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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Visceral membranectomy and preoperative midline shift are independent predictors of postoperative seizures in patients with chronic subdural haematoma

Entfernen der viszeralen Hämatommembran und präoperative Mittellinienverlagerung sind unabhängige Risikofaktoren für postoperative Krampfanfälle in Patienten mit chronischem Subduralhämatom

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  • presenting/speaker Lukas Goertz - Universitätsklinikum Köln, Köln, Deutschland
  • Joerg Speier - Universitätsklinikum Köln, Köln, Deutschland
  • André Pascal Schulte - Sankt Franziskus-Hospital, Köln, Deutschland
  • Pantelis Stavrinou - Universitätsklinikum Köln, Köln, Deutschland
  • Roland H. Goldbrunner - Universitätsklinikum Köln, Köln, Deutschland
  • Boris Krischek - Universitätsklinikum Köln, Köln, Deutschland
  • Marco Timmer - Universitätsklinikum Köln, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV133

doi: 10.3205/20dgnc134, urn:nbn:de:0183-20dgnc1348

Published: June 26, 2020

© 2020 Goertz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Postoperative seizures represent a potential complication of surgical chronic subdural hematoma (cSDH) evacuation and may occur in 1 – 23% of cases. A risk factor analysis can help to identify patients that may benefit from anti-epileptic prophylaxis.

Methods: This is a retrospective, single-center analysis of consecutive patients with cSDH that underwent burr hole or open craniotomy within a 2-year period. We retrospectively collected patient characteristics, hematoma specifics and procedural aspects and evaluated their impact on postoperative seizures within a 14-day follow-up period by means of univariate and bivariate logistic regression analysis.

Results: The final population consisted of 101 patients with a mean age of 70.1 ± 32.1 years. The incidence of postoperative seizures was 13.9%. At discharge, the mean Markwalder Grading Scale score was higher in patients with seizures (1.1 ± 1.1) than in patients without seizures (0.5 ± 0.8, p=0.04). In the univariate analysis, preoperative midline shift (8.3 mm vs. 4.5 mm, p=0.045), open craniotomy (85.7% vs. 55.2%, p=0.031), and visceral membranectomy (57.1% vs. 20.7%, p=0.004) were significantly associated with postoperative seizures. Binary logistic regression analysis confirmed preoperative midline shift (OR: 1.13, 95% CI: 1.01 – 1.26, p=0.029) and membranectomy (OR: 3.9, 95% CI: 1.0 – 15.0, p=0.048) as independent risk factors for seizures.

Conclusion: Since seizures can be associated with significant morbidity, patients with preoperative midline-shift may benefit fro perioperative anti-epileptic prophylaxis. Furthermore, membranectomy may not be routinely necessary during surgery, as it may trigger seizures and it does not impact recurrence rates, as shown by previous studies.