Incidence et impact clinique des crises comitiales périopératoires pour les hématomes sous-duraux chroniques

Battaglia, Fabrice; Lubrano, V.; Ribeiro-Filho, T.; Pradel, Vincent; Roche, Pièrre-Hugues

doi:10.1016/j.neuchi.2012.04.002

Cited by 16 publications

(8 citation statements)

References 13 publications

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“…He decided not to give prophylactic antiepileptic due to their side effect and the risk to develop seizures very low. Similar to results of Chen et al [4], Ohno et al [14] and Battaglia et al [11], in contrast to that Sabo et al [5] had notice that 32% of patients who didn't receive prophylactic antiepileptic developed seizure with high morbidity so they advice to give prophylactic antiepileptic. In our study, we prospectively analyzed 26 patients treated surgically for CSDH using a burr-hole and irrigation.…”

Section: Discussionsupporting

confidence: 77%

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Anticonvulsants for Preventing Seizures in Patients with Chronic Subdural Haematoma: Pilot Study

Ghoneim¹,

Abbass²

2020

OJMN

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Introduction: There is increasing of the incidence of chronic subdural hematomas (CSDH), due to increase of the elderly population with increase of intake oral anticoagulation and antiplatelet drugs in this category of patients. Seizures occur as a complication in 2.3% to 20.4% of the patients. There is a considerable side effect associated with using of anti-epileptic drugs (AEDs). Aim of the Study: To rule the value of prophylactic antiepileptic drugs in prevention of seizures after surgical evacuation of chronic subdural hematoma. Methods: A prospective controlled non-randomized study was performed on 26 patients with chronic or subacute subdural hematoma that was surgically evacuated through burr-holes from April 2017 to June 2019. We divided the patients into 2 groups: group A patients received prophylactic antiepileptic drugs for 6 month and group B patients didn't receive prophylactic antiepileptic drugs and the 2 groups were observed to detect occurrence of post-operative seizures for 6-month follow-up after surgery. Medical history, demographic data and imaging characteristics were recorded. Results: Seizure prevalence for all patients during hospitalization and 6-month follow-up was zero among the 13 patients who received prophylactic anti-seizure medications, and was 1 (7.7%) among the 13 patients who didn't receive prophylactic anti-seizure medications. Conclusions: The incidence of post-operative seizures in patients with chronic subdural hematoma operated upon by burr holes evacuation is low. The administration of prophylactic antiepileptic drugs decreases the incidence of seizures after evacuation of CSDH, but the difference was not significant. So prophylactic antiepileptic drugs should not be routinely given for all patients with CSDH operated upon by burr hole evacuation unless there is risk factor for seizure development.

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Section: Discussionsupporting

confidence: 77%

“…The incidence of seizures in patients with chronic subdural hematoma varied from 2.3% to 20.4% [4] [5]. This is higher than the numbers we found in daily clinical practice [11]. The causes of this high incidences and, varied numbers are not obvious.…”

Section: Discussioncontrasting

confidence: 62%

Anticonvulsants for Preventing Seizures in Patients with Chronic Subdural Haematoma: Pilot Study

Ghoneim¹,

Abbass²

2020

OJMN

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“…[ 45 ] The mortality is high in postoperative seizure cases, therefore seizure prophylaxis should be given in high-risk patients (low Glasgow Coma Scale (GCS) and preoperative cognitive impairment). [ 52 ] Lower mean GCS on admission is predictive of seizures in CSDH. [ 53 ] The preoperative AED prophylaxis is likely to reduce the incidence of postoperative seizures in CSDH.…”

