Abstract
BackgroundNew-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.MethodsThe 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.ResultsA total of 302 patients underwent CP between 2002 and 2017, 276 of whom were included in the outcome analysis and the incidence of NOSAC was 23.2%. Although time between DHC and CP differed significantly between DHC indication groups, time between DHC and seizure onset did not differ, suggesting the occurrence of seizures to be independent of the procedure of CP. Time of follow-up was the only factor associated with the occurrence of NOSAC.ConclusionNew-onset seizures may be a consequence of the initial condition leading to DHC rather than of CP itself. Time of follow-up seems to play a major role in detection of new-onset seizures.
Highlights
According to numerous reports given in the literature, newonset seizures are a common complication of cranioplasty (CP)
While some authors advocate that new-onset seizures after cranioplasty (NOSAC) are a consequence of procedural complications, such as hemorrhage, hydrocephalus, and wound healing disorder [13, 17, 22], others focus on the identification of other risk factors [16, 18–21]
We suggest the phenomenon of New-onset seizures after cranioplasty (NOSAC) to be mainly an effect of the initial condition of patients undergoing decompressive hemicraniectomy (DHC) and subsequent CP, and that the differences in their observed frequency were caused by massive bias but to be very much dependent on time of follow-up
Summary
According to numerous reports given in the literature, newonset seizures are a common complication of cranioplasty (CP). While some authors advocate that new-onset seizures after cranioplasty (NOSAC) are a consequence of procedural complications, such as hemorrhage, hydrocephalus, and wound healing disorder [13, 17, 22], others focus on the identification of other risk factors [16, 18–21]. According to these mainly retrospective analyses, risk factors include patient age at CP, time between decompressive craniectomy (DHC) and CP, presence of a ventriculoperitoneal shunt.
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