Non-convulsive status epilepticus in the postanesthesia care unit following meningioma excision (original) (raw)
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Acta Neurochirurgica, 2021
Background New-onset seizures after cranioplasty (NOSAC) are reported to be a frequent complication of cranioplasty (CP) after decompressive hemicraniectomy (DHC). There are considerable differences in the incidence of NOSAC and contradictory data about presumed risk factors in the literature. We suggest NOSAC to be a consequence of patients’ initial condition which led to DHC, rather than a complication of subsequent CP. We conducted a retrospective analysis to verify our hypothesis. Methods The medical records of all patients ≥ 18 years who underwent CP between 2002 and 2017 at our institution were evaluated including incidence of seizures, time of seizure onset, and presumed risk factors. Indication for DHC, type of implant used, timing of CP, patient age, presence of a ventriculoperitoneal shunt (VP shunt), and postoperative complications were compared between patients with and without NOSAC. Results A total of 302 patients underwent CP between 2002 and 2017, 276 of whom were in...
Should epidural drain be recommended after supratentorial craniotomy for epileptic patients?
Surgical Neurology, 2009
Background: ED was once and is still commonly applied to prevent mainly EH and subgaleal CSF collection. We designed this study to observe if ED could decrease the incidence and volume of EH and subgaleal CSF collection after supratentorial craniotomy in epileptic patients. Methods: Three hundred forty-two epileptic patients were divided into 2 groups according to their first craniotomy date (group 1 in odd date and group 2 in even date). Patients in group 1 had ED and those in group 2 had no ED. The patient numbers and volumes of EH and subgaleal CSF collections in both groups were recorded and statistically analyzed. Results: There were 22 EHs in group 1 and 20 EHs in group 2. There were 11 and 10 subgaleal CSF collections in groups 1 and 2, respectively. The average volume of EH was 13.5 ± 8.12 and 14.65 ± 7.72 mL in groups 1 and 2, respectively. The average volume of subgaleal CSF collection was 42.76 ± 12.09 and 43.75 ± 11.44 mL in groups 1 and 2, respectively. There were no statistical differences in the incidence and average volume of EH and subgaleal CSF collection between the 2 groups. Conclusions: ED cannot decrease the incidence and volume of EH and subgaleal CSF collection. ED should not be recommended after supratentorial epileptic craniotomy.
Epileptic Syndrome and Cranioplasty: Implication of Reconstructions in the Electroencephalogram
World Neurosurgery, 2020
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The Canadian Journal of Neurological Sciences Le Journal Canadien Des Sciences Neurologiques, 2000
Awake craniotomy is performed using neurolept analgesia, a term first proposed by De Castro and Mundeleer in 1959 to describe a state of indifference and immobilization produced by the combined administration of the neuroleptic haloperidol and the narcotic analgesic phenoperidine. 1 Following numerous modifications, the combination of droperidol and fentanyl became the most widely used method for producing neurolept analgesia, which is distinguished from neurolept anaesthesia by the preservation of consciousness, although the two terms are often used interchangeably. The technique of awake craniotomy demands, perhaps more so than any other neurosurgical ABSTRACT: In 1886, Victor Horsley excised an epileptogenic posttraumatic cortical scar in a 23-yearold man under general anaesthesia and discussed his choice of anaesthesia: "I have not employed ether in operations on man, fearing that it would tend to cause cerebral excitement; chloroform, of course, producing on the contrary, well-marked depression." His concerns regarding anaesthesia are reiterated 100 years later as evidenced by the ongoing controversy over the choice of anaesthetic in surgical procedures for epilepsy. The current controversies regarding the necessity for local anaesthesia in temporal lobe epilepsy operations concern the utility of electrocorticography in surgical decision making, its relationship to seizure outcome and the value of intraoperative language mapping in dominant temporal lobe resections. The increasing sophistication of pre-operative investigation and localization of both areas of epileptogenesis and normal brain function and the introduction of minimally invasive surgical techniques and smaller focal resections are changing the indications for local anaesthesia in temporal lobe epilepsy. Thus, indications which were previously absolute are now perhaps relative. This article reviews the current indications for craniotomy under local anaesthesia in the surgical treatment of temporal lobe epilepsy. RÉSUMÉ: La crâniotomie sous anesthésie locale: indications et techniques dans le traitement chirurgical de l'épilepsie temporale. En 1886, Victor Horsley a excisé une cicatrice corticale post-traumatique épileptogène chez un jeune homme de 23 ans sous anesthésie générale et a discuté du choix de l'anesthésie: "je n'ai pas utilisé l'éther pour les interventions chez l'homme par crainte de causer de l'excitation cérébrale; le chloroforme, bien entendu, produit au contraire une dépression marquée." Ses inquiétudes concernant l'anesthésie sont réitérées 100 ans plus tard comme en témoigne la présente controverse sur le choix de la substance anesthésique pour la chirurgie de l'épilepsie. Les controverses actuelles concernant la nécessité d'une anesthésie locale dans la chirurgie de l'épilepsie temporale concernent l'utilité de l'électrocorticographie comme aide à la décision au cours de la chirurgie, sa relation aux résultats et sa valeur pour la cartographie du langage pendant l'intervention dans la résection d'un lobe temporal dominant. L'investigation préopératoire de plus en plus sophistiquée, la localisation des zones épileptogènes et des zones normales, l'introduction de techniques chirurgicales très peu effractives et les résections focales plus limitées changent les indications pour l'anesthésie locale dans l'épilepsie temporale. Ainsi, les indications qui étaient antérieurement absolues sont probablement relatives. Cet article revoit les indications actuelles de la crâniotomie sous anesthésie locale dans le traitement chirurgical de l'épilepsie temporale.
