Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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What Should Be Considered to Cause the Early Post-Craniotomy Seizure : Antibiotics (Cefazolin) Irrigation

  • Jang, Ji Hwan (Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Song, Kyung Sun (Department of Neurosurgery, Neurovascular Center of New Korea Hospital) ;
  • Bang, Jae Seung (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Oh, Chang Wan (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Kwon, O-Ki (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Chung, Young Seob (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Boramae Hospital)
  • Received : 2015.06.05
  • Accepted : 2015.08.20
  • Published : 2015.11.28
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Abstract

Objective : Post-craniotomy seizure (PCS) is reported only rarely. However, our department noted a 433% increase in PCS for a year beginning September 2010, especially after cerebrovascular surgery. Our goal was to identify the cause of our unusual outbreak of PCS. Methods : For almost one year after September 2010, cases of PCS increased significantly in our department. We analyzed 973 patients who had received a major craniotomy between January 2009 and November 2011. We included seizures that occurred only in the first 24 postoperative hours, which we defined as early PCS. After verifying the presence of PCS, we analyzed multiple seizure-provoking factors and their relation to the duration and character of seizure activity. Results : Overall PCS incidence was 7.2% (70/973). Cefazolin (2 g/L saline) was the antibiotic drug used for intraoperative irrigation in 88.4% of the operations, and no PCS occurred without intraoperative cefazolin irrigation. When analyzed by operation type, clipping surgery for unruptured aneurysms was the most frequently associated with PCS (80%). Using logistic regression, only 2 g cefazolin intraoperative irrigation (p=0.024) and unruptured aneurysm clipping surgery (p<0.001) were associated with early PCS. The seizure rate of unruptured aneurysm clipping surgery using 2 g cefazolin intraoperative irrigation was 32.9%. Conclusion : Intraoperative cefazolin irrigation must be avoided in patients undergoing craniotomy, especially for clipping of unruptured aneurysms, because of the increased risk of early PCS.

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References

  1. Akula KK, Dhir A, Kulkarni SK : Pro-convulsant effect of cefazolin sodium against pentylenetetrazol- or picrotoxin-induced convulsions in mice. Indian J Exp Biol 45 : 720-725, 2007
  2. Arkaravichien W, Tamungklang J, Arkaravichien T : Cefazolin induced seizures in hemodialysis patients. J Med Assoc Thai 89 : 1981-1983, 2006
  3. Boswell MV, Wolfe JR : Intrathecal cefazolin-induced seizures following attempted discography. Pain Physician 7 : 103-106, 2004
  4. De Sarro A, De Sarro GB, Ascioti C, Nistico G : Epileptogenic activity of some beta-lactam derivatives : structure-activity relationship. Neuropharmacology 28 : 359-365, 1989 https://doi.org/10.1016/0028-3908(89)90030-0
  5. De Sarro A, Zappala M, Chimirri A, Grasso S, De Sarro GB : Quinolones potentiate cefazolin-induced seizures in DBA/2 mice. Antimicrob Agents Chemother 37 : 1497-1503, 1993 https://doi.org/10.1128/AAC.37.7.1497
  6. Gardner P, Leipzig T, Phillips P : Infections of central nervous system shunts. Med Clin North Am 69 : 297-314, 1985 https://doi.org/10.1016/S0025-7125(16)31044-6
  7. Hoffler D, Demers HG, Niemeyer R : [Neurotoxicity of modern cephalosporins]. Dtsch Med Wochenschr 111 : 197-198, 1986
  8. James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA : Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurgery 7 : 459-463, 1980 https://doi.org/10.1227/00006123-198011000-00006
  9. Kamei C, Sunami A, Tasaka K : Epileptogenic activity of cephalosporins in rats and their structure-activity relationship. Epilepsia 24 : 431-439, 1983 https://doi.org/10.1111/j.1528-1157.1983.tb04913.x
  10. Lee Y, Pyun SB, Park EK, Youn SW : Persistent dysarthria after cefazolin-induced status epilepticus. Brain Inj 23 : 846-851, 2009 https://doi.org/10.1080/02699050903196704
  11. Lin CS, Cheng CJ, Chou CH, Lin SH : Piperacillin/tazobactam-induced seizure rapidly reversed by high flux hemodialysis in a patient on peritoneal dialysis. Am J Med Sci 333 : 181-184, 2007 https://doi.org/10.1097/MAJ.0b013e31803195e7
  12. Manzella JP, Paul RL, Butler IL : CNS toxicity associated with intraventricular injection of cefazolin. Report of three cases. J Neurosurg 68 : 970-971, 1988 https://doi.org/10.3171/jns.1988.68.6.0970
  13. Martin ES 3rd, Bagwell JT, Bush-Veith S, Renger H Jr : Seizures after intraventricular cefazolin administration. Clin Pharm 11 : 104-105, 1992
  14. McLaurin RL : Treatment of infected ventricular shunts. Childs Brain 1 : 306-310, 1975
  15. Michenfelder JD, Cucchiara RF, Sundt TM Jr : Influence of intraoperative antibiotic choice on the incidence of early postcraniotomy seizures. J Neurosurg 72 : 703-705, 1990 https://doi.org/10.3171/jns.1990.72.5.0703
  16. Nistico G, De Sarro GB, Naccari F, Musolino R, Rotiroti D, Gallitto G, et al. : Cefazolin : a valid model of experimental epilepsy? Monogr Neural Sci 5 : 14-19, 1980
  17. Park KS, Lee YW : The effect of topical application of antibiotics on the cerebral cortex. J Korean Neurosurg Soc 10 : 39-52, 1981
  18. Schliamser SE, Cars O, Norrby SR : Neurotoxicity of beta-lactam antibiotics : predisposing factors and pathogenesis. J Antimicrob Chemother 27 : 405-425, 1991 https://doi.org/10.1093/jac/27.4.405
  19. Wald SL, McLaurin RL : Cerebrospinal fluid antibiotic levels during treatment of shunt infections. J Neurosurg 52 : 41-46, 1980 https://doi.org/10.3171/jns.1980.52.1.0041
  20. Yost RL, Lee JD, O'Leary JP : Convulsions associated with sodium cefazolin : a case report. Am Surg 43 : 417-420, 1977
  21. Yu QH, Kitazumi K, Kamei C, Tasaka K : Epileptogenic activity induced by intravenous injection of certain cephalosporins in rats. J Pharmacobiodyn 7 : 586-592, 1984 https://doi.org/10.1248/bpb1978.7.586

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