Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings

Chen, Chih‐Wei; Kuo, Jinn‐Rung; Lin, Hung‐Jung; Yeh, Chao‐Hung; Wong, Bing-Sang; Kao, Cheng-Hsing; Chio, Chung-Ching

doi:10.1016/j.jocn.2004.03.019

Cited by 55 publications

(61 citation statements)

References 31 publications

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“…Comparisons between series are limited so far as there is no clear consent in the literature regarding indication and modalities of perioperative anti-epileptic coverage (4,13,29).…”

Section: Discussionmentioning

confidence: 99%

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

et al. 2009

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OBJECTIVE Most symptomatic chronic subdural hematomas are treated by subdural drainage. However, a subperiostal (i.e., extracranial) passive closed-drainage system in combination with double burr hole trepanation is used at our institution. Therefore, we wanted to analyze our results and compare them with the alternate treatment strategies reported in the current literature. METHODS In a retrospective single-center study, we analyzed the data of all patients undergoing double burr hole trepanation with a subperiostal passive closed-drainage system. Data analysis included general patient data, complications, postoperative seizure rate, and outcome. RESULTS One hundred forty-seven patients underwent surgery for 183 symptomatic chronic subdural hematomas. The perioperative mortality rate was 3.4%. Hematoma persistence or recurrence occurred in 13.1% of the cases. The postoperative seizure rate was 6.6%, and the infection rate was 1.6%, including 3 cases of superficial wound infection and 1 case with deep infection. The reintervention rate was 9.3%, including trepanation in 8.2% of the patients and craniotomy in 1.1%. The overall complication rate was 10.9%. CONCLUSION Double burr hole trepanation combined with a subperiostal passive closed-drainage system is a technically easy, highly effective, safe, and cost-efficient treatment strategy for symptomatic chronic subdural hematomas. The absence of a drain in direct contact with the hematoma capsule may moderate the risk of postoperative seizure and limit the secondary spread of infection to intracranial compartments.

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“…Comparisons between series are limited so far as there is no clear consent in the literature regarding indication and modalities of perioperative anti-epileptic coverage (4,13,29).…”

Section: Discussionmentioning

confidence: 99%

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

et al. 2009

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“…The occurrence of seizures immediately or during the 2 weeks after burr hole drainage has been well recognized as an incidence of about 5% in chronic SDH. 3,12) In our study, six patients were considered as 'suspicious NCS' because only interictal activities were shown on 30 minutes routine EEG recordings and their clinical symptoms were disappeared after adjusting antiepileptic medications. Without continuous monitoring, it is difficult to record ictal activities during the clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Nonconvulsive Seizures of Traumatic Brain Injury Patients

Lee

Hur

Moon

et al. 2013

Korean J Neurotrauma

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Objective: Seizures are common consequence of traumatic brain injury and have been reported in clinical series as an incidence of 15% to 22%. Among them, nonconvulsive seizures (NCS) are often unrecognized during the early period of neurosurgical hospitalization because their clinical presentations can be misunderstood as consequent symptoms of clinical course, and the diagnosis can be confirmed only by the electroencephalographic (EEG) recording. Methods: We retrospectively reviewed our clinical database of traumatic brain injury (TBI) patients admitted between March 2008 and September 2012. Twenty one patients with suspicious symptoms of NCS, such as decrease of consciousness, aphasia or irritability, were included. Routine wake and sleep EEG or bedside continuous EEG monitoring were done in all patients. Results: Ten out of twenty-one patients showed abnormal activities on EEG. Ictal discharges were documented on four patients. Based on clinical symptoms and EEG findings, these four patients were diagnosed as NCS. Two out of four NCS patients showed EEG findings of nonconvulsive status epilepticus (NCSE). Another six patients with abnormal EEG activities were considered as 'suspicious NCS' because only interictal activities were recorded on EEG but increasing dose or adding on antiepileptics relieved their symptoms. All NCS/NCSE were successfully controlled by appropriate antiepileptic therapy. Conclusion: Our result showed that NCS was diagnosed in about 20% of patients with suspicious symptoms. There's a possibility that actual NCS might have happened more. Because untreated NCS/NCSE might cause worse clinical outcome, careful observation and urgent EEG recordings should be considered in a patient with suspicious NCS symptoms. (Korean J Neurotrauma 2013;9:64-68) KEY WORDS: Traumatic brain injury ㆍNonconvulsive seizure ㆍStatus epilepticus ㆍElectroencephalography.

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“…The disease will be more frequent in coming years with increase of life expectancy (8,9). CSH is consecutive to trauma in a large proportion with a frequency varying from 56% to 80% (10)(11)(12)(13)(14)(15)(16). Other risk factors include coagulopathies, therapeutic anticoagulation, antiplatelet agents, alcohol abuse, epilepsy, and intracranial hypotension (6,(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Background and Importancementioning

confidence: 99%

Open Drainage in Chronic Subdural Hematomas: A Prospective Study of 189 Cases

Bakhti

Tighilt

Djennas

2016

IrJNS

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Background & Importance: Chronic subdural hematoma (CSH) is one of the most frequent intracranial hemorrhages in adults. However, gold standard treatment of CSH is not yet defined. Since the 80's, closed drainage is a standard among techniques using drains because the open type has been incriminated in high rates of postoperative infections. However, closed drainage requires materiel which is sometimes not available or expensive in some countries. Open drainage was reintroduced in our department in the middle of the 90's because of economic crisis at this time. We have then conducted a prospective study to assess safety and efficacy of open drainage in treatment of CSH.Case Presentation: A prospective study of adult patients with CSH was conducted from January 2008 to December 2011. All patients have the same surgical procedure which included one burr-hole craniostomy, spontaneous evacuation and open drainage. The study focused on infectious complications, postoperative seizures, and recurrences. Results are compared with those of literature. In our study, 189 patients were operated with mean age of 69.2 years old. Of all, 163 patients were cured. Overall rate of complications was 15.34% with an infection rate of 1.58%, a postoperative seizure rate of 1.05% and a recurrence rate of 14.2%. Mortality rate was 5.8%. Results were in concordance with those of large series of literature. Conclusion:Data of the current study suggested that open drainage is a safe and efficient method in treatment of CSH. It is also a costefficient treatment that could be very interesting for middle-and low-income countries. Keywords AbstractBackground and Importance

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Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings

Cited by 55 publications

References 31 publications

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

Nonconvulsive Seizures of Traumatic Brain Injury Patients

Open Drainage in Chronic Subdural Hematomas: A Prospective Study of 189 Cases

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