Abstracts

Rationale: Hemispherectomy is an extremely useful technique for treatment of refractory epilepsy associated with hemiplegic syndromes, Rasmussen syndrome, Sturge-Weber and hemispheric cortical dysplasia, among other etiologies. Different techniques (anatomical, functional, hemispherotomy) have been employed. Anatomical resections were shown to carry higher early and late complication rates; functional hemispherectomy and hemispherotomy have roughly the same complication rate. Intracranial hypertension due to hydrocephalus is one of the possible complications after hemispherectomy. We describe the frequency, type and treatment of post-functional hemispherectomy hydrocephalus in our series. Methods: Seventy-three patients were studied. All patients were submitted to functional hemispherectomy. Thirty-six had hemiplegic syndrome, 24 had Rasmussen encephalitis, 4 had hemimegaloencephaly, 4 cortical dysplasia, 1 had post-encephalitic syndrome and 4 had Sturge -Weber. All patients were followed-up for at least one year. Results: Three patients developed post-hemispherectomy hydrocephalus. One patient had a hemiplegic syndrome, one had Rasmussen syndrome and one post-encephalitic syndrome. The patient with Rasmussen syndrome received an ipsilateral VP shunt 1 month after hemispherectomy; the patient with hemiplegic syndrome received an ipsilateral VP shunt 4 months after hemispherectomy and the patient with post-encephalitic syndrome (who was previously shunt-dependent), received a contralateral VP shunt 2 days after hemispherectomy. All patients fully recovered after shunting. Conclusions: Hypertensive hydrocephalus might occur in around 4% of the patients submitted to functional hemispherectomy, and its ocurrance is apparently not related to a specific etiology. Patients who would develop hypertensive hydrocephalus did so within the first months post-operatively, or very early. Although life-threatening, adequate treatment led to full resolution in all patients.