[Status epilepticus after brain tumor surgery]

ABTRACT

BACKGROUND

Status epilepticus (SE) is characterized by continuous course of clinical and/or electrographic epileptic seizures. There are little data on the course and outcomes of SE after resection of brain tumors.

OBJECTIVE

To analyze clinical and electrographic manifestations of SE, its course and outcomes in short-term period after resection of brain tumors.

MATERIAL AND METHODS

We analyzed medical records of 18 patients over 18 years old between 2012 and 2019. All patients underwent resection of brain tumor and developed SE after surgery. Clinical criteria were repeated epileptic seizures without interictal recovery of consciousness, stereotypical motor phenomena, impaired consciousness with continued epileptic activity according to video-EEG data. We analyzed EEG data, neurological status, CT and laboratory data.

RESULTS

Metastases (33%) and meningiomas (16%) prevailed. Supratentorial tumors were observed in 61% of patients. Two patients had preoperative seizures. Non-convulsive SE was diagnosed in 62% of patients. SE was successfully treated in 77% of cases. Mortality rate in patients with SE was 44%.

CONCLUSION

Early postoperative SE is rare after brain tumor surgery (about 0.09%). Nevertheless, this complication is associated with high mortality. Non-convulsive SE is common (62%) that should be considered in postoperative management.

[Early predictive biomarkers of posttraumatic epilepsy]

Traumatic brain injury (TBI) affects about 50 million people in the world every year. Posttraumatic epilepsy (PTE) is a significant complication of TBI of any severity. PTE occurs in 20% of patients with TBI. Treatment of patients with PTE is particularly difficult due to obvious tendency towards drug resistance. Currently, there are no validated predictive biomarkers for PTE. Development of a system of validated predictive markers would improve PTE prediction quality and therapeutic approach for these patients. This review is devoted to the current data on the most perspective predictive biomarkers of PTE for clinical practice.

[Convulsive syndrome as a manifestation of acute cerebral damage due to paradoxical air embolism in neurosurgical patients. Series of clinical cases and literature review]

Introduction

Paradoxical air embolism (PAE) is a rare potentially fatal complication followed by entering of air emboli from the right cardiac chambers and pulmonary artery to large circulation circle.

Objective

To analyze five patients who underwent neurosurgical intervention complicated by PAE and early postoperative convulsive syndrome.

Material and methods

There were five patients who developed early postoperative convulsive syndrome after previous neurosurgery in sitting position complicated by PAE. Convulsive syndrome required intensive care at the ICU. MRI confirmed ischemic foci de novo outside the zone of surgical intervention in all cases. All patients underwent video-EEG monitoring in order to select anticonvulsant therapy and evaluate its effectiveness. The authors were able to match the epileptogenic focus in the cerebral cortex with MRI data. Available literature data devoted to the problem of convulsive syndrome after neurosurgery complicated by PAE were analyzed.

Results

The focus of epileptiform activity coincided with one of the foci of hyperintense MR signal in all cases.

Conclusion

Video-EEG monitoring is advisable in patients with impaired consciousness who underwent neurosurgery complicated by PAE.

[The management of patients with new epileptic seizures in the early period after resection of hemispheric tumors: two case reports and a literature review]

Epileptic seizures developing for the first time after a neurosurgical intervention (de novo seizures) are a challenge for choosing an optimal treatment. The pathogenesis of these seizures is often associated with factors that become inactive in the early postoperative period. These seizures can not serve the basis for diagnosing symptomatic epilepsy and should be regarded as a brain response to surgery, and patients do not need anticonvulsant therapy that reduces the quality of life. But in some situations, new early postoperative seizures serve the onset of symptomatic epilepsy and require prolonged anticonvulsant therapy. To date, one of the main techniques to identify the nature of newly developed seizure and to plan further treatment (whether or not to use anticonvulsant therapy) is video EEG monitoring. We present two clinical cases of patients who developed de novo convulsive seizures in the early postoperative period in similar situations after resection of intracerebral tumors. The use of video EEG monitoring allowed avoiding unreasonable use of anticonvulsant therapy in one of the patients.