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  • What Should Be Considered to Cause the Early Post-craniotomy Seizure: Antibiotics (Cefazolin) Irrigation

    Final Number:

    Young Seob Chung MD PhD; Ji Hwan Jang; Kyung Sun Song; Jae Seung Bang MD; Chang Wan Oh MD, PhD; O-Ki Kwon MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Post-craniotomy seizure (PCS) is reported only rarely. However, our department noted a 433% increase in PCS for a year beginning September 2010, especially after cerebrovascular surgery. Our goal was to identify the cause of our unusual outbreak of PCS.

    Methods: For almost one year after September 2010, cases of PCS increased significantly in our department. We analyzed 973 patients who had received a major craniotomy between January 2009 and November 2011. We included seizures that occurred only in the first 24 postoperative hours, which we defined as early PCS. After verifying the presence of PCS, we analyzed multiple seizure-provoking factors and their relation to the duration and character of seizure activity.

    Results: Overall PCS incidence was 7.2% (70/973). Cefazolin (2 g/L saline) was the antibiotic drug used for intraoperative irrigation in 88.4% of the operations, and no PCS occurred without intraoperative cefazolin irrigation. When analyzed by operation type, clipping surgery for unruptured aneurysms was the most frequently associated with PCS (80%). Using logistic regression, only 2 g cefazolin intraoperative irrigation (p=0.024) and unruptured aneurysm clipping surgery (p<0.001) were associated with early PCS. The seizure rate of unruptured aneurysm clipping surgery using 2 g cefazolin intraoperative irrigation was 32.9%.

    Conclusions: Intraoperative cefazolin irrigation must be avoided in patients undergoing craniotomy, especially for clipping of unruptured aneurysms, because of the increased risk of early PCS.

    Patient Care: Intraoperative irrigation with saline mixed with antibiotics, especially cefazolin, which we was used to this procedure customarily as reassurance, expecting to enhance the efficacy of antibiotics to prevent postoperative infecton, but increased the risk of postoperative seizure, should not be used.

    Learning Objectives: To know the causes associated with post-craniotomy seizure,which occurs within the first 24 hours.


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