Hemorrhage resulted from cortical venous infarction with seizure as first symptom after craniotomy: a clinical analysis of 11 patients
10.3760/cma.j.cn115354-20230824-00081
- VernacularTitle:开颅手术后以癫痫发作为首发症状的皮质静脉梗死性脑出血11例临床分析
- Author:
Xiaodong GUO
1
;
Zhenhua WANG
;
Peng XU
;
Minghui LIU
;
Wenming HAO
;
Xinchao YANG
;
Xiaoqi LU
;
Jinglun LI
;
Anhui YAO
;
Benhan WANG
Author Information
1. 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，郑州 450042
- Keywords:
Seizure;
Hemorrhage resulted from cortical venous infarction;
Cortical vein;
Cerebral hemorrhage;
Venous protection
- From:
Chinese Journal of Neuromedicine
2023;22(11):1121-1128
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical characteristics and efficacy of hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy.Methods:Eleven patients with hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy admitted to Neurosurgical Center, 988 th Hospital of PLA Joint Logistic Support Force from June 2011 to September 2019 were chosen in our study; primary diseases included meningioma in 7 patients, contusion and laceration of frontal lobe in 2, hypertensive cerebral hemorrhage in 1, and obsessive-compulsive disorder in 1 patient. Epilepsy was the first symptom after craniotomy. Clinical characteristics and efficacy of these patients were analyzed retrospectively; seizure control efficacy was evaluated by Engel grading. Results:First seizure occurred 4 h-7 d after craniotomy in these 11 patients, including 2 with focal sensory retention seizure, 3 with focal bilateral tonic-clonic seizure, and 6 with general tonic-clonic seizure. Follow-up cranial CT revealed hematoma in surgical region, adjacent cortex or subcortex in 9 patients (hematoma volume: 15-50 mL); emergency craniotomy (hematoma clearance) and decompressive craniectomy was performed in 5 patients; only emergency craniotomy (hematoma clearance) was performed in 3 patients; conservative treatment was performed in 1 patient. A small amount of diffuse bleeding with severe cerebral edema in the surgical region appeared in 2 patients, and the transient limb paralysis gradually recovered after 2 months of conservative treatment. Follow-up was performed for (4.5±1.7) years ([2.3-7.0] years). During the last follow-up, 4 patients were normal, 5 patients had mild to moderate hemiplegia, 1 had mild decreased vision in the right eye, and 1 had long-term coma. Epileptic control efficacy analysis indicated that 8 had Engel grading I and 3 grading II.Conclusion:Complete removal of hematoma and inactivated brain tissues can effectively control seizures and rebleeding in patients with hemorrhage resulted from cortical venous infarction.
