Kombogiorgas Dimitris, Jatavallabhula N Shastri, Sgouros Spyros, Josan Vivek, Walsh A Richard, Hockley Anthony D
Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
Childs Nerv Syst. 2006 Nov;22(11):1441-5. doi: 10.1007/s00381-006-0117-4. Epub 2006 May 30.
We performed a retrospective analysis of children undergoing supratentorial craniotomy, attempting to identify possible risk factors for postoperative epilepsy and the need for prophylactic anticonvulsant therapy.
We analysed 107 consecutive patients (55% males) who had supratentorial craniotomy for a variety of diagnoses (tumours, trauma, infection, vascular malformations and others) during 1995-1999. Mean age at operation was 89 months (range: 1-180 months). Patients who presented with epilepsy were excluded. Postoperative epilepsy was considered present if patients required systematic pharmacological treatment, at a minimum follow-up of 6 months. Linear regression was used to analyse the effect of sex, anticonvulsant prophylaxis, duration of operation, closure of dura, postoperative infection, the diagnosis, anatomical region of brain affected, operation type (craniotomy/craniectomy) and the need for brain resection.
Prophylactic anticonvulsants were given to 52% of the patients; 97% had craniotomy; in five patients, the dura was left open; in 33%, some kind of brain tissue resection had been performed; two patients (1.8%) developed postoperative infection; one patient died. Only 13 patients (12%) developed postoperative epilepsy. The only two factors with statistical significance were female sex (p=0.045) and the absence of dural closure (p=0.001). All other factors were not significant (p>0.258).
Postoperative epilepsy after supratentorial craniotomy is uncommon in children, incidence being 12%. The administration of prophylactic anticonvulsants does not appear to influence the risk of epilepsy. Surprisingly, females have statistically higher risk. Lack of dural closure has higher risk of epilepsy, but this may reflect the type of pathology.
我们对接受幕上开颅手术的儿童进行了回顾性分析，试图确定术后癫痫的可能危险因素以及预防性抗惊厥治疗的必要性。
我们分析了1995年至1999年间连续107例接受幕上开颅手术的患者（55%为男性），这些患者因各种诊断（肿瘤、创伤、感染、血管畸形等）接受手术。手术时的平均年龄为89个月（范围：1至180个月）。有癫痫表现的患者被排除。如果患者在至少6个月的随访期内需进行系统性药物治疗，则认为存在术后癫痫。采用线性回归分析性别、抗惊厥预防、手术持续时间、硬脑膜关闭、术后感染、诊断、受影响脑区的解剖位置、手术类型（开颅术/颅骨切除术）以及脑切除需求的影响。
52%的患者接受了预防性抗惊厥药物治疗；97%的患者接受了开颅手术；5例患者硬脑膜未关闭；33%的患者进行了某种脑组织切除；2例患者（1.8%）发生术后感染；1例患者死亡。仅13例患者（12%）发生术后癫痫。具有统计学意义的仅两个因素为女性（p = 0.045）和硬脑膜未关闭（p = 0.001）。所有其他因素均无统计学意义（p>0.258）。
幕上开颅术后儿童发生癫痫并不常见，发生率为12%。预防性抗惊厥药物的使用似乎不影响癫痫风险。令人惊讶的是，女性在统计学上风险更高。硬脑膜未关闭癫痫风险更高，但这可能反映了病理类型。
