Horiuchi Sayaka, Kanaya Kohei, Horiuchi Tetsuyoshi
Medical student, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Front Surg. 2022 Apr 19;9:881874. doi: 10.3389/fsurg.2022.881874. eCollection 2022.
Postoperative seizures and epilepsy are common complications of craniotomy. In this study, we aimed to investigate the characteristics of seizures and epilepsy after craniotomy.
A total of 293 consecutive craniotomy surgeries were analyzed. Infratentorial surgeries, epilepsy surgeries, surgeries using the same approach conducted for the same patients, and the cases with incomplete clinical data were excluded. A total of 211 surgeries were included in this study. We evaluated the following clinical characteristics in all patients: sex, age, preoperative epilepsy, use of preoperative antiseizure medication (ASM), indication for operation, early postoperative seizure (EPS), delayed postoperative seizure (DPS), and postoperative de novo epilepsy. The day of onset of EPSs was defined as within 7 days post-surgery, and the day of onset of DPSs was defined as later than 7 days and less than 60 days post-surgery.
Twenty-eight patients were previously diagnosed with epilepsy. Nine patients had EPSs (4.3%), and 10 patients had DPSs (4.7%). Seven cases of EPSs and six cases of DPSs were observed in 183 patients without previous epilepsy (3.8% and 3.3%, respectively). Three of the seven patients with EPSs (42.9%) and all six patients with DPSs (100%) developed de novo epilepsy. Postoperative de novo epilepsy was observed in 9 (4.9%) of the 183 patients without epilepsy. EPSs and DPSs were significant risk factors for epilepsy ( < 0.01). The odds ratios of EPSs and DPSs for the development of epilepsy were 12.71 (95% confidence interval [CI]: 3.94-112.80; < 0.01) and 22.88 (95% CI: 5.38-55.72; < 0.01), respectively. ASM was administered prophylactically to 51 patients. The prophylactic use of ASMs did not prevent EPSs or postoperative de novo epilepsy.
EPSs and DPSs occurred in 4.3% and 4.7% of the patients, respectively, after craniotomy. Postoperative de novo epilepsy occurred in 4.9% of patients. This study revealed that EPSs and DPSs were risk factors for de novo epilepsy. Previous epilepsy was not a significant risk factor for EPSs. The prophylactic use of ASMs did not prevent EPSs or de novo epilepsy.
术后癫痫发作和癫痫是开颅手术常见的并发症。在本研究中，我们旨在调查开颅手术后癫痫发作和癫痫的特征。
对连续293例开颅手术进行分析。排除幕下手术、癫痫手术、同一患者采用相同入路的手术以及临床资料不完整的病例。本研究共纳入211例手术。我们评估了所有患者的以下临床特征：性别、年龄、术前癫痫、术前抗癫痫药物（ASM）的使用、手术指征、术后早期癫痫发作（EPS）、术后延迟癫痫发作（DPS）和术后新发癫痫。EPS的发作日定义为术后7天内，DPS的发作日定义为术后7天以后且少于60天。
28例患者既往被诊断为癫痫。9例患者发生EPS（4.3%），10例患者发生DPS（4.7%）。在183例既往无癫痫的患者中观察到7例EPS和6例DPS（分别为3.8%和3.3%）。7例EPS患者中有3例（42.9%）和所有6例DPS患者（100%）发生新发癫痫。183例无癫痫患者中有9例（4.9%）发生术后新发癫痫。EPS和DPS是癫痫的显著危险因素（P<0.01）。EPS和DPS发生癫痫的比值比分别为12.71（95%置信区间[CI]：3.94-112.80；P<0.01）和22.88（95%CI：5.38-55.72；P<0.01）。51例患者预防性使用ASM。预防性使用ASM未能预防EPS或术后新发癫痫。
开颅手术后，EPS和DPS分别发生在4.3%和4.7%的患者中。4.9%的患者发生术后新发癫痫。本研究表明，EPS和DPS是新发癫痫的危险因素。既往癫痫不是EPS的显著危险因素。预防性使用ASM未能预防EPS或新发癫痫。
