Australian School of Advanced Medicine, 2 Technology Place, Macquarie University, NSW 2109, Australia.
J Clin Neurosci. 2013 Nov;20(11):1498-502. doi: 10.1016/j.jocn.2013.02.013. Epub 2013 Jul 27.
Few studies detail the risk of in-hospital seizures following elective surgical or endovascular treatment of unruptured intracranial aneurysms (UIA). We compared the peri-procedural seizure incidence for clipping and coiling of UIA. A retrospective cohort study using the Australian National Hospital Morbidity Database from 1998 to 2008 was conducted. Treatment modalities were compared for the combined primary end point related to seizure. Putative risk factors were investigated with univariate and multivariate logistic regression analysis to identify independent predictors of outcome. A total of 5922 hospitalisations for UIA (3098 clipping, 2824 coiling) were identified. Overall, surgery was associated with a 2.7% (95% confidence interval [CI] 2.2-3.4) incidence of peri-operative seizures, compared to a 0.6% (95% CI 0.4-1.0) incidence following endovascular treatment (adjusted odds ratio [OR] 4.40; 95% CI 2.64-7.33; p<0.001). The incidences of seizures declined over the 11 year study period in both treatment groups, from 4.2% to 2.0% for surgery and from 2.8% to 0.3% for endovascular. Haemorrhagic complication with intracerebral haemorrhage predicted occurrence of a seizure (OR 3.41; 95% CI 1.20-9.66; p=0.021), whereas endovascular coiling was associated with a better seizure outcome (OR 0.23; 95% CI 0.14-0.39; p<0.001). Overall, elective surgical treatment of UIA is associated with a higher risk of seizure occurrence compared to endovascular coiling. Contrary to conventional thinking, the risk of seizures following endovascular treatment is not entirely absent. Current recommendations must be considered in relation to the issue of driving after elective intracranial aneurysm treatment.
很少有研究详细描述择期手术或血管内治疗未破裂颅内动脉瘤（UIA）后住院期间癫痫发作的风险。我们比较了夹闭和血管内治疗 UIA 的围手术期癫痫发作发生率。使用澳大利亚国家医院发病率数据库进行了一项回顾性队列研究，时间范围为 1998 年至 2008 年。将治疗方式与与癫痫发作相关的联合主要终点进行比较。使用单变量和多变量逻辑回归分析调查了假定的危险因素，以确定结果的独立预测因素。共确定了 5922 例 UIA 住院患者（夹闭 3098 例，血管内治疗 2824 例）。总体而言，手术相关的围手术期癫痫发作发生率为 2.7%（95%置信区间 [CI] 2.2-3.4），而血管内治疗后为 0.6%（95% CI 0.4-1.0）（调整后的优势比 [OR] 4.40；95% CI 2.64-7.33；p<0.001）。在这 11 年的研究期间，两组的癫痫发作发生率均下降，手术组从 4.2%降至 2.0%，血管内组从 2.8%降至 0.3%。伴颅内出血的出血性并发症预测癫痫发作的发生（OR 3.41；95% CI 1.20-9.66；p=0.021），而血管内血管内治疗与更好的癫痫发作结局相关（OR 0.23；95% CI 0.14-0.39；p<0.001）。总体而言，与血管内治疗相比，UIA 的择期手术治疗与更高的癫痫发作风险相关。与传统观念相反，血管内治疗后癫痫发作的风险并非完全不存在。在考虑与择期颅内动脉瘤治疗后驾驶相关的问题时，必须考虑当前的建议。
