Abstract
Few studies detail the risk of in-hospital seizures following elective surgical or
endovascular treatment of unruptured intracranial aneurysms (UIA). We compared the
peri-procedural seizure incidence for clipping and coiling of UIA. A retrospective
cohort study using the Australian National Hospital Morbidity Database from 1998 to
2008 was conducted. Treatment modalities were compared for the combined primary end
point related to seizure. Putative risk factors were investigated with univariate
and multivariate logistic regression analysis to identify independent predictors of
outcome. A total of 5922 hospitalisations for UIA (3098 clipping, 2824 coiling) were
identified. Overall, surgery was associated with a 2.7% (95% confidence interval [CI]
2.2–3.4) incidence of peri-operative seizures, compared to a 0.6% (95% CI 0.4–1.0)
incidence following endovascular treatment (adjusted odds ratio [OR] 4.40; 95% CI
2.64–7.33; p < 0.001). The incidences of seizures declined over the 11 year study period in both treatment groups, from 4.2% to 2.0% for surgery and from
2.8% to 0.3% for endovascular. Haemorrhagic complication with intracerebral haemorrhage
predicted occurrence of a seizure (OR 3.41; 95% CI 1.20–9.66; p = 0.021), whereas endovascular coiling was associated with a better seizure outcome
(OR 0.23; 95% CI 0.14–0.39; p < 0.001). Overall, elective surgical treatment of UIA is associated with a higher risk
of seizure occurrence compared to endovascular coiling. Contrary to conventional thinking,
the risk of seizures following endovascular treatment is not entirely absent. Current
recommendations must be considered in relation to the issue of driving after elective
intracranial aneurysm treatment.
Keywords
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Article info
Publication history
Accepted:
February 23,
2013
Received:
October 21,
2012
Identification
Copyright
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
