颅骨缺损成形术后并发癫痫发作的临床分析

Clinical analysis of epileptic seizures after skull defect cranioplasty

目的 探讨颅骨缺损成形术后癫痫发作原因、防治措施。方法 回顾性分析2012年12月~2016年6月我院神经外科颅骨缺损成形术患者130例的临床资料,分析术后癫痫发作原因及治疗措施。根据术后是否使用抗癫痫药物分为预防癫痫组（72例）及未预防癫痫组（58例）,比较两组癫痫发作发生率。结果 130例患者中术后癫痫发作16例（12.3%）,其中局灶性发作11例,全面性发作5例。术后预防癫痫组癫痫发作情况与未预防癫痫组比较,差异有统计学意义（P〈0.05）。结论 术前存在潜在的致痫灶,术后脑组织血流动力学变化,术中脑组织损伤,硬膜破损是颅骨缺损成形术后癫痫发作的可能诱发原因,术中规范操作及术后预防性用药可以降低术后癫痫发作。

Objeetive To explore the cause and control measures of epileptic seizure after craniocerebral defect surgery. Methods From December 2012 to June 2016,the clinical data of 130 patients undergone craniofacial defect surgery in the department of neurosurgery,in our hospital were retrospectively analyzed in order to find the postoperative cause and therapeutic measures of epileptic seizure.According to whether antiepileptic drug used or not,they were divided into prevention epilepsy group （n=72） and non-prevention epilepsy group （n=58）.The incidence of epileptic seizure in two groups were compared.Results Among 130 cases,16 patients （12.3%） were occurred with epileptic seizure,focal seizures in 11 and generalized seizures in 5.After surgery,the occurred situation with epileptic seizures in the prevention epilepsy group, displayed a statistical difference compared with that in the non-prevention epilepsy group （P〈0.05）.Conclusion Preoperative epileptogenic foci,postoperative cerebral hemodynamic changes,intraoperative brain injury, and dural rupture are the possible causes of epileptic seizures after craniofacial defect surgery.Intraoperative normative operation and postoperative prophylactic drug use can decrease the occurrence of epileptic seizure after surgery.