis cases (50% vs. 13%, p=0.001), but was not significantly related to increased CSF protein or pleocytosis. Management variability was seen in steroid use, antibiotic duration, and time to mobilization. Based on this, standardized postoperative order sheets were created and are currently in use.
CONCLUSIONS: Postoperative fevers were quite common after hemispherectomy, but were rarely associated with meningitis. Children with meningitis tended to be more ill, with higher temperature spikes. Shunting was also infrequent and may be associated with infection. Variability in management has led to standardized order sheets in our institution in order to improve patient care.