title: What Should Be Considered to Cause the Early Post-Craniotomy Seizure: Antibiotics (Cefazolin) Irrigation.
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%.
  
  
  CONCLUSIONS
  Intraoperative cefazolin irrigation must be avoided in patients undergoing craniotomy, especially for clipping of unruptured aneurysms, because of the increased risk of early PCS.
authors.affiliation: Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors.forename: Ji Hwan
authors.initials: JH
authors.lastname: Jang
authors.affiliation: Department of Neurosurgery, Neurovascular Center of New Korea Hospital, Gimpo, Korea.
authors.forename: Kyung Sun
authors.initials: KS
authors.lastname: Song
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Bang
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Boramae Hospital, Seoul, Korea.
authors.forename: Young Seob
authors.initials: YS
authors.lastname: Chung
keywords: Cefazolin; Craniotomy; Intraoperative irrigation; Postoperative seizure; Surgical clipping