Section: Seizure Prophylaxismentioning

confidence: 99%

Chronic subdural hematoma

et al. 2016

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Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule. Contrast-enhanced CT or MRI could detect associated primary or metastatic dural diseases. Although definite history of trauma could be obtained in a majority of cases, some cases may be secondary to coagulation defect, intracranial hypotension, use of anticoagulants and antiplatelet drugs, etc., Recurrent bleeding, increased exudates from outer membrane, and cerebrospinal fluid entrapment have been implicated in the enlargement of CSDH. Burr-hole evacuation is the treatment of choice for an uncomplicated CSDH. Most of the recent trials favor the use of drain to reduce recurrence rate. Craniotomy and twist drill craniostomy also play a role in the management. Dural biopsy should be taken, especially in recurrence and thick outer membrane. Nonsurgical management is reserved for asymptomatic or high operative risk patients. The steroids and angiotensin converting enzyme inhibitors may also play a role in the management. Single management strategy is not appropriate for all the cases of CSDH. Better understanding of the nature of the pathology, rational selection of an ideal treatment strategy for an individual patient, and identification of the merits and limitations of different surgical techniques could help in improving the prognosis.

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“…This is particularly important because patients with cSDH are at high risk for seizures, especially during the postsurgical period when seizure activity is associated with hematoma recurrence and repeat surgical evacuation. 20-23 A nonsignificantly higher rate of seizure activity was seen with passive drainage (3 patients [14.3%] vs 0; OR = 0; 95% CI 0.006-2.538, P = .231), suggesting a trend that may show significance with a larger sample size.…”

Section: Discussionmentioning

confidence: 97%

Use of Novel Automated Active Irrigation With Drainage Versus Passive Drainage Alone for Chronic Subdural Hematoma—A Propensity Score-Matched Comparative Study With Volumetric Analysis

Baig

Hess

Khan

et al. 2023

Operative Neurosurgery

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BACKGROUND: Passive drainage post-surgical evacuation of symptomatic chronic subdural hematoma (cSDH) is currently standard of care. High rates of infection, drain occlusion, and recurrence are associated complications. OBJECTIVE: To explore the use of a novel double-lumen active automated irrigation and aspiration system, IRRAflow (IRRAS), for patients with cSDH and compared procedural and clinical outcomes against passive drainage alone with propensity score matching (PSM) and volumetric analysis. METHODS: A prospectively maintained database was retrospectively searched for consecutive patients presenting with cSDH. One-to-one PSM of covariates (including baseline comorbidities and presentation hematoma volume) in active and passive irrigation groups was performed to adjust for treatment selection bias. Rates of hematoma clearance, catheter-related occlusion, and infection; number of revisions; and length of hospital stay were recorded. RESULTS: This study included 55 patients: active continuous irrigation-drainage-21 (21 post-PSM) and passive drainage-34 (21 post-PSM). For PSM groups, a significantly higher rate of hematoma clearance was obtained in the active irrigationdrainage group (0.5 ± 0.4 vs 0.4 ± 0.5 mL/day) and in the passive drainage group; odds ratio (OR) = 1.291 (CI: 1.062-1.570, P = .002) and a significantly lower rate of catheter-related infections (OR = 0.051; CI: 0.004-0.697, P = .039). A nonsignificantly lower hematoma expansion rate at discharge was noted in the active irrigation-drainage group (4.8% vs 23.8%; OR = 0.127; P = .186). No statistical difference in all-cause in-hospital mortality or discharge Glasgow Coma Scale score was observed between groups. CONCLUSION: Active and automated continuous irrigation plus drainage after cSDH surgical evacuation resulted in faster hematoma clearance and led to favorable clinical outcomes and low complication and revision rates compared with passive irrigation.

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Incidence et impact clinique des crises comitiales périopératoires pour les hématomes sous-duraux chroniques

Cited by 16 publications

References 13 publications

Anticonvulsants for Preventing Seizures in Patients with Chronic Subdural Haematoma: Pilot Study

Anticonvulsants for Preventing Seizures in Patients with Chronic Subdural Haematoma: Pilot Study

Chronic subdural hematoma

Use of Novel Automated Active Irrigation With Drainage Versus Passive Drainage Alone for Chronic Subdural Hematoma—A Propensity Score-Matched Comparative Study With Volumetric Analysis

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