J.Jpn. Surg. Soc.. 62(1): 63-90, 1961

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THE INFLUENCES OF CEREBRAL HEMISPHERECTOMY ON THE MIDBRAIN-AUTONOMIC NERVOUS SYSTEM

Clinical and laboratory findings were compared before and after cerebral hemispherectomy in 9 cases of infantile hemiplegia, and the influences of this operation on the autonomic nervous system were investigated. The results obtained are as follows:
1) Metabolism : Metabolic processes in the patients were disturbed subclinically for one month following the operation, but gradually returned to normal in the 2nd postoperative month.
2) Body temperature : The rise in body temperature after operation lasted for one month, at the level about 37°C, in all cases, which is longer than that observed in other types of neurosurgical operations.
3) Vasomotor system : No significant change in pulse-rate and blood pressure was observed with exception of one case. Blood pressures measured on the both arms were not different. Electrocardiographic recordings did not show marked abnormalities after operation, except the development of respiratory arrhythmia in one case. Plethy smographic studies revealed peripheral vaso-dilatation in the extremities contralateral to the operated side.
4) Skin temperature: Skin temperature on the paretic side was unstable and influenced with the environmental factors easily before the operation. Such tendency became slightly more marked after operation.
5) Gastro-intestinal system: Frequent vomiting in the 1st postoperative month was observed in 3 cases. The tendency to constipation was noted in all cases.
6) Perspiration: Perspiration of the helf of the body contral-lateral to the operated side increased in the 6 months after operation and then decresed gradually .
7) Macrogenitosomia precox was found in 4 male and 1 female infants, of which one case showed adipositas and 3 cases developed lethalgic state in the two postoperative weeks. Negativism was observed in one of them.
From these results, it seems possible that the operative insults extended to the autonomic nervous centers in the hypothalamus, and the autonomic function in the cerebral cortex, was removed with the ablation of the cortex, and therefore, the disturbances in the autonomic nervous function became apparent after operation. However, loss of cerebral cortex may have not so important participation, and many of these symptoms were transient and disappeared almost completely in 6 months after operation, and the patients have not found any difficulty in the daily life.
(Author's abstract)

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