Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
Neurosurgery. 2011 Sep;69(3):644-50; discussion 650. doi: 10.1227/NEU.0b013e31821bc46d.
It is not clear whether treatment modality (clipping or coiling) affects the risk of seizures after treatment for cerebral aneurysms.
To determine whether there is an increased risk of seizures after clipping vs coiling.
Hospitalizations for clipping or coiling of ruptured and unruptured aneurysms were identified in the Nationwide Inpatient Sample Database for 2002 to 2007 by International Classification of Diseases 9th Revision codes for subarachnoid hemorrhage or unruptured cerebral aneurysm and codes for clipping or coiling. Clipping and coiling were compared for the combined primary endpoint of seizures or epilepsy. The analysis was adjusted for patient-specific and hospital-specific factors using generalized linear models with generalized estimated equations.
There were 10 899 hospitalizations for ruptured aneurysms (6593 clipping, 4306 coiling), and 9686 hospitalizations for unruptured aneurysms (4483 clipping, 5203 coiling). For ruptured aneurysm patients, clipping had a similar incidence of seizures or epilepsy compared with coiling (10.7% vs 11.1%, respectively, adjusted odds ratio: 0.596; 95% confidence interval: 0.158-2.248; P = .445 after adjustment for patient-specific and hospital-specific factors). For unruptured aneurysm patients, clipping was associated with a significantly higher risk of seizures or epilepsy (9.2%) compared with coiling (6.2%) (adjusted odds ratio: 1.362; 95% confidence interval: 0.155-1.606; P < .001 after adjustment for patient-specific and hospital-specific factors). Seizures or epilepsy were significantly associated with longer hospitalizations (P < .01) and higher hospital charges (P < .0001), except in coiled unruptured aneurysm patients, in which seizures or epilepsy were not significantly associated with hospital charges (P = .31).
In unruptured cerebral aneurysm patients, clipping is associated with a higher risk of seizures or epilepsy.
目前尚不清楚治疗方式（夹闭或栓塞）是否会增加脑动脉瘤治疗后的癫痫发作风险。
确定夹闭与栓塞治疗后癫痫发作的风险是否增加。
通过国际疾病分类第 9 版代码（蛛网膜下腔出血或未破裂脑动脉瘤）和夹闭或栓塞代码，从 2002 年至 2007 年的全国住院患者样本数据库中确定夹闭或栓塞治疗破裂和未破裂动脉瘤的住院患者。夹闭和栓塞治疗的主要终点是癫痫发作或癫痫。使用广义估计方程的广义线性模型，根据患者和医院的具体情况调整风险因素。
共有 10899 例破裂性动脉瘤（夹闭 6593 例，栓塞 4306 例）和 9686 例未破裂性动脉瘤（夹闭 4483 例，栓塞 5203 例）患者。与栓塞治疗相比，夹闭治疗破裂性动脉瘤患者的癫痫发作或癫痫发生率相似（分别为 10.7%和 11.1%，校正比值比：0.596；95%置信区间：0.158-2.248；调整患者和医院因素后，P =.445）。对于未破裂性动脉瘤患者，夹闭与癫痫发作或癫痫的风险显著增加相关（夹闭 9.2%，栓塞 6.2%）（校正比值比：1.362；95%置信区间：0.155-1.606；调整患者和医院因素后，P <.001）。癫痫发作或癫痫与住院时间延长（P <.01）和住院费用增加（P <.0001）显著相关，除了在栓塞治疗的未破裂性动脉瘤患者中，癫痫发作或癫痫与住院费用无显著相关性（P =.31）。
在未破裂性脑动脉瘤患者中，夹闭与癫痫发作或癫痫的风险增加相关。
