Factors associated with early seizures after surgery of unruptured intracranial aneurysms.

OBJECTIVE: The aim of the study was to better define the incidence of and risk factors for early seizures after repair of unruptured intracranial aneurysms in modern microsurgical techniques.

PATIENTS AND METHODS: The medical records of 414 consecutive patients who underwent neck clipping of unruptured intracranial aneurysms in our institution over a 5-year period were retrospectively reviewed. Clinical and neuroimaging variables were analyzed to investigate putative predictors of perioperative seizures using multivariate logistic regression analysis.

RESULTS: Overall, 24 patients (5.8%) developed seizures within 14 days of surgery without routine prophylactic use of anticonvulsants. Eleven patients experienced partial seizures, while 13 experienced secondary generalized seizures. The interval between surgery and seizure onset was less than 6 h in 8 patients, 6-24 h in 3, and 1-14 days in 11. History of dialysis (odds ratio [OR] = 77.6, 95% confidence interval [CI] 7.5-1783.4, P < 0.001), and presence of cerebral contusion (OR = 5.1, 95% CI 1.3-16.9, P = 0.02) or infarction (OR = 13.9, 95% CI 3.9-48.5, P < 0.001) detected by postoperative computed tomography were independent and significant risk factors. No patients with early seizures went on to develop refractory epilepsy.

CONCLUSIONS: Dialysis and iatrogenic brain damage were associated with a higher risk of early seizures after aneurysm surgery. Our data support the selective use of anticonvulsants during the perioperative period of elective aneurysm surgery.