Introduction: 

Intraoperative seizures (IOSs) during awake craniotomy (AC) are associated with significant morbidity. The reported incidence of IOS is between 3% and 30%. The aim of this study was to identify risk factors for IOS during AC for elective resection or biopsy of a space-occupying brain lesion.

Methods: 

In this retrospective study, we reviewed the records of all awake craniotomies performed by a single neurosurgeon at a single university hospital between July 2006 and December 2018. IOS was defined as a clinically apparent seizure that occurred in the operating room and was documented in the medical records. Explanatory variables were chosen based on previously published literature on risk factors for IOS.

Results: 

Five hundred and sixty-two patients had a total of 607 AC procedures during the study period; 581 cases with complete anesthesia records were included in analysis. Twenty-nine (5.0%) IOS events were reported during 29 (5%) awake craniotomies. Most seizures (27/29; 93%) were focal in nature and did not limit planned intraoperative stimulation mapping. Variables associated with IOS at a univariate P-value <0.1 (frontal location of tumor, preoperative radiotherapy, preoperative use of antiepileptic drugs, intraoperative use of dexmedetomidine, and intraoperative stimulation mapping) were included in a multivariable logistic regression. Frontal location of tumor (adjusted odds ratio: 5.68, 95% confidence interval: 2.11-15.30) and intraoperative dexmedetomidine use (adjusted odds ratio: 2.724, 95% confidence interval: 1.24-6.00) were independently associated with IOS in the multivariable analysis.

Conclusions: 

This study identified a low incidence (5%) of IOS during AC. The association between dexmedetomidine and IOS should be further studied in randomized trials as this is a modifiable risk factor.

中文翻译：

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清醒开颅手术期间术中癫痫发作的危险因素和特征：对 562 名占位性脑病变患者连续进行的回顾性队列研究

介绍： 

清醒开颅手术(AC) 期间的术中癫痫发作 (IOS) 与显着的发病率相关。据报道，IOS 的发生率在 3% 至 30% 之间。本研究的目的是确定 AC 期间对占位性脑病变进行选择性切除或活检时发生 IOS 的危险因素。

方法： 

在这项回顾性研究中，我们回顾了 2006 年 7 月至 2018 年 12 月期间，由一名神经外科医生在同一所大学医院进行的所有清醒开颅手术的记录。IOS 被定义为在手术室中发生的临床上明显的癫痫发作，并记录在医疗记录中。记录。根据先前发表的有关 IOS 风险因素的文献选择解释变量。

结果： 

研究期间，562 名患者总共接受了 607 次 AC 手术；581例有完整麻醉记录的病例纳入分析。在 29 次 (5%) 清醒开颅手术期间报告了 29 次 (5.0%) IOS 事件。大多数癫痫发作（27/29；93%）本质上是局灶性的，并且不限制计划的术中刺激标测。与 IOS 相关的单变量P值 <0.1 的变量（肿瘤的额叶位置、术前放疗、术前抗癫痫药物的使用、术中右美托咪定的使用以及术中刺激映射）均包含在多变量逻辑回归中。在多变量分析中，肿瘤的额部位置（调整后的比值比：5.68，95% 置信区间：2.11-15.30）和术中右美托咪定的使用（调整后的比值比：2.724，95% 置信区间：1.24-6.00）与 IOS 独立相关。

结论： 

这项研究发现 AC 期间 IOS 的发生率较低（5%）。右美托咪定和 IOS 之间的关联应在随机试验中进一步研究，因为这是一个可改变的危险因素。