Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
J Neurosurg. 2009 Dec;111(6):1257-62. doi: 10.3171/2009.6.JNS0928.
Despite the prevalence of chronic subdural hematoma (CSDHs) in the rapidly growing elderly population, several aspects of disease management remain unclear. In particular, there is still conflicting evidence regarding the efficacy of antiepileptic drug (AED) prophylaxis in patients with CSDH who undergo bur hole drainage. The authors endeavored to evaluate the efficacy of AED prophylaxis in reducing the incidence of seizures and improving outcome in this patient population.
A single surgeon's clinical database (E.S.C.) was analyzed for cases involving bur hole drainage for CSDH. Cases involving nonhemorrhagic subdural effusions as well as acute subdural hemorrhages evacuated by craniotomy were excluded from this study. Patient medical records were evaluated for relevant demographic data, medical history, imaging characteristics, clinical details of the treatment, hospital stay, and discharge summaries.
The authors included 88 patients with bur hole-treated CSDH. Eleven patients (12.5%) suffered at least 1 seizure between hemorrhage onset and discharge from their treatment hospital admission. Seizures were more frequent in women than men (p = 0.030) and least frequent in patients with right-sided lesions (p = 0.030). In a multiple logistic regression model, preoperative initiation of AED prophylaxis was the only significant predictor of the lower incidence of postoperative seizures (OR 0.10, p = 0.013). However, preoperative initiation of AED prophylaxis did not significantly affect outcome at discharge.
The finding in this study demonstrates that preoperative AED prophylaxis likely reduces the incidence of postoperative seizures in patients with CSDH treated with bur hole drainage. A future prospective randomized study is necessary to evaluate the effect of seizure reduction on clinical outcome.
尽管慢性硬脑膜下血肿（CSDH）在快速增长的老年人群中普遍存在，但疾病管理的几个方面仍不清楚。特别是，对于接受颅骨钻孔引流术的 CSDH 患者，抗癫痫药物（AED）预防的疗效仍存在相互矛盾的证据。作者努力评估 AED 预防在降低此类患者人群癫痫发作发生率和改善预后方面的疗效。
对涉及颅骨钻孔引流治疗 CSDH 的单外科医生临床数据库（E.S.C.）进行分析。排除非出血性硬脑膜下积液以及开颅手术清除急性硬脑膜下血肿的病例。评估患者病历以获取相关人口统计学数据、病史、影像学特征、治疗临床细节、住院时间和出院总结。
作者纳入了 88 例接受颅骨钻孔治疗的 CSDH 患者。11 例（12.5%）在发病至出院期间至少发生 1 次癫痫发作。女性的癫痫发作频率高于男性（p = 0.030），右侧病变患者的癫痫发作频率最低（p = 0.030）。在多因素逻辑回归模型中，术前开始 AED 预防是术后癫痫发作发生率降低的唯一显著预测因素（OR 0.10，p = 0.013）。然而，术前开始 AED 预防并未显著影响出院时的结局。
本研究的发现表明，对于接受颅骨钻孔引流术治疗的 CSDH 患者，术前 AED 预防可能降低术后癫痫发作的发生率。需要进行前瞻性随机研究以评估减少癫痫发作对临床结局的影响。
