Massimi Luca, Frassanito Paolo, Bianchi Federico, Fiorillo Luigi, Battaglia Domenica Immacolata, Tamburrini Gianpiero
Neuroscience Department, Catholic University Medical School, 00168 Rome, Italy.
Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Children (Basel). 2022 Sep 24;9(10):1465. doi: 10.3390/children9101465.
Background: Postoperative seizures (PS) occur in 10−15% of patients. This study aims to provide an update on the role of surgery in PS. Methods: All children undergoing a craniotomy for supratentorial lesions in the last 10 years were considered except those with preoperative seizures, perioperative antiepileptic drugs prophylaxis, head-injury and infections, repeated surgery, or preoperative hyponatremia. Children undergoing surgery for intra-axial lesions (Group 1, 74 cases) were compared with those harboring extra-axial lesions (Group 2, 91 cases). Results: PS occurred in 9% of 165 cases and epilepsy in 3% of 165 cases (mean follow-up: 5.7 years). There was no difference between the two study groups with regard to demographic data or tumor size. Group 1 showed a higher rate of gross total tumor resection (p = 0.002), while Group 2 had a higher rate of postoperative hyponatremia (p < 0.0001). There were no differences between the two groups in the occurrence of seizures (6.7% vs. 11%) or epilepsy (2.7% vs. 3.2%). No correlations were found between seizures and age, tumor location, histotype, tumor size, or the extent of tumor resection. Hyponatremia affected the risk of PS in Group 2 (p = 0.02). Conclusions: This study shows a lower rate of PS and epilepsy than series including children with preoperative seizures. Hyponatremia has a significant role. Neurosurgery is safe but surgical complications may cause late epilepsy.
术后癫痫发作（PS）在10% - 15%的患者中出现。本研究旨在更新手术在PS中的作用。方法：纳入过去10年中所有接受幕上病变开颅手术的儿童，但排除术前有癫痫发作、围手术期使用抗癫痫药物预防、头部受伤和感染、重复手术或术前低钠血症的儿童。将接受轴内病变手术的儿童（第1组，74例）与患有轴外病变的儿童（第2组，91例）进行比较。结果：165例患者中9%发生PS，3%发生癫痫（平均随访：5.7年）。两组在人口统计学数据或肿瘤大小方面无差异。第1组的肿瘤全切除率较高（p = 0.002），而第2组的术后低钠血症发生率较高（p < 0.0001）。两组在癫痫发作（6.7%对11%）或癫痫（2.7%对3.2%）的发生方面无差异。未发现癫痫发作与年龄、肿瘤位置、组织类型、肿瘤大小或肿瘤切除范围之间存在相关性。低钠血症影响第2组PS的风险（p = 0.02）。结论：本研究显示PS和癫痫的发生率低于包括术前有癫痫发作儿童的系列研究。低钠血症起重要作用。神经外科手术是安全的，但手术并发症可能导致迟发性癫痫。
