Department of Neurosurgery, Fujita Health University School of Medicine, 1-98 Kutsukake, Toyoake, 458-0831, Japan.
Neurosurg Rev. 2013 Jul;36(3):447-54. doi: 10.1007/s10143-013-0460-3. Epub 2013 Apr 7.
Seizures occurring after clipping of unruptured cerebral aneurysms have rarely been documented in the literature. The objective of this retrospective study is to clarify whether the frequency of early seizures, i.e., seizures occurring within 14 days of surgery, is influenced by patient- or aneurysm-specific characteristics. Data on 1,000 consecutive patients who underwent clipping of unruptured anterior circulation aneurysms were reviewed. They consisted of 387 men and 613 women with mean age of 59.8 ± 9.7 years. Fifty-one patients (5.1 %) developed early seizures. Interestingly, the frequency was similar to that occurring after clipping of unruptured posterior circulation aneurysms (n = 20, 5.0 %). Multivariate regression analysis revealed that younger age was correlated with early seizures (odds ratio (OR) 0.902; 95 % confidence interval (CI) 0.891-0.989). However, other variables, including aneurysm size and operation length, were not correlated. Although patients with history of epilepsy exhibited relatively high frequency of early seizures, the difference was not statistically significant. The frequency was unaffected by location or multiplicity of aneurysms. Thirty-one patients (61 %) developed seizures within 24 h of clipping. Regarding seizure types, 34 (67 %) developed generalized seizures and the other 17 (33 %) experienced partial seizures. Patients with generalized seizures were significantly more likely to harbor an iatrogenic brain lesion than those with partial seizures (47 vs. 18 %; OR 4.148; 95 % CI 1.005-17.113). Among 40 patients with follow-up period >12 months, seizures were temporary without recurrence in 38 (95 %). Although early seizures are mostly benign, a small possibility of them becoming a permanent morbidity needs to be explained to patients undergoing elective clipping.
夹闭未破裂脑动脉瘤后很少有文献记录到发作。本回顾性研究的目的是阐明早期发作（即手术 14 天内发生的发作）的频率是否受患者或动脉瘤特征的影响。回顾了 1000 例连续接受未破裂前循环动脉瘤夹闭术的患者的数据。他们包括 387 名男性和 613 名女性，平均年龄为 59.8±9.7 岁。51 例（5.1%）发生早期发作。有趣的是，其发生率与未破裂后循环动脉瘤夹闭术相似（n=20，5.0%）。多变量回归分析显示，年龄较小与早期发作相关（优势比（OR）0.902；95%置信区间（CI）0.891-0.989）。然而，包括动脉瘤大小和手术时间在内的其他变量与早期发作无关。尽管有癫痫病史的患者早期发作频率相对较高，但差异无统计学意义。发作频率不受动脉瘤位置或多发性的影响。31 例（61%）在夹闭后 24 小时内发生癫痫发作。关于发作类型，34 例（67%）为全身性发作，17 例（33%）为部分性发作。全身性发作的患者比部分性发作的患者更容易发生医源性脑损伤（47%比 18%；OR 4.148；95%CI 1.005-17.113）。在 40 例随访时间>12 个月的患者中，发作是暂时的，无复发 38 例（95%）。虽然早期发作大多是良性的，但需要向接受择期夹闭的患者解释其发生永久性发病率的可能性较小。
