gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

Different treatment patterns to prevent post-craniotomy seizures – Comparison of 122 patients

Meeting Abstract

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  • Julius Höhne - Klinik für Neurochirurgie, Klinikum der Universität Regensburg, Germany
  • Ernil Hansen - Klinik für Anaesthesiologie, Klinikum der Universität Regensburg, Germany
  • Alexander Brawanski - Klinik für Neurochirurgie, Klinikum der Universität Regensburg, Germany
  • Max Lange - Klinik für Neurochirurgie, Klinikum der Universität Regensburg, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.18.05

doi: 10.3205/16dgnc346, urn:nbn:de:0183-16dgnc3460

Veröffentlicht: 8. Juni 2016

© 2016 Höhne et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Due to the risk of postoperative seizures, the prophylactic use of antiepileptic drugs (AED) for patients undergoing supratentorial craniotomy has been advocated. The practice remains controversial. The reasoning presupposes that the possibility of an adverse drug reaction from the AED is lower than the probability of harm due to a seizure. Even short periods of hypotension during the operation can lead to acute kidney and myocardial injury. Cardiovascular effects and tolerability of Levetiracetam (LEV) were compared with Levetiracetam combined with Lacosamide (LCM) and Phenytoin (PHT) retrospectively when used as perioperative seizure prophylaxis.

Method: In this restrospective analysis, we screened 538 patients and included a total of 122 consecutive patients undergoing craniotomy between April 2007 and September 2011. Patients already receiving LEV as AED preoperatively, received LCM as add-on therapy for seizure prophylaxis and were compared with a patient group receiving PHT and with patients receiving LEV as AED without prior prophylactic medication. 40 patients with primary or secondary supratentorial brain tumors received LEV (19 female, 21 male; mean age 56 years), 41 patients received LEV/ LCM (16 female, 25 male; mean age 56 years) and 41 patients received PHT (15 female, 26 male; mean age 50 years). The patient data included demographic, indication and related procedural data. The cumulative dose of norepinephrine, atropine and the change in systolic blood pressure during and after the administration of the AED were analyzed.

Results: The commonest indications for craniotomy were Glioblastoma (n= 14 vs. n=12 vs. n=15), meningiomas (n=9 vs. n=7 vs. n=10), low-grade gliomas (n=6 vs. n=13 vs. n=6) and brain metastases (n=5 vs. n=4 vs. n=5). 1 LEV/ LCM patient (2%) and 4 PHT patients (4.5%) had a seizure despite treatment. Possible side effects were observed in 2 patients associated with PHT. During anesthesia there was a significant drop in systolic blood pressure in the PHT group after administration of the AED perioperatively when compared to LEV (p=0,001) and LEV/LCM (p= <0,0001) respectively. Higher doses and more frequent administration of NET tended to be associated with PHT.

Conclusions: LEV alone and in combination with LCM for patients with and without symptomatic epilepsy as seizure prophylaxis provides a safe and feasible alternative to PHT, which seems to be associated with an unfavorable drop in blood pressure during anesthesia and more adverse reactions.