Introduction: There is limited data with regards to the associated risk of post-operative seizures in patients with surgically treated subdural hematomas. Use of anti-epileptic drugs (AEDs) is associated with significant side effects. In this study, we sought to identify the risk of post-operative seizures in patients with chronic subdural hematomas(CSDH) after burr-hole evacuation and the associated clinical and radiological factors.
Methods: A retrospective chart review was performed on patients operated via burr-hole for CSDH in our institution from 2008 to 2010. None of the patients received prophylactic AEDS. The development of post-operative seizures at one year follow-up was identified. Demographic data, co-morbidities, initial GCS, maximum hematoma thickness, midline shift and rate or reoperation were obtained and compared between both groups.
Results: A CSDH was evacuated in 220patients. Post-operative seizures occurred in 2.3%(5/220). The mean time of onset of seizures was 8.4±2.2 days with a median of 7days. There was no prior history of epilepsy in our patients. There was no significant difference in age and gender between seizing and non-seizing groups (P=0.16 and P=0.337, respectively). The most common co-morbidity was hypertension; no statistically significant difference between both groups (38.1% non-seizing vs 40% in seizing; P˜1). Alzheimer’s disease was more common in the seizing group (20%) versus the non-seizing group (2.8%) though no statistical difference was found (P=0.15). GCS scores were similar in both groups (median of 13 on both; P=0.74). The mean midline shift in both groups was similar (4.6±0.19mm non-seizing vs 4.2±0.73mm). The reoperation rate was 10.9%(24/220). None from the seizing group was reoperated.
Conclusions: For our series, the incidence of post-operative seizures in patients with CSDH evacuated via burr-holes was low. Prophylactic AEDs should not be routinely administered if no other risk factor for seizure exists. Demographic and clinical factors did not appear to influence on post-operative seizures.
Patient Care: Perioperative and post-operative anti-epileptic drug prophylaxis is not warranted. Decreased risk of medication side-effects and cost of care.
Learning Objectives: By the conclusion of this session, the participants should know the incidence of post-operative seizures in patients treated with burr hole evacuation for chronic subdural hematomas, determine risk factors associated, as well as determine if prophylactic anti-epileptic drugs are needed peri-operatively.
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