颅内破裂动脉瘤的手术方式与癫痫发作的关系

Relationship between surgical methods and epileptic seizure in patients with ruptured intracranial aneurysms

摘要:

目的 探讨颅内破裂动脉瘤患者的手术方式对癫痫发作的影响，以及与出血严重程度和患者预后的关系。方法 回顾性分析我院神经外科2013年5月至2017年5月手术治疗的颅内破裂动脉瘤患者的临床资料，根据手术方式，患者被分为夹闭组和栓塞组，比较两组的基线特征，并发症和预后，并根据临床分级，比较癫痫发作率和患者预后。结果 363例患者行开颅夹闭手术，211例患者行介入栓塞手术，两组的癫痫发作率无明显差异（P=1.000），但在Hunt-Hess 1-3级和改良Fisher 1-2级的患者中，夹闭组的患者癫痫发作率明显更高（P=0.036；P=0.013）。在Hunt-Hess 1-3级和改良Fisher 1-2级的患者中，有癫痫发作的比无癫痫发作的预后更差（P=0.010；P=0.031）。结论 破裂动脉瘤患者在两种手术后癫痫发作率无明显差异，但在临床分级低的患者中，开颅夹闭手术后癫痫发作率更高，且与预后不良相关。

Abstract:

Objective To investigate the effect of surgical methods on epileptic seizure and its relationship with bleeding severity and outcome of patients with ruptured intracranial aneurysms.Methods A retrospective analysis was conducted on the clinical data of patients with ruptured intracranial aneurysms who underwent a surgery at the Department of Neurosurgery in our hospital from May 2013 to May 2017. According to the surgical methods, the patients were divided into clipping group and coiling group. Baseline characteristics, complications, and outcomes were compared between the two groups; meanwhile, the incidence of epileptic seizure and outcomes of the patients were compared based on their clinical grades.Results A total of 363 patients underwent a clipping operation and 211 patients underwent a coiling operation. There was no significant difference in the incidence of epileptic seizure between the two groups (P=1.000), but the incidence of epileptic seizure was significantly higher in the clipping group for patients classified as Hunt-Hess grade 1-3 and modified Fisher grade 1-2 (P=0.036;P=0.013). In the patients classified as Hunt-Hess grade 1-3 and modified Fisher grade 1-2, a worse outcome was observed for those with a epileptic seizure compared with those without (P=0.010;P=0.031).Conclusions After undergoing either of the above two types of surgeries, there was no significant difference in the incidence of epileptic seizure between patients with ruptured intracranial aneurysms; however, a clipping operation results in a higher incidence of epileptic seizure in patients with low clinical grades, and is associated with poor outcomes.