Anesthetic management of a patient after functional hemispherectomy using bilateral bispectral index monitoring.

A 16-year-old woman with hypomelanosis of Ito (HI) was scheduled for surgical correction of a left wrist contracture and left cavus foot deformity under general anesthesia. She had left hemiplegia and right hemianopia, but otherwise normal cerebral function. At the age of 8 months she had undergone right functional hemispherectomy for medically intractable epilepsy caused by right hemimegalencephaly (HME), a recognized feature of HI. Nonetheless, she continued to take carbamazepine as anticonvulsant therapy. Laboratory tests revealed slight elevations in the serum concentrations of total cholesterol, creatine kinase, alanine transaminase, and γ-glutamyltransferase.