Incidence and Risk Factors for Intraoperative Seizures During Elective Craniotomy

Area of Science:

• Neurosurgery
• Neurology
• Anesthesiology

Background:

• Perioperative seizures impact craniotomy patients, yet intraoperative seizure data is scarce.
• This study addresses the limited understanding of intraoperative seizures during elective supratentorial craniotomy.
• Evoked potential monitoring was utilized in this investigation.

Purpose of the Study:

• To determine the incidence of intraoperative seizures during elective supratentorial craniotomy.
• To identify independent risk factors associated with intraoperative seizures.
• To evaluate the protective effects of prophylactic anticonvulsant medications.

Main Methods:

• A retrospective case-control study design was employed.
• 1916 patients undergoing elective supratentorial craniotomy with evoked potential monitoring were analyzed.
• Logistic regression was used for multivariate analysis to identify risk factors.

Main Results:

• The incidence of intraoperative seizures was 2.3% (45/1916 patients).
• Seizure history, brain tumor diagnosis, and temporal craniotomy were significant risk factors.
• Prophylactic phenytoin/fosphenytoin and levetiracetam reduced seizure risk, with phenytoin/fosphenytoin showing greater efficacy.

Conclusions:

• The incidence of intraoperative seizures during supratentorial craniotomy is 2.3%.
• Key risk factors include prior seizure history, intracranial tumors, and temporal craniotomy.
• Intraoperative prophylactic anticonvulsant administration is protective against seizures.