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Category: Volume 09 Issue 12 December 2021
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Title: Anaesthesia Approach for Cerebral Hemispherotomy in a Child with Hemimegaencephaly and Cortical Dysplasia with Intractable Epilepsy

Authors: Dr Pratima Kothare, Dr Dipti Madan

 DOI: https://dx.doi.org/10.18535/jmscr/v9i12.04

Abstract

Cerebral Hemispherectomy (CH), is an advanced and rare surgical treatment to reduce or eliminate intractable seizures in children with Hemimegaencephaly (HME) and Cortical Dysplasia (CD). Aim of early surgical intervention is to have a seizure free patient.

Presenting a case of a 12 month, 12 kg child, with seizures from day 13 of birth in the form of small jerks lasting for 3 to 4 minutes multiple times a day and was prescribed a multidrug regimen of anticonvulsants since then. Brain MRI showed right megaloencephaly with dysplastic cortex of white matter. The patient was induced with standard intravenous induction, endotracheally intubated, and maintained on normocapneic volume controlled ventilation.

The duration of the surgery was approximately 9 hours. A blood loss of almost the patient’s entire blood volume was observed (80 ml/kg), with subsequent hypotension, fall in hemoglobin and metabolic disturbances accompanying massive blood loss. There were no intraoperative seizures. The patient was ventilated electively for 3 days postoperatively, with no postoperative complications and uneventful Pediatric Intensive Care Unit (PICU) stay.

Keywords: pediatric neurosurgery, intractable seizures, hemimegalencephaly, cortical dysplasia, cerebral hemispherotomy.

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Corresponding Author

Dr Dipti Madan

Bombay Hospital Institute of Medical Sciences, 12 New Marine Lines, Mumbai- 400020