Search Results

You are looking at 1 - 4 of 4 items for :

  • Author or Editor: Eishi Asano x
  • Journal of Neurosurgery: Pediatrics x
Clear All Modify Search
Restricted access

Sandeep Sood, Eishi Asano and Harry T. Chugani

Object

Fever is a common occurrence after cerebral hemispherectomy in children and prolongs the hospital stay. The authors determined whether an external ventriculostomy might reduce the incidence of fever following a hemispherectomy.

Methods

The postoperative courses of 27 patients who had undergone cerebral hemispherectomy for intractable seizures were retrospectively analyzed.

Results

Thirteen children underwent an external ventriculostomy, and only 1 had an elevated axillary body temperature of ≥ 39°C during the postoperative period. Among 14 patients who did not undergo an external ventriculostomy, 7 had a posthemispherectomy fever of ≥ 39°C. Patients who underwent an external ventriculostomy had a lower risk of postoperative fever compared with those who did not undergo the procedure (8 vs 50%, respectively; p = 0.03, Fisher exact test). None of the patients had an infection accounting for the cause of the fever. The hospital stay for patients who had undergone postoperative external ventriculostomy was significantly shorter than for those who had not (7.2 ± 2 vs 11.3 ± 5 days, respectively; p = 0.01, Student t-test).

Conclusions

The use of external ventriculostomy following hemispherectomy for intractable epilepsy in children reduces the incidence of postoperative fever due to infection.

Free access

Sandeep Sood, Neena I. Marupudi, Eishi Asano, Abilash Haridas and Steven D. Ham

OBJECT

Corpus callosotomy and hemispherotomy are conventionally performed via a large craniotomy with the aid of a microscope for children with intractable epilepsy. Primary technical considerations include completeness of disconnection and blood loss. The authors describe an endoscopic technique performed through a microcraniotomy for these procedures.

METHODS

Four patients with drop attacks and 2 with intractable seizures related to a neonatal stroke underwent endoscopic complete corpus callosotomy and hemispherotomy, respectively. The surgeries were performed through a 2- to 3-cm precoronal microcraniotomy. Interhemispheric dissection to the corpus callosum was done using the standard technique. Subsequently, the bimanual technique with a suction device mounted on an endoscope was used to perform a complete corpus callosotomy, including interforniceal and anterior commissure disconnection. In patients who had hemispherotomy, the fornix was resected posteriorly and lateral disconnection was done by unroofing the temporal horn. Anteriorly, endoscopic corticectomy was done along the ipsilateral anterior cerebral artery to reach the bifurcation of the internal carotid artery to complete the anterior disconnection. Postoperative MRI and diffusion tensor imaging (DTI) of the brain were performed to confirm complete disconnection.

RESULTS

The procedure was accomplished successfully in all patients, with excellent visualization secured. None of the patients required a blood transfusion. Postoperative MRI and DTI confirmed completeness of the disconnection. Patients who underwent corpus callosotomy had complete resolution of drop attacks at a mean follow-up of 6 months, and patients who underwent hemispherotomy became seizure free.

CONCLUSIONS

Endoscopic corpus callosotomy and hemispherotomy are surgically feasible procedures associated with minimal blood loss, minimal risk, and excellent visualization.

Full access

Sandeep Sood, Eishi Asano, Deniz Altinok and Aimee Luat

Traditionally corpus callosotomy is done through a craniotomy centered at the coronal suture, with the aid of a microscope. This involves dissecting through the interhemispheric fissure below the falx to reach the corpus callosum. The authors describe a posterior interhemispheric approach to complete corpus callosotomy with an endoscope, which bypasses the need to perform interhemispheric dissection because the falx is generally close to the corpus callosum in this region.

Free access

P. Sarat Chandra and Manjari Tripathi