Hamou Hussam, Alzaiyani Mohammed, Rossmann Tobias, Pjontek Rastislav, Kremer Benedikt, Zaytoun Hasan, Ridwan Hani, Clusmann Hans, Hoellig Anke, Veldeman Michael
Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria.
Front Neurol. 2022 Sep 8;13:977329. doi: 10.3389/fneur.2022.977329. eCollection 2022.
Chronic subdural hematoma (cSDH) is becoming more prevalent due to population aging and the increasing use of antithrombotic drugs. Postoperative seizure in cSDH have a negative effect on outcome, and there currently no consensus regarding prophylactic anti-epileptic drug (AED) treatment. The objective of this study was to evaluate predisposing and triggering factors associated with postoperative epileptic seizure in patients with cSDH.
All patients, who were surgically treated for cSDH in a single tertiary care center between 2015 and 2019, were considered for inclusion. Relevant patient- and hematoma-specific characteristics were retrospectively extracted from hospital records. Paroxysmal events categorized by the treating physician as suspected postoperative seizures were noted. The clinical outcome was extracted from the last available follow-up visit and classified according to the Glasgow outcome scale (GOS).
Of the included 349 patients, 54 (15.5%) developed suspected postoperative epileptic complications in the form of early seizure (≤ 7 days) in 11 patients (3.2%) and late seizure (>7 days) in 43 patients (12.3%). In the logistic regression analysis, solely depressed brain volume (supratentorial volume (ml) not filled with re-expanded brain) was independently associated with postoperative seizure (odds ratio [] 1.006, 95% : 1.001-1.011; = 0.034). The occurrence of postoperative seizure ( 6.210, 95% : 2.704-14.258; < 0.001) and preoperative Markwalder grading ( 2.919, 95% : 1.538-5.543; = 0.001) were independently associated with unfavorable (GOS) outcome.
Larger postoperative depressed brain volume was the only factor independently associated with suspected postoperative seizure, and it could help identify a subgroup of patients with higher susceptibility to epileptic events. Based on our data, no formal recommendation can be made regarding the prophylactic use of anti-epileptic drugs. Nevertheless, the relative safety of new generation AEDs and the detrimental effect of postoperative seizure on outcome may justify its use in a selected patient population.
由于人口老龄化以及抗血栓药物使用的增加，慢性硬膜下血肿（cSDH）正变得越来越普遍。cSDH术后癫痫发作对预后有负面影响，目前对于预防性抗癫痫药物（AED）治疗尚无共识。本研究的目的是评估与cSDH患者术后癫痫发作相关的易感因素和触发因素。
纳入2015年至2019年在单一三级医疗中心接受cSDH手术治疗的所有患者。从医院记录中回顾性提取相关的患者和血肿特异性特征。记录经治疗医生分类为疑似术后癫痫发作的阵发性事件。从最后一次可用的随访中提取临床结局，并根据格拉斯哥结局量表（GOS）进行分类。
在纳入的349例患者中，54例（15.5%）出现疑似术后癫痫并发症，其中11例（3.2%）为早期发作（≤7天），43例（12.3%）为晚期发作（>7天）。在逻辑回归分析中，仅脑容积凹陷（幕上未被重新扩张的脑填充的容积（ml））与术后癫痫发作独立相关（比值比[ ]1.006，95%置信区间：1.001 - 1.011；P = 0.034）。术后癫痫发作的发生（P = 6.210，95%置信区间：2.704 - 14.258；P < 0.001）和术前Markwalder分级（P = 2.919，95%置信区间：1.538 - 5.543；P = 0.001）与不良（GOS）结局独立相关。
术后较大的脑容积凹陷是与疑似术后癫痫发作独立相关的唯一因素，它有助于识别对癫痫事件易感性较高的患者亚组。基于我们的数据，对于预防性使用抗癫痫药物无法给出正式建议。然而，新一代AEDs的相对安全性以及术后癫痫发作对结局的有害影响可能证明在特定患者群体中使用它是合理的。
