HEMISPHERECTOMY - A HEMIDECORTICATION APPROACH AND REVIEW OF 52 CASES

Between 1975 and 1994, 52 hemispherectomies, of which two were anatomi cal and 50 hemidecortications, were performed at Johns Hopkins Medical Institutions. Eighteen patients were 2 years old or less. There were three perioperative mortalities and one patient died 9 months later fr om causes not related to surgery. One patient developed hydrocephalus 6 years postsurgery and has been treated effectively. Seizure control and the functional status of each patient were measured as outcome var iables. Forty-six (96%) of the surviving patients were seizure free or had reduced seizures as of their last follow-up examination. Twenty-o ne individuals (44%) were participating in age-appropriate classes or working independently, 18 were classified as semiindependent, and nine children will likely depend on a lifetime of assisted living. The rel ationships between the outcome variables and the patient's age at surg ery, the interval to surgery, and the etiology of the disease were com pared. The authors' clinical experiences strongly suggest the importan ce of a multidisciplinary approach to patient selection and follow-up care. Moreover, anesthetic management of infant surgery is a major com ponent of success.