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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Prevent seizures after evacuation of chronic subdural hematomas

Meeting Abstract

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  • André Pascal Schulte - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln, Köln
  • Marco Timmer - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln, Köln
  • Jörg Speier - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln, Köln
  • Roland Goldbrunner - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln, Köln

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.19.04

doi: 10.3205/14dgnc111, urn:nbn:de:0183-14dgnc1114

Published: May 13, 2014

© 2014 Schulte et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Due to demographic development of our population and the increasing use of anticoagulants, there is a steadily increasing number of operations on chronic subdural hematoma. For the clinical course of the disease the occurrence of postoperative seizures is critical. The aim of this study was to identify risk factors for the development of postoperative seizures, in order to influence the clinical course positively.

Method: In the period from March 2010 to March 2012, we retrospectively analyzed all cases which underwent surgical treatment of chronic subdural hematoma in our hospital. Of the 125 identified patients, 101 met the inclusion criteria. The data analysis was based on the patient's file, the operating reports and the pre- and postoperative imaging. The multifactorial data collection included the baseline clinical data, Glascow Coma Scale (GCS) before and 24 hours after surgery, the incidence of postoperative seizures, the surgical technique (burr hole vs. minicraniotomy, opening vs. leaving the visceral capsule), the length of hospitalisation, pre- and postoperative CT scan morphology. Univariate and multivariate logistic regressions analyses were performed to identify statistical associations.

Results: Postoperative seizures or EEG changes were observed in 14 patients (13.9%). This resulted in an increase in the total length of hospitalisation (means: 9 days without, 17 days with seizure). The seizures occurred within the first fourteen days after surgery (mean on day 4). As significant risk factors, the opening of the visceral capsule (p=0.0038) and the evacuation of the hematoma through a minicraniotomy (p=0.0471) were identified. Postoperative CT scan morphology, the patient's age or the preoperative GCS had no significant effect on the incidence of postoperative seizures.

Conclusions: Due to the clear result of multivariate analysis, opening of the visceral capsule should be avoided to prevent seizures after evacuation of chronic subdural hematomas. If it is possible from size and morphology of the hematoma, the evacuation through one or two burr holes should be preferred to a minicraniotomy.

Note: André Pascal Schulte and Marco Timmer contributed equally.