Kamath Ashwin A, Limbrick David L, Smyth Matthew D
Department of Neurological Surgery, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO, 63110, USA,
Childs Nerv Syst. 2015 Feb;31(2):291-6. doi: 10.1007/s00381-014-2572-7. Epub 2014 Oct 21.
Patients who have undergone hemispherotomy for intractable epilepsy tend to develop postoperative fevers, which can be severe and/or prolonged, for unclear reasons. The purpose of this paper is to characterize postoperative fever curves after hemispherotomy based on factors including seizure etiology, perioperative blood loss, and the presence or absence of ventricular drainage.
We present 72 patients who underwent hemispherotomy at our institution between 1995 and 2013 by four surgeons. Data including daily maximum body temperature, seizure etiology, ventricular drain use, steroid and antipyretic use, and seizure control were gathered retrospectively based on electronic records including operative summaries, nursing notes, discharge summaries, and follow-up clinic notes.
Seventy-two patients from 11 weeks to 21 years old (mean 7.4 years old) underwent hemispherotomy between 1995 and 2013. Sixty (83%) had fevers postoperatively, while the remainder were afebrile. Patients without external ventricular drains had higher and more prolonged fevers compared to those with drains (p = 0.003). Patients with Rasmussen's encephalitis tended to have higher postoperative fevers than patients with other seizure etiologies (p = 0.005), while patients with cortical dysplasia and polymicrogyria tended to have less severe fevers (p = 0.027 and 0.017, respectively). Fifty-five patients (76%) had freedom from disabling seizures (Engel class I), and 96% showed worthwhile improvement or better (Engel classes I-III).
Postoperative fever can be anticipated in hemispherotomy patients, may vary based on certain seizure etiologies, and may be mitigated by routinely utilizing external ventricular drainage. Hemispherotomy is an effective surgical procedure for intractable epilepsy in selected patients.
因难治性癫痫接受大脑半球切除术的患者术后往往会出现发热，原因不明，且发热可能严重和/或持续时间较长。本文旨在根据癫痫病因、围手术期失血情况以及是否存在脑室引流等因素，对大脑半球切除术后的发热曲线特征进行描述。
我们呈现了1995年至2013年间在本机构由四位外科医生实施大脑半球切除术的72例患者。基于包括手术总结、护理记录、出院总结和随访门诊记录在内的电子记录，回顾性收集了每日最高体温、癫痫病因、脑室引流使用情况、类固醇和退烧药使用情况以及癫痫控制情况等数据。
1995年至2013年间，72例年龄在11周龄至21岁（平均7.4岁）的患者接受了大脑半球切除术。60例（83%）术后发热，其余患者未发热。与有脑室引流的患者相比，没有外部脑室引流的患者发热更高且持续时间更长（p = 0.003）。患有拉斯穆森脑炎的患者术后发热往往高于其他癫痫病因的患者（p = 0.005），而患有皮质发育异常和多小脑回的患者发热往往不太严重（分别为p = 0.027和0.017）。55例患者（76%）无致残性癫痫发作（恩格尔I级），96%的患者显示有显著改善或更好（恩格尔I - III级）。
大脑半球切除术患者术后可能会出现发热，发热情况可能因某些癫痫病因而异，常规使用外部脑室引流可能会减轻发热。大脑半球切除术对特定患者的难治性癫痫是一种有效的外科手术。
