Minimizing blood loss in hemispherectomy for hemimegalencephaly in low-weight infants: technical note

Introduction: Drug-resistant seizures due to hemimegalencephaly in neonates and infants are a unique surgical and anesthesia challenge. While early surgery in these patients may predict a better seizure control, a lower body weight, limited blood volume, and surgical blood loss may make hemispherectomy prohibitive. Methods: Two infants (weight, 8.7 kg and 3.7 kg) underwent interhemispheric vertical hemispherotomy with endoscope assistance. In the first case, during the lateral disconnection, excessive bleeding prompted the surgeon to coagulate the lenticulostriate arteries at the origin from the middle cerebral artery to reduce bleeding. In the second infant, the lenticulostriate arteries were coagulated before initiating the lateral disconnection. Results: In both infants, the blood loss from lateral dissection was reduced by coagulation of lenticulostriate arteries. Conclusion: The authors suggest that early coagulation of the lenticulostriate arteries is a useful strategy to minimize blood loss in low-weight infants undergoing hemispherotomy.