Title : Identifying risk factors for post-operative seizure in patients undergoing chronic subdural hematoma treatment with craniotomy, burr hole evacuation or middle meningeal artery embolization
Abstract:
Objective: Post-operative seizures can occur in 2.6% to 23% of patients with chronic subdural hematomas (cSDH). Hematoma size, midline shift, worse clinical status at admission, and craniotomy with membranectomy have been described as risk factors for its development; however, the impact of middle meningeal artery embolization (MMAe) remains unexplored. This retrospective study aims to determine post-operative seizure rates in cSDH patients treated with MMAe and compare them with those undergoing craniotomy and burr hole evacuation.
Methods: A bi-institutional retrospective review of 592 cSDH treated surgically and endovascularly from 2017 to 2021 was conducted. Patient, hematoma, and procedural characteristics were compared among interventions using Fisher exact tests, t-tests, and ANOVA. Multivariate logistic regression was employed to compare the relationship of post-operative seizures with the type of treatment, adjusting for sex, age, subdural SDH thickness, midline shift, pre-operative GCS score, and prophylactic AED use. Secondary outcomes evaluated included complications, additional drainage, and length of hospitalization.
Results: Post-operative seizure rates were 3.1% for burr hole evacuation, 2.6% for burr hole evacuation with MMAe, 15.3% for craniotomy, 11.1% for craniotomy with MMAe, and 6.7% for MMAe alone. Multivariate logistic regression revealed lower seizure rates in patients undergoing burr hole evacuation with or without MMAe compared to those with MMAe alone (p=0.007, OR 0.18, 95% CI 0.05-0.62). Craniotomy with or without subsequent MMAe had a higher risk of post-operative seizure compared to burr hole drainage with or without MMAe (p=0.0002, OR 5.66, 95% CI 2.28-14.04). Overall post-operative complications were lower in MMAe alone compared to burr hole drainage alone (P=0.01, OR 0.35, 95% CI 0.15-0.79).
Conclusion: Burr hole evacuation demonstrated the lowest post-operative seizure rates in cSDH patients, followed by MMAe alone and then craniotomy, and this association was significant after controlling for confounders.
