Fevers Following Hemispherectomy Usually Harmless

A large study has found that postoperative fevers in children following hemispherectomy are seldom serious, so most children can be spared painful spinal taps or other invasive treatments. The study was published in the November 2002 issue of Pediatric Surgery.

Hemispherectomy is a procedure in which half the brain is removed to relieve frequent severe seizures that cannot be controlled by medications. Researchers reviewed the charts from 106 consecutive procedures, including 102 hemidecortications, a less-radical form of the procedure. They found that more than 80% of the patients had postoperative fevers. Of these, 62% were given lumbar punctures to diagnose suspected bacterial meningitis. Only six were diagnosed with meningitis and these children had complained of headache, lethargy, and wound discharge, which most of the children with low-grade fever did not experience.

Other factors that indicated infections included elevated white blood cell counts in the cerebrospinal fluid, very high temperatures, and prolonged use of steroids. As a result of the study, the researchers, from Johns Hopkins Children's Center (Baltimore, MD, USA), say doctors and nurses may allow fevers without other symptoms to persist as long as two weeks if the child is active and playful.

"This study has already been helpful to the physicians and nurses providing postoperative care for these children because it helps them anticipate which patients truly require spinal taps,” said Eric Kossoff, a pediatric surgeon at the Children's Center who led the research.




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