Anesthetic approach for epilepsy surgery: a 4-year experience at the referral center of the Egas Moniz Hospital

Authors

DOI:

https://doi.org/10.25751/rspa.19958

Keywords:

Epilepsy, General Anesthesia, Conscious Sedation, Perioperative Care, Neurosurgery

Abstract

Introduction: About 30-40% of Epilepsy cases are refractory to medical therapy, with surgery being a possibility to improve symptomatic control, reduce or discontinue anticonvulsant medication and improve quality of life. Descriptions of the anesthetic approach in scientific literature are rare, despite the numerous challenges it presents related to the patient, surgery, and perioperative care. The aim of this study is to retrospectively analyze the anesthetic approach for epilepsy surgery over the course of 4 years in the referral center of Egas Moniz Hospital.

Material and Methods: Review of medical records of patients undergoing Epilepsy surgery between January 2014 and December 2017. Information on demographic data, perioperative care, follow-up, and therapeutic success was collected and analyzed.

Results: 68 patients underwent Epilepsy surgery, with a mean age of 37.7 years, classified ASA II (77.9%) and ASA III (22.1%). Techniques chosen were general anesthesia (95.6%) and conscious sedation (4,4%). Intraoperative complications were significant bleeding (4.4%), seizures (2.9%) and bradycardia (2.9%).
Stay in Intensive Care Unit (63.2%) last a mean of 1.6 days, included on 7.8 days of hospital stay. At outpatient follow-up, there was a reduction of about 90% in seizures and anticonvulsant therapy.

Discussion: Knowledge and experience of anesthetic approach in Epilepsy surgery are crucial to make these complex procedures effective and safe, decreasing the rate of complications and improving quality of life.

Conclusions: Tailor-made perioperative approach to each patient/surgery seems to be the key to therapeutic success and prognosis.

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References

1. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017; 58(4): p. 522-530.
2. Pedroviejo V, Ayuso M, Jiménez A. Tratamiento anestésico del paciente adulto epiléptico no neuroquirúrgico. Rev Esp Anestesiol Reanim. 2009; 59(7): p. 425-435.
3. Pacreu S, Vilà E, Moltó L, Bande D, Rueda M, Fernández Candil JL. Manejo anestésico en la cirugía de epilepsia con electrocorticografía intraoperatoria. Rev Esp Anestesiol Reanim. 2018;65: p. 108-111
4. Bindra A, Chouhan RS, Prabhakar H, Chandra PS, Tripathi M. Perioperative anesthetic implications of epilepsy surgery. J Anesth. 2015; 29: p. 229–234.
5. Erickson K, Cole D. Anesthetic Considerations for Awake Craniotomy for Epilepsy and Functional Neurosurgery. Anesthesiol Clin. 2012; 30: p. 241-268.
6. Koh JL, Egan B, McGraw T. Pediatric epilepsy surgery: anesthetic considerations. Anesthesiol Clin. 2012; 30(2): p. 191–206.
7. Sanus GZ, Yuksel O, Tunali Y, Ozkara C, Yeni N, Ozlen F, et al. Surgical and anesthesiological considerations of awake craniotomy: Cerrahpasa experience. Turk Neurosurg. 2015; 25(2): p. 210-217.
8. Shetty A, Pardeshi S, Shah VM, Kulkarni A. Anesthesia considerations in epilepsy surgery. Int J Surg. 2016; (36): p. 454-459.
9. Hader W, Tellez-Zenteno J, Metcalfe A, Hernandez-Ronquillo L, Wiebe S, Su Kwon C, et al. Complications of epilepsy surgery: A systematic review of focal surgical resections and invasive EEG monitoring. Epilepsia. 2013; 54(5): p. 840-847.
10. Sokhal N, Rath GP, Chaturvedi A, Dash HH, Bithal PK, Chandra PS. Anaesthesia for awake craniotomy: A retrospective study of 54 cases. Indian J Anaesth. 2015; 59(5): p. 300-305.
11. Khanna P, Ray BR, Govindrajan SR. Anesthetic management of pediatric patients with Sturge–Weber. J Anesth. 2015; 29(6): p. 857-861
12. Iturri Clavero F, González Uriarte A, Tamayo Medel G, Pomposo Gaztelu IC, Cano Dorronsoro M, Martínez Ruiz A. Perioperative considerations in vagal nerve stimulator implantation. Rev Esp Anestesiol Reanim. 2010; 57(7): p. 431–438.
13. Kunieda T, Kikuchi T, Miyamoto S. Epilepsy surgery: surgical aspects. Curr Opin Anesthesiol. 2012; 25: p. 533-53.
14. Chui J, Venkatraghavan L, Manninen P. Presurgical Evaluation of Patients with Epilepsy: the role of the anesthesiologist. Anesth Analg. 2013; 116(4): p. 881–888.
15. Hader W, Tellez-Zenteno J, Metcalfe A, Hernandez-Ronquillo L, Wiebe S, Su Kwon C, et al. Complications of epilepsy surgery: A systematic review of focal surgical resections and invasive EEG monitoring. Epilepsia. 2013; 54(5): p. 840-847.

Published

2020-10-02

How to Cite

Costa-Martins, I., Calhau, R., Rodrigues, N., Carreteiro, J., & André, A. I. (2020). Anesthetic approach for epilepsy surgery: a 4-year experience at the referral center of the Egas Moniz Hospital. Journal of the Portuguese Society of Anesthesiology, 29(3), 156–163. https://doi.org/10.25751/rspa.19958