Incidence Of Hemiparesis Research Articles

Complications of interhemispheric transcallosal approach in children: Review of 15 years experience

Objective The interhemispheric transcallosal approach to deep-seated lesions in and around the ventricular system avoids cortical manipulation and injury. Few case series discuss the morbidity associated with this approach. This study describes the 15-year experience of the senior author in Southern California. Methods All pediatric patients who have undergone interhemispheric, transcallosal resections of mass lesions over a 15-year period were identified. The surgical approach was uniform with respect to positioning of the patient. Intra-operative and post-operative data were collected retrospectively from the medical records. The need for bridging vein ligation as well as the incidence of hemiparesis, seizures, memory disturbances, and the need for subsequent cerebrospinal fluid (CSF) diversion were identified. Results Sixty-five patients were identified. The incidence of transient post-operative hemiparesis appeared to be higher in those patients who required ligation of one or two parasagittal veins (44.6% versus 18.5%) with no difference in long-term outcome. Nineteen percent (18.5%) of patients had post-operative seizures; however, no long-term seizure disorder was identified. Nine percent (9.2%) had reports of transient short-term memory deficits. Thirty-four percent (33.8%) of patients required secondary operative intervention for CSF diversion. The total complication rate, including need for CSF diversion, transient hemiparesis, infection, post-operative seizures, and memory disturbance was 36.9%. By 1 year, the total number of patients with persistent hemiparesis, memory disturbance, or seizures refractory to medication was 4 (6.2%). Conclusion This series demonstrates that the interhemispheric transcallosal corridor is a versatile and safe approach in childhood, resulting in low post-operative permanent morbidity.

Halothane reduces focal ischemic injury in the rat when brain temperature is controlled.

Previous work has demonstrated that rats anesthetized with halothane during focal cerebral ischemia have better histologic and neurologic outcome than do rats undergoing the same insult when awake. The purpose of this experiment was to determine whether this difference persists when brain temperature is held similar in halothane-anesthetized and awake experimental groups. Two ischemia experiments were performed. In both, the middle cerebral artery was occluded for 90 min. Temperature was monitored from a radiotelemetered thermistor implanted in the cerebral cortex. Four days after ischemia, infarct volume and neurologic function were assessed. In experiment 1, brain temperature was not controlled in awake rats. Temperature in rats anesthetized with halothane, approximately 1 minimum alveolar concentration, was regulated by servomechanism by surface heating or cooling to replicate the temperature profiles generated by awake animals. To address methodologic issues regarding infarct volume analysis, a subset of nine rats was examined for the effect of the histologic staining technique and the mathematical modeling algorithms used for computation of infarct volume values. In experiment 2, the brain temperature of awake and halothane-anesthetized rats was maintained normothermic (38.0 degrees C) throughout ischemia and early recirculation. In experiment 1 no difference between groups was observed for cortical (halothane 146 +/- 95 mm3 and awake 126 +/- 108 mm3; P = 0.64) or subcortical (halothane 110 +/- 48 mm3 and awake 100 +/- 66 mm3; P = 0.66) infarct volume. Neurologic function was also similar between groups. Total infarct volume was approximately 11% greater when histologic sections were stained with hematoxylin and eosin than when they were stained with nitro blue tetrazolium, although volumes correlated closely between the two techniques (r2 = 0.996). Analysis by orthogonal or frustum projection from two-dimensional planimetric areas to three-dimensional volumes resulted in nearly identical values (r2 = 0.999). In experiment 2, halothane-anesthetized rats experienced a 46% reduction in cortical infarct volume (halothane 106 +/- 97 mm3 and awake 197 +/- 103 mm3; P = 0.03). The incidence of hemiparesis was reduced in the anesthetized group (P = 0.03). When brain temperature was maintained normothermic throughout the focal ischemic insult, a neurologic and histologic protective effect for halothane anesthesia was observed. This effect of halothane was not sufficient to persist when large variations in brain temperature were allowed. Regulation of brain temperature is a critical factor in the determination of the effects of anesthetics on focal ischemic brain damage.

Assessment of craniocerebral asymmetries in children by computed tomography.

Computed tomographic (CT) scans of 32 children (mean age 2.8 +/- 2.5 years) with a wide range of craniocerebral asymmetry (CCA) were analyzed. Hemiparesis and epilepsy were the main clinical presentations. Two-thirds of the patients had brain infarcts. The degree of cerebral and ventricular asymmetry was evaluated by ratios obtained by linear measurements. The patients were divided into two groups according to the index of maximal asymmetry. The incidence of hemiparesis and the width of the cerebral ventricles did not differ in the two groups. This may be due to the fact that most of our patients suffered from perinatal insult to the brain, allowing time for remodeling and plastic changes to occur. The use of measurable structural parameters in craniocerebral asymmetry offers a basis for comparable radiological assessment.

Stereotaxic thalamotomy in 55 cases of dystonia.

The results of stereotaxic thalamotomy in 55 cases of dystonia are presented. The 16 cases with generalized dystonia were of varied pathogenesis, only 7 being typical of the idiopathic form of adolescent onset. Four of the 16 cases benefited considerably, but the others showed little or no lasting improvement. These results are in contrast to those obtained by Cooper (1976). Of the 27 cases with segmental or focal dystonia, 22 had spasmodic torticollis; 16 of these had bilateral thalamotomies, and 62 per cent were much improved. The incidence of operative complications, in particular dysarthria, was high following bilateral lesions. The incidence of hemiparesis, known to have persisted for more than a year, was 15 per cent. This complication was as frequent in those with unilateral as with bilateral thalamotomies. The incidence of dysarthria in those without preoperative bulbar dystonia was much higher in those who had bilateral lesions (56 per cent) as compared with those who had unilateral lesions (11 per cent). The group that has been identified as benefiting greatly from stereotaxic surgery comprises those with hemidystonia following unilateral brain damage. In these patients, symptomatic improvement in abnormal movement is striking and the incidence of operative side effects from unilateral lesions is low.