钛网颅骨修补术后癫痫发作的相关研究

【摘要】目的探讨可能导致钛网颅骨修补术后癫痫发作的危险因素，并提出相应的预防措施。方法回顾性分析223例实施钛网颅骨修补术治疗的颅骨缺损患者的临床资料，术后对患者进行随访。根据术后有无癫痫发作，分为癫痫组（48例）和无癫痫组（175例）。采用单因素和多因素Logistic回归分析，探讨可能导致癫痫发作的危险因素。结果术后癫痫发作率为21.52%（共48例）。单因素分析结果显示，性别、颅骨缺损面积、时间以及修补术中损坏硬膜等因素可能与术后癫痫发作相关（均P＜0.05）。多因素Logistic回归分析显示，性别（OR=7.956，95% CI：2.759～22.944）、颅骨缺损面积（OR=1.032，95% CI：1.018～1.046）、颅骨缺损时间（OR=1.146，95% CI：1.043～1.260）、颅骨修补术中损坏硬膜（OR=2.558，95% CI：1.234～5.302）可能是导致术后癫痫发作的独立危险因素（均P＜0.05）。结论颅骨缺损面积、颅骨缺损时间、修补术中损坏硬膜均是可能导致术后癫痫发作的危险因素。因此，在去骨瓣减压术时尽量兼顾去除骨瓣的面积，颅骨缺损后尽早行颅骨修补，在修补术中尽量避免损坏硬膜等措施，可减少修补术后癫痫发作。

Abstract： Objective To explore the risk factors of seizures after titanium mesh cranioplasty, and put forward the corresponding preventive measures. Methods The clinical data of 223 patients with skull defect treated with titanium mesh cranioplasty were analyzed retrospectively. All patients were followed up after operation. They were divided into epilepsy group(48 cases) and non epilepsy group(175 cases) based on whether postoperative seizures onset. Univariate analysis and multivariate logistic regression analysis were used to explore the risk factors of postoperative seizures. Results The postoperative seizure rate was 21.52%(48 cases). Univariate analysis showed that the gender, skull defect area, time and dura mater damage during cranioplasty may be related to postoperative seizures(all P<0.05). Multivariate logistic regression analysis showed that gender(OR=7.956， 95% CI：2.759～22.944), skull defect area(OR=1.032，95% CI：1.018～1.046), skull defect time(OR=1.146，95% CI：1.043～1.260) and dura mater damage during cranioplasty(OR=2.558，95% CI：1.234～5.302) could be independent risk factors for postoperative seizures(all P<0.05). Conclusions The skull defect area, the skull defect time and the dura mater damage during cranioplasty are the risk factors that may lead to postoperative seizures. Therefore, the area of bone flap removed should be considered as much as possible during decompressive craniectomy, cranioplasty should be performed as early as possible after skull defect, and try to avoid damaging the dura mater during the cranioplasty, which can reduce seizures after cranioplasty.