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  • The incidence of seizures in patients with chronic subdural hematomas treated with burr hole evacuation.

    Final Number:

    Hermes G. Garcia-Marrero MD; Emil A Pastrana MD; Samuel Estronza-Ojeda MD; Jaime A. Inserni BA, MD, FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    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.

    References: Battaglia F, Lubrano V, Ribeiro-Filho T, Pradel V, Roche PH. Incidence and clinical impact of seizures after surgery for chronic subdural haematoma. Neurochirurgie. 2012 Aug;58(4):230-4 Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Anderson K, Sussman E, Carpenter A, Connolly ES Jr. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012 Apr;35(2):155-69 Grobelny BT, Ducruet AF, Zacharia BE, Hickman ZL, Andersen KN, Sussman E, Carpenter A, Connolly ES. Preoperative antiepileptic drug administration and the incidence of postoperative seizures following bur hole-treated chronic subdural hematoma. J Neurosurg. 2009 Dec;111(6):1257-62. Huang YH, Yang TM, Lin YJ, Tsai NW, Lin WC, Wang HC, Chang WN, Lu CH. Risk factors and outcome of seizures after chronic subdural hematoma. Neurocrit Care. 2011 Apr;14(2):253-9. Rabinstein AA, Chung SY, Rudzinski LA, Lanzino G. Seizures after evacuation of subdural hematomas: incidence, risk factors, and functional impact. J Neurosurg. 2010 Feb;112(2):455-60 Yuan D, Zhao J, Liu J, Jiang X, Yuan X. Clinical features of 417 patients with chronic subdural hematoma. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2013 May;38(5):517-20.

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