颅骨缺损患者颅骨修补术后癫痫发作的危险因素分析

目的分析影响颅骨缺损患者颅骨修补术后癫痫发作的临床危险因素。方法回顾性分析1996年1月至2018年9月中国人民解放军联勤保障部队第九八八医院全军神经外科中心行颅骨修补术治疗的1064例颅骨缺损患者的临床资料。术后对所有患者行临床随访,根据是否有癫痫发作将患者分为癫痫组(155例)和无癫痫组(909例),采用单因素和多因素logistic回归分析判断影响颅骨缺损患者颅骨修补术后癫痫发作的临床危险因素。结果1064例患者均顺利完成颅骨修补手术,随访时间为(13.0±9.6)个月(3~120个月),术后155例(14.6%)患者出现了癫痫发作。单因素分析结果显示,颅骨缺损时间、原因、部位、侧别、面积、去骨瓣减压时未修补硬脑膜及颅骨修补术中开放硬脑膜均是影响患者术后癫痫发作的临床因素(均P<0.05)。多因素logistic回归分析结果显示,去骨瓣减压时未修补硬脑膜(OR=8.523,95%CI:1.081~23.394,P<0.001)、颅骨修补术中开放硬脑膜(OR=7.763,95%CI:2.582~22.769,P<0.001)及颅骨修补时间>6个月(OR=2.874,95%CI:2.671~12.972,P=0.027)是影响患者术后癫痫发作的独立危险因素。结论去骨瓣减压时未修补硬脑膜、修补术中开放硬脑膜及颅骨修补时间>6个月可增加颅骨缺损患者颅骨修补术后癫痫发作的概率。

Analysis of risk factors for seizures after cranioplasty in patients with skull defects

Objective To investigate the clinical risk factors for seizures after cranioplasty in patients with skull defects.Methods A retrospective study was conducted on the clinical data of 1064 patients with skull defects who underwent cranioplasty at Department of Neurosurgery,the 988th Hospital of PLA from January 1996 to September 2018.All patients underwent clinical follow up and were divided into epilepsy group(155 cases)and non-epilepsy group(909 cases)based on whether they had seizures.Univariate and multivariate logistic regression analyses were applied to investigate the clinical risk factors for seizures post cranioplasty in patients with skull defects.Results All patients underwent successful cranioplasty and were followed up for the duration of 3-120 months with an average of 13.0±9.6 months.There were 155 patients(14.6%)developing seizures after cranioplasty.Univariate analysis showed that the skull defect time,cause,position,side,area,failure to repair the dura mater during decompressive craniectomy and opening the dura mater during cranioplasty were clinical factors for seizures post cranioplasty in patients with skull defects(all P<0.05).Further multivariate analysis showed that failure to repair the dura mater during decompressive craniectomy(OR=8.523,95%CI:1.081-23.394,P<0.001),opening the dura mater during cranioplasty(OR=7.763,95%CI:2.582-22.769,P<0.001)and skull repair time more than 6 months(OR=2.874,95%CI:2.671-12.972,P=0.027)were independent risk factors for seizures post cranioplasty in patients with skull defects.Conclusion Failure to repair the dura mater during decompressive craniectomy,opening the dura mater during cranioplasty and skull repair time more than 6 months can increase incidence of seizures after cranioplasty in patients with skull defects.