Introduction: Post-operative seizures complicate various types of cranial neurosurgeries and increase morbidity and or mortality. Given the relatively high complication rate of cranioplasty, an understanding of seizure incidence and factors predisposing patients to post-operative seizures remains vital to treatment of these patients. Knowledge of the risks associated with this relatively frequent cranial neurosurgery informs consent of patients, patient safety, and operative preparations.
Methods: This study retrospectively reviews adult patients (>18 years age) who received cranioplasty from 2007-2015 at UNC Hospitals. Patients were stratified based on preoperative anti-epileptic medications, sidedness, material of bone flap, association with infection, and time between craniectomy and cranioplasty, among other variables. Early seizures were defined as clinical or electrographic events within 30 days of cranioplasty.
Results: Between 2007 and 2015, 149 adult patients underwent cranioplasty, with a total of 165 surgeries. A total of 15 patients (10%) experienced early post-operative seizures, 9 of which did not have history of prior seizure. Of these 15 patients, 67% were left sided, 47% received synthetic bone flaps, 60% were male, and 53% were associated with infection. Median time before cranioplasty was 143 days among patients who seized, compared to 131 days in patients who did not. Median length of hospital stay was comparable between patients who did and did not seize (2 days in each group).
Conclusions: Among adult patients who received cranioplasty and experienced early post-operative seizures, the most frequent etiology for craniectomy was infection of bone flap from prior craniotomy. The majority of patients who seized had left sided surgeries, were male, and did not have history of seizures pre-operatively. Identification of factors such as infection can help provide appropriate assessment of complication risk and aid in clinical management.
Patient Care: Our clinical review provides factors which may increase the risk of post-operative seizures in patients undergoing cranioplasty. This information can help identify patients at risk for this complication.
Learning Objectives: 1)Review clinical outcomes and complications in adult patients who undergo cranioplasty. 2)Review incidence of early seizures after cranioplasty at a single institution. 3) Identify clinical risk factors associated with development of early post-operative seizures