Postcranioplasty seizures following decompressive craniectomy and seizure prophylaxis: a retrospective analysis at a single institution

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OBJECTIVE

Cranioplasty is a relatively simple and less invasive intervention, but it is associated with a high incidence of postoperative seizures. The incidence of, and the risk factors for, such seizures and the effect of prophylactic antiepileptic drugs (AEDs) have not been well studied. The authors’ aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty.

METHODS

The records of patients who had undergone cranioplasty at the authors’ medical center between 2009 and 2014 with at last 2 years of follow-up were retrospectively reviewed. Demographic and clinical characteristics, the occurrence of postoperative seizures, and postoperative complications were analyzed.

RESULTS

Among the 583 patients eligible for inclusion in the study, 247 had preexisting seizures or used AEDs before the cranioplasty and 336 had no seizures prior to cranioplasty. Of these 336 patients, 89 (26.5%) had new-onset seizures following cranioplasty. Prophylactic AEDs were administered to 56 patients for 1 week after cranioplasty. No early seizures occurred in these patients, and this finding was statistically significant (p = 0.012). Liver cirrhosis, intraoperative blood loss, and shunt-dependent hydrocephalus were risk factors for postcranioplasty seizures in the multivariable analysis.

CONCLUSIONS

Cranioplasty is associated with a high incidence of postoperative seizures. The prophylactic use of AEDs can reduce the occurrence of early seizures.

ABBREVIATIONS AED = antiepileptic drug; DC = decompressive craniectomy; PMMA = polymethylmethacrylate; TBI = traumatic brain injury.
Article Information

Contributor Notes

Correspondence Po-Hsun Tu: Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College & University, Taoyuan City, Taiwan. d12096@cloud.cgmh.org.tw.INCLUDE WHEN CITING Published online September 21, 2018; DOI: 10.3171/2018.4.JNS172519.

M.C.Y. and C.C.C. contributed equally to this study and share first authorship.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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