title: Intraoperative seizures during craniotomy under general anesthesia.
abstract: OBJECTIVE
  An acute symptomatic seizure is a clinical seizure occurring at the time of or in close temporal association with a brain insult. We report an acute symptomatic seizure occurring during a surgical procedure in a patient who did not have a prior history of epilepsy and who did not have a lesion associated with an increased risk of epilepsy. To characterize the incidence and clinical features of intraoperative seizures during craniotomy under general anesthesia, we reviewed cases where continuous EEG was acquired during craniotomy.
  
  
  METHODS
  Records of 400 consecutive cases with propofol as general anesthesia during craniotomy were reviewed. Demographic data, indication for surgery, clinical history, history of prior seizures, duration of surgery and duration of burst suppression were recorded. Cases where seizures were observed were analyzed in detail.
  
  
  RESULTS
  Two out of 400 patients experienced intraoperative seizures, including one patient who appeared to have an acute symptomatic seizure related to the surgical procedure itself and a second patient who experienced two seizures likely related to an underlying diagnosis of epilepsy.
  
  
  CONCLUSIONS
  This is the first report of an acute symptomatic seizure secondary to a neurosurgical procedure. Overall, 0.5% of patients monitored experienced seizures, indicating that intraoperative seizures are rare, and EEG monitoring during craniotomies is of low yield in detecting seizures.
authors.affiliation: Loma Linda University, School of Medicine, Loma Linda, CA 92354, USA. Electronic address: jhowe@llu.edu.
authors.forename: John
authors.initials: J
authors.lastname: Howe
authors.affiliation: Loma Linda University, Department of Neurology, Loma Linda, CA 92354, USA. Electronic address: l.xiaoying@gmail.com.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Lu
authors.affiliation: University of California Riverside, Biology, Riverside, CA, USA. Electronic address: zthom002@ucr.edu.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Thompson
authors.affiliation: Loma Linda University, Department of Neurology, Loma Linda, CA 92354, USA. Electronic address: GPeterson@llu.edu.
authors.forename: Gordon W
authors.initials: GW
authors.lastname: Peterson
authors.affiliation: Loma Linda University, Department of Neurology, Loma Linda, CA 92354, USA. Electronic address: Tlosey@llu.edu.
authors.forename: Travis E
authors.initials: TE
authors.lastname: Losey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D002648:Child; D003399:Craniotomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D004569:Electroencephalography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D064795:Intraoperative Neurophysiological Monitoring / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Acute symptomatic seizure; Craniotomy; EEG; Intraoperative monitoring; Propofol; Seizure