Case ReportSeizure After Percutaneous Endoscopic Surgery—Incidence, Risk Factors, Prevention, and Management
Introduction
Percutaneous endoscopic surgery has been a popular method to treat lumbar disc herniation. Various surgical techniques have been recommended for more indications.1, 2, 3, 4, 5, 6, 7 However, this procedure is relatively challenging. Complications such as inadequate decompression, nerve root injury, vessel injury, and dural tear have been reported.8,9 Seizure after percutaneous endoscopic surgery is a relatively rare and unexpected complication. Choi et al.10 suggested that increased intracranial pressure (ICP) might induce seizure during surgery. In the present report, we have provided our observations and experiences regarding the signs and management of this major complication.
Section snippets
Methods
From October 2006 to March 2019, the cases of 816 patients with thoracic lumbar disorders who had undergone percutaneous endoscopic surgery in our hospital were retrospectively analyzed. Surgery had been performed by 3 doctors for various diagnoses, including a herniated intervertebral disc (HIVD; n = 691; 84.68%), stenosis (n = 41; 5.02%), and infectious spondylodiscitis (n = 84; 10.29%). The overall complication rate was 2.57%. We reviewed the medical records for the following complications:
Results
Of the 816 patients, 3 (0.34%) experienced a seizure attack after percutaneous endoscopic surgery. The incidence rate was 0.86% in the GA group using the interlaminar approach and 0% in the LA group using the transforaminal approach (P = 0.156). The characteristics of the 3 patients with seizure are presented in Table 2. Of the 3 patients, 2 had experienced a convulsion episode during reversal of the residual muscle relaxant effect. The third patient had started convulsing after extubation at
Discussion
Seizure is an electrical disturbance in the brain, commonly caused by electrolyte imbalances, hypoxia, brain tumor, stroke, traumatic brain injury, or central nervous system infection. It can also occur after brain surgery; however, it is rare as a complication after spinal surgery.11,12 To the best of our knowledge, only cases of seizure after percutaneous endoscopic discectomy have been reported.10,13, 14, 15, 16, 17, 18 Although the incidence of this complication is rare, seizure is
Conclusion
Percutaneous endoscopic surgery has been proved to be an effective, safe, and minimally invasive surgery technique. However, the rare complication of seizure can occur. Although the definite cause of seizure remains uncertain, we found that recurring uncontrolled hypertension could be a red flag sign for a seizure attack during surgery. When recurring uncontrolled hypertension occurs, all risk factors for seizure should be checked and corrected immediately. Reducing the infusion pressure,
CRediT authorship contribution statement
Chia-Yu Lin: Conceptualization, Methodology, Data curation, Formal analysis, Writing - original draft. Chien-Chun Chang: Conceptualization, Methodology, Data curation, Formal analysis, Writing - original draft. Chun Tseng: Data curation. Yen-Jen Chen: Formal analysis. Chun-Hao Tsai: Writing - review & editing. Yuan-Shun Lo: Formal analysis. Pang-Hsuan Hsiao: Formal analysis. Hsi-Kai Tsou: Writing - review & editing. Chih-Sheng Lin: Formal analysis. Hsien-Te Chen: Conceptualization, Methodology,
Acknowledgments
English Language editing was supplied by Wallace Academic Editing Company.
References (30)
- et al.
Endoscopic intralaminar approach for the treatment of lumbar disc herniation
World Neurosurg
(2017) - et al.
Percutaneous endoscopic retrieval of intraspinal cement leakage: technical note
World Neurosurg
(2018) - et al.
Epidural adhesiolysis complicated by cefazolin-induced status epilepticus: two cases
Clin Neurol Neurosurg
(2008) - et al.
Seizure-like movements during induction of anaesthesia with sevoflurane
Br J Anaesth
(1992) - et al.
Maternal convulsion during high-dose sevoflurane anaesthesia for open foetal surgery
Br J Anaesth
(2017) - et al.
Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: prospective controlled study under local and general anesthesia
Surg Neurol Int
(2011) - et al.
A modified approach of percutaneous endoscopic lumbar discectomy (PELD) for far lateral disc herniation at L5-S1 with foot drop
Korean J Pain
(2016) - et al.
New strategy for minimally invasive endoscopic surgery to treat infectious spondylodiscitis in the thoracolumbar spine
Pain Physician
(2019) - et al.
Percutaneous endoscopic debridement and drainage with four different approach methods for the treatment of spinal infection
Pain Physician
(2017) - et al.
Percutaneous endoscopic lumbar discectomy for highly migrated lumbar disc herniation
Pain Physician
(2017)
Learning curve of percutaneous endoscopic lumbar discectomy based on the period (early vs. late) and technique (in-and-out vs. in-and-out-and-in): a retrospective comparative study
J Korean Neurosurg Soc
Complications of lumbar disc herniation following full-endoscopic interlaminar lumbar discectomy: a large, single-center, retrospective study
Pain Physician
Risk of developing seizure after percutaneous endoscopic lumbar discectomy
J Spinal Disord Tech
Seizure and delayed emergence from anesthesia resulting from remote cerebellar hemorrhage after lumbar spine surgery—a case report
Korean J Anesthesiol
Possible causes of seizure after spine surgery
J Pediatr Neurosci
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Conflict of interest statement: The present study was supported by China Medical University Hospital (grant CMUH CRS-108-034).
Chia-Yu Lin and Chien-Chun Chang contributed equally to the present study.