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Risk factors for preoperative seizures in pediatric patients with intracranial aneurysms
Ruiqi Chen1, Xin Zan1, Anqi Xiao1
1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Insights
Pediatric intracranial aneurysms pose a high seizure risk. Younger age, trauma, and aneurysm characteristics predict preoperative seizures. Surgery reduces late postoperative seizures compared to endovascular treatment.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Neurology
Background:
- Seizures are a significant complication of intracranial aneurysms, particularly in pediatric patients.
- Risk factors for seizures in adults are known, but remain poorly understood in children.
Purpose of the Study:
- To identify risk factors for preoperative seizures in pediatric patients with intracranial aneurysms.
- To evaluate the impact of surgical versus endovascular treatment on postoperative seizures.
Main Methods:
- Retrospective analysis of 64 pediatric patients with intracranial aneurysms (January 2012 - April 2017).
- Comparison between patients with and without preoperative seizures.
- Logistic regression used to identify independent risk factors.
Main Results:
- 37.5% of patients experienced preoperative seizures.
- Younger age (0-5 years), head trauma, ruptured aneurysms, lobe hematomas, high modified Fisher grade (3-4), giant aneurysms, pseudoaneurysms, and distal aneurysms were associated with increased preoperative seizure risk.
- Surgical intervention showed a lower incidence of late postoperative seizures (1-6 months) compared to endovascular treatment.
Conclusions:
- Pediatric intracranial aneurysms carry a high risk of seizures.
- Specific clinical and radiological factors predict preoperative seizures in this population.
- Surgical treatment may offer better long-term seizure control than endovascular approaches.
Objective:
Seizures are common complications following intracranial aneurysms and present a greater risk to pediatric patients than adults. Though the risk factors of seizures in adults with intracranial aneurysms have been well documented, the risk factors in pediatric patients remain unknown. The aim of this study was to evaluate the risk factors for preoperative seizures and the effect of the treatment approach on postoperative seizures in pediatric patients with intracranial aneurysms.
Patients And Methods:
The data of 64 pediatric patients (mean age 11.4 ± 5.7 years; 68.8 % of males) with intracranial aneurysms were retrospectively analyzed from January 2012 to April 2017. Comparisons were made between patients with preoperative seizures (case group) and those without (control group).
Results:
Twenty-four patients (37.5 %) had preoperative seizures, and 15 patients (23.4 %) had postoperative seizures. Multiple logistic regression analysis revealed that younger age (0-5 years), head trauma history, ruptured aneurysms, lobe hematomas, modified Fisher grade 3-4, giant aneurysms, pseudoaneurysms and distal arterial aneurysms were independently associated with the increased risk of preoperative seizures. Patients in the surgical and endovascular groups did not differ significantly in the rates of preoperative seizures or early postoperative seizures (within 1 month) (P > 0.05). However, a significantly lower incidence of late postoperative seizures (1-3 months and 3-6 months) was observed in the surgical group compared with the endovascular group (P < 0.05).
Conclusion:
Pediatric patients with intracranial aneurysms are at high risk for seizures. Risk factors for preoperative seizures included younger age (0-5 years), head trauma history, lobe hematomas, modified Fisher grade 3-4, giant aneurysms, pseudoaneurysms and distal arterial aneurysms. Compared with the endovascular treatment, surgical intervention provided more benefits with regard to reducing the risk of late postoperative seizures.
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