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Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizures

S T Lee1, T N Lui, C N Chang

  • 1Department of Surgery, Chang Gung Medical College & Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.

Surgical Neurology
|May 1, 1989
PubMed

Insights

This study found that phenytoin effectively reduced postoperative seizures in patients undergoing intracranial surgery. Prophylactic anticonvulsant administration before wound closure is recommended for urgent craniotomies.

Area of Science:

  • Neurosurgery
  • Pharmacology
  • Clinical Neurology

Background:

  • Postoperative seizures are a significant complication following intracranial surgery.
  • Anticonvulsant prophylaxis aims to mitigate seizure risk in this patient population.

Purpose of the Study:

  • To evaluate the efficacy of phenytoin in preventing early postoperative seizures after supratentorial intracranial surgery.
  • To assess the achievement of therapeutic serum levels of phenytoin in surgical patients.

Main Methods:

  • A randomized controlled trial involving 374 patients undergoing intracranial surgery.
  • Intravenous phenytoin (15 mg/kg) administered preoperatively, followed by 5-6 mg/kg/day postoperatively for 3 days.
  • A placebo group received identical treatment for comparison.

Main Results:

  • Phenytoin administration resulted in significantly fewer immediate and early postoperative seizures compared to placebo (3 vs. 13 seizures).
  • Therapeutic serum phenytoin levels (10-20 micrograms/mL) were achieved in 59.8% of treated patients.
  • No postoperative hematomas were observed in patients experiencing seizures.

Conclusions:

  • Phenytoin is effective in reducing the incidence of early postoperative seizures following supratentorial intracranial surgery.
  • Prophylactic anticonvulsant administration should be considered, particularly for urgent craniotomies, with administration timed before wound closure to maintain therapeutic levels.

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