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Posthemispherectomy hydrocephalus: results of a comprehensive, multiinstitutional review. Epilepsia 2013 Feb;54(2):383-9 PMID: 23106378 PMCID: PMC3566367

Pubmed ID

23106378

DOI

10.1111/epi.12010

Abstract

PURPOSE: Hemispherectomy surgery for medically intractable epilepsy is known to cause hydrocephalus in a subset of patients. Existing data regarding the incidence of, and risk factors for, developing posthemispherectomy hydrocephalus have been limited by the relatively small number of cases performed by any single center. Our goal was to better understand this phenomenon and to identify risk factors that may predispose patients to developing hydrocephalus after hemispherectomy surgery.

METHODS: Fifteen pediatric epilepsy centers participated in this study. A retrospective chart review was performed on all available patients who had hemispherectomy surgery. Data collected included surgical techniques, etiology of seizures, prior brain surgery, symptoms and signs of hydrocephalus, timing of shunt placement, and basic demographics.

KEY FINDINGS: Data were collected from 736 patients who underwent hemispherectomy surgery between 1986 and 2011. Forty-six patients had preexisting shunted hydrocephalus and were excluded from analysis, yielding 690 patients for this study. One hundred sixty-two patients (23%) required hydrocephalus treatment. The timing of hydrocephalus ranged from the immediate postoperative period to 8.5 years after surgery, with 43 patients (27%) receiving shunts >90 days after surgery. Multivariate regression analysis revealed anatomic hemispherectomies (odds ratio [OR] 4.1, p < 0.0001) and previous brain surgery (OR 1.7, p = 0.04) as independent significant risk factors for developing hydrocephalus. There was a trend toward significance for the use of hemostatic agents (OR 2.2, p = 0.07) and the involvement of basal ganglia or thalamus in the resection (OR 2.2, p = 0.08) as risk factors.

SIGNIFICANCE: Hydrocephalus is a common sequela of hemispherectomy surgery. Surgical technique and prior brain surgery influence the occurrence of posthemispherectomy hydrocephalus. A significant portion of patients develop hydrocephalus on a delayed basis, indicating the need for long-term surveillance.

Author List

Lew SM, Matthews AE, Hartman AL, Haranhalli N, Post-Hemispherectomy Hydrocephalus Workgroup

Authors

Sean Lew MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin
Anne E. Matthews PAC Physician Assistant Surgical in the Neurosurgery department at Medical College of Wisconsin




Scopus

2-s2.0-84873408765   25 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Basal Ganglia
Cerebrospinal Fluid Shunts
Child
Child, Preschool
Epilepsy
Female
Hemispherectomy
Hemostatics
Humans
Hydrocephalus
Infant
Logistic Models
Male
Postoperative Complications
Retrospective Studies
Risk Factors
Thalamus
Young Adult
jenkins-FCD Prod-310 bff9d975ec7f2d302586822146c2801dd4449aad