Department of Neurosurgery, Stroke and Epilepsy Center, TMG Asaka Medical Center, Asaka, Saitama, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Department of Neurosurgery, Stroke and Epilepsy Center, TMG Asaka Medical Center, Asaka, Saitama, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo, Japan.
Clin Neurol Neurosurg. 2021 Jan;200:106298. doi: 10.1016/j.clineuro.2020.106298. Epub 2020 Oct 8.
To evaluate the incidence of nonconvulsive status epilepticus (NCSE) after surgery for ruptured intracranial aneurysms, to define factors associated with this complication, and to determine its impact on the outcome.
Clinical and neurophysiological data of 66 patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent continuous EEG (cEEG) monitoring after microsurgical clipping (53 cases) or endovascular coiling (13 cases) of the ruptured aneurysm were analyzed retrospectively. The diagnosis of NCSE was based on the American Clinical Neurophysiology Society and Salzburg Consensus criteria.
NCSE was revealed in 10 patients (15 %), all of whom underwent craniotomy and aneurysm clipping. In comparison to the subgroup without NCSE, among those who were diagnosed with this complication there was a significantly greater proportion of men (70 % vs. 34 %; P = 0.041), cases with the Glasgow Coma Scale score at admission < 13 (90 % vs. 36 %; P = 0.004), the Hunt and Hess aSAH grades 3-5 (90 % vs. 45 %; P = 0.013), and hydrocephalus (70 % vs. 29 %; P = 0.044). In addition, they required a significantly longer hospital stay (medians, 62.5 vs. 39.5 days; P = 0.015) and showed trend for the lower rate of favorable disability outcomes (20 % vs. 54 %; P = 0.084).
NCSE is encountered rather often after the microsurgical clipping of ruptured intracranial aneurysms, especially in severely disabled patients with high-grade aSAH and/or associated hydrocpephalus, and may significantly affect the clinical course and prolong recovery. cEEG monitoring may be helpful for timely diagnosis and treatment of this complication.
评估破裂颅内动脉瘤手术后非惊厥性癫痫持续状态（NCSE）的发生率，确定与该并发症相关的因素，并确定其对预后的影响。
回顾性分析 66 例接受破裂颅内动脉瘤显微夹闭术（53 例）或血管内栓塞术（13 例）的蛛网膜下腔出血（aSAH）患者的临床和神经生理数据。这些患者在手术后均进行连续脑电图（cEEG）监测。NCSE 的诊断基于美国临床神经生理学会和萨尔茨堡共识标准。
10 例患者（15%）被诊断为 NCSE，所有患者均接受了开颅夹闭手术。与未发生 NCSE 的亚组相比，在被诊断为该并发症的患者中，男性的比例明显更高（70% vs. 34%；P = 0.041），入院时格拉斯哥昏迷量表评分<13 的病例比例更高（90% vs. 36%；P = 0.004），Hunt 和 Hess 分级为 3-5 级的病例比例更高（90% vs. 45%；P = 0.013），脑积水的病例比例更高（70% vs. 29%；P = 0.044）。此外，这些患者需要更长的住院时间（中位数分别为 62.5 天和 39.5 天；P = 0.015），且预后不良的可能性较低（20% vs. 54%；P = 0.084）。
破裂颅内动脉瘤显微夹闭术后常发生 NCSE，尤其是在伴有高分级 aSAH 和/或脑积水的重度残疾患者中，这可能显著影响患者的临床病程并延长康复时间。cEEG 监测可能有助于及时诊断和治疗该并发症。
