Risk factors for the development of seizures after cranioplasty in patients that sustained traumatic brain injury: a systematic review

Spencer, R. , Manivannan, S., Sharouf, F., Bhatti, M. I. and Zaben, M. (2019) Risk factors for the development of seizures after cranioplasty in patients that sustained traumatic brain injury: a systematic review. Seizure, 69, pp. 11-16. (doi: 10.1016/j.seizure.2019.03.014) (PMID:30952091)

Abstract

Decompressive craniectomy (DC) is used for the treatment of raised intracranial pressure secondary to traumatic brain injury. Cranioplasty is a reconstructive procedure that restores the structural integrity of the skull following (DC). Seizures are a recognised complication of cranioplasty but its incidence and risk factors in TBI patients are unclear. Accurate prognostication can help direct prophylactic and treatment strategies for seizures. In this systematic review, we aim to evaluate current literature on these factors. A PROSPERO-registered systematic review was performed in accordance with PRISMA guidelines. Data was synthesised qualitatively and quantitatively in meta-analysis where appropriate. A total of 8 relevant studies were identified, reporting 919 cranioplasty patients. Random-effects meta-analysis reveals a pooled incidence of post-cranioplasty seizures (PCS) of 5.1% (95% CI 2.6–8.2%). Identified risk factors from a single study included increasing age (OR 6.1, p = 0.006), contusion at cranioplasty location (OR 4.8, p = 0.015), and use of monopolar diathermy at cranioplasty (OR 3.5, p = 0.04). There is an association between an extended DC-cranioplasty interval and PCS risk although it did not reach statistical significance (p = 0.062). Predictive factors for PCS are poorly investigated in the TBI population to date. Heterogeneity of included studies preclude meta-analysis of risk factors. Further studies are required to define the true incidence of PCS in TBI and its predictors, and trials are needed to inform management of these patients.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Spencer, Dr Robert
• Authors: Spencer, R., Manivannan, S., Sharouf, F., Bhatti, M. I., and Zaben, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Seizure
• Publisher: Elsevier
• ISSN: 1059-1311
• ISSN (Online): 1532-2688
• Published Online: 21 March 2019
• Copyright Holders: Copyright © 2019 Crown Copyright
• First Published: First published in Seizure 69: 11-16
• Publisher Policy: Reproduced in accordance with the publisher copyright policy