Preoperative valproate administration does not increase blood loss during temporal lobectomy

Area of Science:

• Neurology
• Neurosurgery
• Pharmacology

Background:

• Medically refractory epilepsy often requires surgical intervention.
• Valproate (VPA) is a common anticonvulsant, but its effect on surgical bleeding is debated.
• Concerns exist regarding VPA-induced thrombocytopenia and platelet dysfunction potentially increasing surgical blood loss.

Purpose of the Study:

• To investigate the hypothesis that perioperative Valproate (VPA) administration increases surgical bleeding and complications in patients undergoing temporal lobectomy.
• To evaluate the association between VPA use and estimated blood loss, red blood cell volume changes, and transfusion incidence.

Main Methods:

• Retrospective review of 87 patients undergoing epilepsy surgery (temporal lobectomy) between 1986 and 1993.
• Patients were divided into two groups: those receiving VPA preoperatively and those not recently on VPA.
• Comparison of estimated surgical blood loss and change in red blood cell (RBC) volume using unpaired t-tests.

Main Results:

• Patients on VPA exhibited relative, but not absolute, preoperative thrombocytopenia.
• No significant differences were observed in estimated blood loss between the VPA and no-VPA groups.
• There were no differences in RBC volume changes or the incidence of postoperative transfusions between the groups.

Conclusions:

• Perioperative Valproate (VPA) administration does not appear to increase hemostatic complications during epilepsy surgery.
• Routine discontinuation of VPA before craniotomy is not recommended based on these findings.
• VPA can be safely continued in patients undergoing surgical treatment for refractory epilepsy.