Seizure after chronic subdural hematoma evacuation: associated factors and effect on clinical outcome

Frontiers in Neurology

Neurology

Liang Wu¹  Xiaofan Yu¹  Bingcheng Zhu¹  Yunfei Li¹  Xufei Guo¹  Yunwei Ou²  Weiming Liu³ 

[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

[2]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

[3]Beijing Neurosurgical Institute, Capital Medical University, Beijing, China

[4]China National Clinical Research Center for Neurological Diseases, Beijing, China

[5]Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China

[6]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

[7]China National Clinical Research Center for Neurological Diseases, Beijing, China

[8]Neurological Center, People’s Hospital of Ningxia Hui Autonomous Region (The Third Clinical Medical College, Ningxia Medical University), Yinchuan, China

关键词: chronic subdural hematoma;    postoperative seizure;    burr-hole craniotomy;    recurrence;    clinical outcome;   

DOI  :  10.3389/fneur.2023.1190878

 received in 2023-03-21, accepted in 2023-04-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectiveChronic subdural hematoma (CSDH) is a common disease in neurosurgery, which usually occurs in the elderly. Seizure is one of the postoperative complications in CSDH patients and can affect patient outcomes. There is currently no consensus on whether antiepileptic drugs should be prescribed prophylactically. The aim of this study was to evaluate independent risk factors for postoperative seizures and unfavorable outcomes in CSDH patients.MethodsWe reviewed 1,244 CSDH patients who had undergone burr-hole craniotomy in this study. Patient clinical data, CT scan results, recurrence and outcome data were collected. We divided the patients into two groups based on whether they had a postoperative seizure. Percentages and χ2 tests were applied for categorical variables. Standard deviations and two-sided unpaired t-tests were applied for continuous variables. Stepwise logistic regression analyses were performed to identify the independent factors of postoperative seizures and unfavorable outcomes.ResultsThe incidence of seizures after CSDH surgery was 4.2% in this study. There was no significant difference in recurrence rate between seizure and non-seizure patients (p = 0.948), and the outcome of seizure patients was significantly poor (p < 0.001). There are more postoperative complications in seizure patients (p < 0.001). Logistic regression analysis showed that the independent risk factors for postoperative seizures included drinking history (p = 0.031), cardiac disease (p = 0.037), brain infarction (p = 0.001) and trabecular hematoma (p < 0.001). The use of urokinase is a protective factor for postoperative seizures (p = 0.028). Hypertension is an independent risk factor for unfavorable outcome in seizure patients (p = 0.038).ConclusionSeizures after CSDH surgery were associated with postoperative complications, higher mortality and poorer clinical outcomes at follow-up. We believe that alcohol consumption, cardiac disease, brain infarction and trabecular hematoma are independent risk factors for seizures. The use of urokinase is a protective factor against seizures. Patients with postoperative seizures need more stringent management of their blood pressure. A prospective randomized study is necessary to determine which subgroups of CSDH patients would benefit from antiepileptic drugs prophylaxis.

【 授权许可】

Unknown   
Copyright © 2023 Wu, Guo, Ou, Yu, Zhu, Li and Liu.