Epileptic Syndrome in the Nearest and Remote Periods of Surgical Treatment of Intracranial Aneurysms

Nikitin N., Panountsev V.

Polenov Research Neurosurgical Institute, Saint Petersburg, Russia


Catamnesis of 307 cases, operated for intracranial aneurysms, was studied. A period of supervision varied from 4 up to 18 years. It was found out, that 32 cases (10.5%) had developed epileptic syndrome (more than 2 seizures) during 1month-16 years after operation; it had happened during the first two years in 15 of them (66%). Worsening of life quality and a state, caused by this syndrome, was watched in 15 out of 32 cases. Constant taking of anticonvulsants was typical of 15 patients; 12 cases took them from time to time and 5 cases did not take them at all. Frequent seizures (more than 3 times a month) were observed in 2 cases only. Risk factors, conditioning epilepsy development in the nearest and remote periods of surgical treatment, included localization of the MCA aneurysm (p<0.001), a combination with intracranial developmental defects (AVM and others) (p<0.05). As for surgical factors, repeated interventions on aneurysm (p<0.001), brain traction during more than 3 hours (p<0.01), guided arterial hypotension (p<0.001), postoperative thrombosis of a parent vessel (p<0.05), hemorrhagic complications (p<0.001), meningitis (p<0.01), seizures in an early postoperative period (p<0.05) and ischemic areas, revealed by control CT, had reliable correlation with future epilepsy development. Taking of anticonvulsants and its duration did not prevent future development of epileptic syndrome (p>0.05). The rate of returning to working activity was reliably lower in cases with seizures (p<0.05). Epileptic syndrome was a cause of its further cessation in those cases (50%), who had already started to work (p<0.001). Epileptic syndrome worsened life quality of patients (47%; p<0.001).