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World Neurosurg. 2020 Apr 03;:
Authors: Lin CY, Chang CC, Tseng C, Chen YJ, Tsai CH, Lo YS, Hsiao PH, Tsou HK, Lin CS, Chen HT
Abstract
BACKGROUND: Percutaneous endoscopic surgery is a popular surgery to treat lumbar spinal disorders. However, seizure following percutaneous endoscopic surgery is an unpredictable complication. The only prodromal sign for seizure currently known is neck pain.
OBJECTIVES: To review incidence, risk factors of seizure during percutaneous endoscopic surgery. To present three cases with seizure and our management.
METHODS: From October 2006 to March 2019, three of 816 patients (0.34%) with thoracic lumbar disorders who had received percutaneous endoscopic surgery experienced a seizure episode. Those three cases were carefully reviewed. Articles on risk factors for seizure following the spinal procedures published before 06/13/2019 were identified through a PubMed search.
RESULTS: We observed the infusion fluid containing cefazolin, infusion rate, prolonged surgery time, dura tear, and sevoflurane anesthesia may be associated with the seizure attack as described in the literature. Three patients who experienced a seizure episode were under general anesthesia with sevoflurane, and the surgical approach used was interlaminar for herniated disc in L5-S1. We noticed a red flag sign, namely an uncontrollable hypertension episode combined with decreasing pulse rate, in all patients who experienced seizure, which was not observed in other patients. All three patients received antihypertensive medication (labetalol) three times or more without response.
CONCLUSION: Seizure following percutaneous endoscopic surgery is rare but lethal. Although it's cause remain unknown, we should check all risk factors for seizure and corrected immediately when a red flag sign, uncontrolled hypertension, appears.
PMID: 32251806 [PubMed - as supplied by publisher]
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