Article
Opening of the haematoma septa reduces the incidence of postoperative seizures in chronic subdural haematoma
Die Eröffnung der Septen vermindert die Inzidenz von postoperativen Krampfanfällen beim chronischen Subduralhämatom
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Authors
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Andreas Kramer
- Universitätsmedizin Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Xenia Degenhartt
- Universitätsmedizin Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Florian Ringel
- Universitätsmedizin Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Angelika Gutenberg
- Universitätsmedizin Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Postsurgical seizure in patients with chronic subdural hematoma (cSDH) is a well known but poorly investigated phenomenon. Apart from pre-existing epilepsy, alcohol withdrawal and electrolyte imbalances, surgical factors might be significant determinators.
Methods: Clinical, radiological and surgical variables in patients with cSDH were retrospectively analyzed and correlated to the incidence of postsurgical seizures.
Results: 211 consecutive patients have been included. Mean age was 75.6 years, 69% were male. Presurgical epilepsy was evident in 5.7% patients, 1.9% were alcohol addicts. Most cSDH were frontoparietal or frontotemporal (74.6%). 81.5% showed hematoma septa, 9.7% were subacute with fresh clots of hematoma. Mean thickness of cSDH was 20.4+/-6.2 mm in axial planes, midline shift averaged 6.3+/-4.6 mm. Pre- to postoperative cSDH reduction was significant (mean of difference -12,7 mm, p<0,0001). The JPD-to-brain angles were 45.1+/-25.8° in axial and 54.4+/-30.4° in coronal planes. In 77.9%, JPD showed cortical contact with eloquent regions (precentral gyrus, Sylvian fissure) and had a “wriggled” course in 30 (14.2%). In 8.9% patients, trapping of space-occupying subdural air was seen.
Surgical complications consisted of cortical bleeding in 2.5%, some fresh subdural hematoma surrounding the JPD in 33.5% and wound infections in 1.4% patients.
19 (9%) patients suffered from postsurgical seizures. Seizures resolved spontaneously in 3 patients, 16 required antiepileptic drugs or early removal of the JPD.
In uni- and multivariate analyses postsurgical seizures were independent of presurgical epilepsy, alcohol abuse, localization and thickness of hematoma, presence of septations, kind of surgery, JPD localization and to-brain angle, subdural air entrapment or electrolyte levels. Instead, in multivariate analyses we can verify that the risk of postsurgical seizures was significantly correlated and increased to left sided cSDH (p=0.037) and a “wriggled” course of the JPD (p=0.033). On the other hand, surgical opening of the hematoma septa significantly reduced the risk of postusurgical seizures in uni- (p=0.032) as well as multivariate analyses (p=0.0001).
Conclusion: Postsurgical seizures in cSDH can be anticipated in patients with left sided cSDH and a wriggled course of the JPD in the CT scan. Intraoperative opening of the hematoma septa seems to have a protective role against postsurgical seizures in cSDH.