Epilepsy, a Neurological Emergency in Oro-maxi-facial Surgery - neuro - psychic Field
Revista de Chimie, 2019
Dental practice does not start with the fear for accidents and complications, much less for emergency, but in order to prevent and effectively treat them, they must be known and diagnosed quickly, correctly and with great discernment. Fortunately, in dental practice, emergency is not met frequently, but if it occurs, however, doctor�s accurate and fast reaction can and save thepatient�s life. Emergency requires maximum efficiency and it imposes to give the most direct and shortest dental practice for solving. It is possible to trigger or aggravate generaldisorders caused by dental work, cases in which we have an obligation to recognize the accident or complication at the time of happening and to intervene urgently and effectively to save the patient�s life. Epilepsy is a neurological disease that alters the transmission of electrical signals within the brain. We conducted our study in the Oral and Maxillofacial Surgery Clinic on 187 patients studied between 2015 and 2018. Of these, ...
Journal of neurosurgery, 2018
Cranioplasty is a relatively simple and less invasive intervention, but it is associated with a high incidence of postoperative seizures. The incidence of, and the risk factors for, such seizures and the effect of prophylactic antiepileptic drugs (AEDs) have not been well studied. The authors' aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty. The records of patients who had undergone cranioplasty at the authors' medical center between 2009 and 2014 with at last 2 years of follow-up were retrospectively reviewed. Demographic and clinical characteristics, the occurrence of postoperative seizures, and postoperative complications were analyzed. Among the 583 patients eligible for inclusion in the study, 247 had preexisting seizures or used AEDs before the cranioplasty and 336 had no seizures prior to cranioplasty. Of these 336 patients, 89 (26.5%) had new-onset seizures follo...
Emergency EEG and diagnostic yield
Acta clinica Croatica, 2009
The aim of the study was to determine whether an acute loss of consciousness, mental status change or related symptoms correlated with the presence of epileptiform abnormalities on urgent EEG. We analyzed 228 consecutive patients admitted to Emergency Room during the past 12 months and referred for urgent EEG evaluation. All patients had either a brief loss of consciousness or acute brain disorder, with a clinical diagnosis of epilepsy, syncope, head trauma, headache, transient ischemic attack (TIA) or vertigo. Statistical analysis was performed using Spearman's rho test for group comparison and multivariate regression analysis. The mean age of patients was 48 +/- 20 years. The frequency of referring clinical diagnoses was as follows: epilepsy 44.7% (102/228), TIA 15.8% (36/228), syncope 15.4% (35/228), headache 11% (25/228), vertigo 7.9% (18/228) and acute head trauma 5.3% (12/228). EEG indicated epileptiform abnormalities in 14.9% (34/228) and focal slowing in 9.2% (21/228) of...
Intraoperative Seizures During Awake Craniotomy
Neurosurgery, 2013
BACKGROUND: Awake craniotomy (AC) for removal of intra-axial brain tumors is a well-established procedure. However, the occurrence and consequences of intraoperative seizures during AC have not been well characterized. OBJECTIVE: To analyze the incidence, risk factors, and consequences of seizures during AC. METHODS: The database of AC at Tel Aviv Medical Center between 2003 to 2011 was reviewed. Occurrences of intraoperative seizures were analyzed with respect to medical history, medications, tumor characteristics, and postoperative outcome. RESULTS: Of the 549 ACs performed during the index period, 477 with complete records were identified. Sixty patients (12.6%) experienced intraoperative seizures. The AC procedure failed in 11 patients (2.3%) due to seizures. Patients with intraoperative seizures were significantly younger than nonseizing patients (45 ± 14 years vs 52 ± 16 years, P = .003), had a higher incidence of frontal lobe involvement (86% vs % 57%, P < .0001), and had ...
Seizure and delayed emergence from anesthesia resulting
2012
A patient with remote cerebellar hemorrhage (RCH) who was presented at the authors' hospital with seizure and delayed emergence from anesthesia after loss of cerebrospinal fluid (CSF) through a dural tear during lumbar spine surgery is described. RCH is a rare and unpredictable complication after spinal surgery. Its most common clinical features are diminished consciousness, headache, and seizure. Its mechanism is still disputed, but is probably venous bleeding secondary to significant intra- or post-operative loss of CSF. Therefore, RCH must be considered in patients with unexplained mental deterioration or disturbance upon emergence and seizure from general anesthesia after spine surgery.