前循环动脉瘤夹闭术后迟发性癫痫的相关因素分析

Analysis of related factors of delayed epilepsy after anterior circulation aneurysm clipping

目的探讨前循环动脉瘤夹闭术后迟发性癫痫的相关影响因素。方法选取2012年1月至2022年1月于南昌大学第四附属医院接受开颅夹闭动脉瘤治疗的动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者250例纳入研究,根据是否发生迟发性癫痫将其分为癫痫组(12例)和非癫痫组(238例),记录患者的年龄、性别、入院时世界神经外科联盟(World Federation of Neurosurgical Societies,WFNS)分级和改良Fisher量表分级、出院后3个月的格拉斯哥预后量表(Glasgow outcome scale,GOS)评分、术中电生理检测情况。结果癫痫组患者的神经电生理监测异常、症状性脑血管痉挛、术后脑水肿比例均显著大于非癫痫组(P<0.05);两组患者的改良Fisher量表评分分布比较,差异有统计学意义(P<0.05);aSAH患者术后癫痫发生率与WFNS分级呈正相关(r=0.958,P<0.05),与GOS评分呈负相关(r=-0.951,P<0.01);两组患者的动脉瘤位置比较差异无统计学意义(P>0.05)。结论神经电生理监测下开颅夹闭动脉瘤能有效降低患者术后癫痫发生率,改善患者预后。WFNS分级越高、GOS评分越低的患者癫痫发生率越高,应对此类患者予以重点关注。

Objective To explore the related factors of delayed epilepsy after anterior circulation aneurysm clipping.Methods From January 2012 to January 2022,250 patients with aneurysmal subarachnoid hemorrhage(aSAH)who underwent craniotomy and clipping of aneurysms in the Fourth Affiliated Hospital of Nanchang University were selected for the study.They were divided into epilepsy group(12 cases)and non-epilepsy group(238 cases)according to whether delayed epilepsy occurred or not.The age,sex,World Federation of Neurosurgical Societies(WFNS)classification and modified Fisher scale classification at admission,Glasgow outcome scale(GOS)3 months after discharge,and intraoperative electrophysiological examination were recorded.Results The proportion of abnormal electrophysiological monitoring,symptomatic cerebral vasospasm and postoperative brain edema in epilepsy group were significantly higher than those in non-epilepsy group(P<0.05).There was significant difference in the distribution of modified Fisher scale scores between the two groups(P<0.05).The incidence of postoperative epilepsy in patients with aSAH was positively correlated with WFNS grade(r=0.958,P<0.05),and negatively correlated with GOS prognosis score(r=-0.951,P<0.01).There was no significant difference in the location of aneurysms between the two groups(P>0.05).Conclusion Clipping aneurysms under neurophysiological monitoring can effectively reduce the incidence of postoperative epilepsy and improve the prognosis of patients.The higher the WFNS grade and the lower the GOS score,the higher the risk of epilepsy,such patients should be paid special attention to.