Chen Chih-Wei, Kuo Jinn-Rung, Lin Hung-Jung, Yeh Chao-Hung, Wong Bing-Sang, Kao Cheng-Hsing, Chio Chung-Ching
Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Yung Kang City, Tainan, Taiwan.
J Clin Neurosci. 2004 Sep;11(7):706-9. doi: 10.1016/j.jocn.2004.03.019.
The incidence of seizures in patients undergoing burr-hole crainiostomy with closed-system drainage for chronic subdural hematoma (CSDH) is low. The post-operative use of anticonvulsants is, thus, controversial. In this study, we tried to correlate pre-operative computed tomographic (CT) appearance of the CSDH with the need for post-operative seizure prophylaxis. From April 1998 to November 2001, 128 cases of CSDH surgically treated at our hospital were studied. All patients underwent burr-hole craniostomy with closed system drainage. All CSDHs were classified as low-density, isodense, and mixed-density lesions according to CT findings. The incidence of early post-operative seizures (within 3 weeks of surgery) among all patients was 5.4% (7/128). In the subgroups by lesion density, the incidences were 6.2% (1/16) in the low-density group, 2.4% (2/83) in the isodense group, and 13.7% (4/29) in the mixed-density group (all p < 0.05). The mean age among the seven patients (five males and two females) who had seizures was 71 years. The locations of the CSDHs among the 128 patients were the left side of the brain in 53 (41.4%) patients, right side in 45 (35.2%), and bilateral in 30 (23.4%) patients. Among the seven patients who suffered from post-operative seizures, five (71.4%) had left side CSDHs, one (14.2%) had a right side CSDH, and one (14.2%) had bilateral CSDHs. We concluded that the post-operative seizure rate appeared high in the group with mixed-density type lesions on CT, and in those with left unilateral CSDH. We suggest the use of prophylactic anticonvulsants for patients with mixed-density lesions on pre-operative CT.
采用闭式引流钻孔颅骨切开术治疗慢性硬膜下血肿（CSDH）的患者癫痫发作发生率较低。因此，术后使用抗惊厥药物存在争议。在本研究中，我们试图将CSDH的术前计算机断层扫描（CT）表现与术后癫痫预防的必要性联系起来。1998年4月至2001年11月，对我院手术治疗的128例CSDH患者进行了研究。所有患者均接受了闭式引流钻孔颅骨切开术。根据CT表现，所有CSDH均分为低密度、等密度和混合密度病变。所有患者术后早期（术后3周内）癫痫发作发生率为5.4%（7/128）。在按病变密度划分的亚组中，低密度组发生率为6.2%（1/16），等密度组为2.4%（2/83），混合密度组为13.7%（4/29）（所有p<0.05）。发生癫痫的7例患者（5例男性和2例女性）的平均年龄为71岁。128例患者中CSDH的位置，左侧大脑53例（41.4%），右侧45例（35.2%），双侧30例（23.4%）。在7例术后癫痫患者中，5例（71.4%）为左侧CSDH，1例（14.2%）为右侧CSDH，1例（14.2%）为双侧CSDH。我们得出结论，CT上混合密度型病变组以及左侧单侧CSDH患者的术后癫痫发生率似乎较高。我们建议对术前CT显示为混合密度病变的患者使用预防性抗惊厥药物。
