颅骨成形术后癫痫发作的危险因素分析

Analysis of risk factors for epileptic seizures after cranioplasty

目的 探讨颅骨成形术后癫痫发作的危险因素。方法 回顾性分析2015年12月至2020年12月行颅骨成形术的72例颅骨缺损病人的临床资料。术后随访2个月,依据癫痫发作的临床表现进行术后癫痫评估。结果 72例中,20例颅骨成形术后出现癫痫发作,发生率为27.8%。即刻癫痫发作(≤24 h)6例,早期癫痫发作(24 h-2周)8例,晚期癫痫发作(>2周)6例。随访期间,未出现伤口感染、人工修补材料外露、颅内感染、术区出血、脑疝等。单因素分析显示年龄、去骨瓣减压术后继发癫痫、颅骨缺损原因和直径与颅骨成形术后癫痫发作有关(P<0.05),多因素logistic回归分析显示颅骨缺损直径是颅骨成形术后癫痫发作的独立危险因素(P<0.05)。结论 颅骨成形术作为神经外科的基础手术之一,手术过程相对简单,但其并发症不容忽视。颅骨成形术后癫痫发作的临床影响因素较多,颅骨缺损直径越大,发生癫痫的风险越高。

Objective To explore the risk factors for epileptic seizures after cranioplasty. Methods The clinical data of 72 patients with skull defect who underwent cranioplasty from December 2015 to December 2020 were analyzed retrospectively. All the patients were followed up for 2 months and postoperative epileptic seizures were assessed according to the clinical manifestations. Results Of these 72 patients, 20 had seizures after cranioplasty, with an incidence of 27.8%. Six patients were classified as immediate seizures(≤24h), 8 as early seizures(24 h-2 weeks), and 6 as late seizures(>2 weeks). There was no wound infection, exposure of artificial repair materials, intracranial infection, bleeding in the operation area, and brain herniation during the follow-up period. Univariate analysis showed that age, secondary epilepsy after decompressive craniectomy, the cause and diameter of skull defect were associated with seizures after cranioplasty(P<0.05). Multivariate logistic regression analysis showed that skull defect diameter was an independent risk factor for seizures after cranioplasty(P<0.05). Conclusions As one of the basic operations of neurosurgery, cranioplasty is relatively simple, but its complications cannot be ignored. There are many clinical risk factors of epilepsy after cranioplasty, and the larger the diameter of the skull defect, the higher the risk of epilepsy.