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

Chih-Wei Chen1, Jinn-Rung Kuo, Hung-Jung Lin

  • 1Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Yung Kang City, Tainan, Taiwan.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|September 1, 2004
PubMed

Insights

Post-operative seizures after chronic subdural hematoma surgery are uncommon. However, mixed-density lesions on CT scans and left-sided hematomas may indicate a higher risk, suggesting a need for prophylactic anticonvulsants in these specific cases.

Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • The incidence of seizures following burr-hole craniostomy for chronic subdural hematoma (CSDH) is low, making the routine use of post-operative anticonvulsants a subject of debate.
  • Pre-operative imaging characteristics of CSDH may help identify patients at higher risk for post-operative seizures.

Purpose of the Study:

  • To investigate the correlation between pre-operative computed tomography (CT) findings of CSDH and the necessity for post-operative seizure prophylaxis.
  • To identify specific CT-based CSDH characteristics associated with an increased risk of early post-operative seizures.

Main Methods:

  • A retrospective study of 128 patients who underwent burr-hole craniostomy with closed-system drainage for CSDH between April 1998 and November 2001.
  • CSDHs were classified based on pre-operative CT appearance: low-density, isodense, and mixed-density lesions.
  • Incidence of early post-operative seizures (within 3 weeks) was analyzed across different density and location subgroups.

Main Results:

  • The overall incidence of early post-operative seizures was 5.4% (7/128).
  • Seizure incidence was significantly higher in patients with mixed-density CSDH (13.7%) compared to low-density (6.2%) and isodense (2.4%) groups (p < 0.05).
  • Patients with left unilateral CSDH experienced seizures more frequently (71.4% of seizure cases) than those with right-sided or bilateral hematomas.

Conclusions:

  • The risk of post-operative seizures appears elevated in patients with mixed-density CSDH on pre-operative CT.
  • Left unilateral CSDH may also be associated with a higher seizure incidence.
  • Prophylactic anticonvulsant therapy is suggested for patients presenting with mixed-density CSDH on pre-operative CT scans.

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