뇌동맥류 파열 환자의 수술 후 경련발작의 위험인자
Risk of Seizures after Operative Treatment of Ruptured Cerebral Aneurysms
소속 상세정보
Chang, In-Bok/장인복
Cho, Byung-Moon/Shin, Dong-Ik/Shim, Young-Bo/Park, Se-Hyuck/Oh, Sae-Moon/조병문/신동익/심영보/박세혁/오세문
KMID : 0359820010300060705
Abstract
척추 경막상 지방종증은 과도하게 비대되고 증가된 경막상 지방조직이 신경조직을 압박하여 신경학적 증상을 유발하는 비교적 드문 질환이며, 주로 장기간 투여한 스테로이드와 관련되어 보고되었다. 특발성 척추 경막상 지방종증은 이러한 스테로이드 사용과 상관없이 발생하는 질환으로, 주로 비만 환자에서 발생하는 매우 드문 질환이다.
저자들은 스테로이드 사용과 관련없이 발생한 척추 경막상 지방종증 환자 2례를 치험하여 문헌 고찰과 함께 보고하는 바이다.
중심 단어: 지방종증·비만.
Objective : Postoperative seizure is a well documented complication of aneurysm surgery. The purpose of the present study was to analyze risk factors for postoperative seizure.
Methods : Between January 1990 and December 1996, we performed craniotomy for ruptured cerebral aneurysms in 321 patients. Among them 206 patients who could be followed up for more than 1 year(range, 1 to 4.6 years) were enrolled to present study. All patients were treated with anticonvulsants for 3 to 18 months postoperatively. We analyze the incidence of postoperative seizure in different sex and age groups, and risk factors associated with postoperative seizures following aneurysm rupture. For statistical processing chi-square test and Fisher´s, exact test were used.
Results : In the follow-up period of 1 to 4.6 years(mean, 1.8 years) postoperative seizure appeared in: 18 out of 206 patients(8.7%). Mean latency between the operation and the first seizure was 6 months(range, 3 weeks to 18 months). The age of the patients has significant influence on the risk of seizure, it occurred more often in younger patients(p=0.0014). Aneurysm location in the MCA was associated with a significantly a higher risk of seizure(p= 0.042). Eight patients(19%) out of 42 patients who suffered delayed ischemic neurologic deficit(DID) developed seizure. Delayed ischemic neurologic deficit was associated with significantly a higher risk of seizure(p=0.019). Infarct and hypertension were associated with significantly a higher risk of seizure(p <0.05). pre- or postoperative ihtracranial hematoma(intracerebral or epidural hematoma) was associated with significantly a higher risk of seizure (p <0.0001).. H-H grade, Fisher grade, Glasgow Outcome Scale of patients and timing of operation after subarachnoid hemorrhage had no significant relation with the risk of seizure.
Conclusion : Factors associated with the development of postoperative seizure were middle cerebral artery aneurysm, delayed ischemic neurologic deficit, infarct on late postoperative CT scan, hypertension, pre or postoperative intracranial hematoma(intracerebral or epidural hematoma). Identification of the risk factors may be help to focus the antiepileptic drug threapy in cases prone to develop seizures. Prospective evaluation is indicated.
키워드
Aneurysm surgery;Seizure;Subarachnoid hemorrhage;뇌동맥류 수술;지주막하출혈;경련발작
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