Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
A retrospective comparison of prophylactic fosphenytoin and levetiracetam in awake craniotomy.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Fecker Adeline L, Sengupta Sidharth, Ernst Lia, Yaylali Ilker, Bushlin Ittai, Raslan Ahmed M, Collins Kelly L
Аннотация
BACKGROUND: Awake craniotomy with direct cortical stimulation (DCS) mapping is the gold standard for resection of pathology in eloquent regions. Prophylactic anti-seizure medications (ASMs) are commonly used to prevent intraoperative seizure. There is a preference for levetiracetam (LEV), due to its low side effect profile. We investigated whether a prophylactic dose of fosphenytoin (FOS) compared to LEV reduced the risk of intraoperative complications.
METHODS: We performed a retrospective analysis of consecutive adult and pediatric awake craniotomy cases from 2018 to 2024 who received either 1 g LEV or 10 mg/kg FOS at the start of surgery. Data was collected on intraoperative events including seizure and new neurologic deficits during mapping, aborted stimulation mapping, and 24-hour neurologic deficits and seizures. A composite outcome was counted if one or more of the complications occurred.
RESULTS: 112 patients met inclusion criteria; 61 (55 %) were included in the LEV group and 51 (45 %) were included in the FOS group. There was no significant difference in number of recorded or clinical intraoperative seizure between treatment groups (p = 0.925). There were no observed side effects from FOS or LEV prophylaxis. FOS was the factor most associated with all the outcomes of interest, followed by home ASM regimen (other and LEV), year of surgery, GBM, and preoperative seizures. In a multivariable model of these top variables, only prophylactic FOS was significantly associated with lower odds of composite events (OR = 0.20, 95 % CI 0.05-0.65, p = 0.011), intraoperative events (OR = 0.26, 95 % CI 0.06-0.91, p = 0.045) and 24-hour deficits (OR = 0.25, 95 % CI 0.07-0.79, p = 0.024). FOS prophylaxis was significantly associated with reduced risk of transient neurologic deficits (OR = 0.20, 95 % CI 0.04-0.82, p = 0.036).
CONCLUSION: Though there was no difference in rate of intraoperative and postoperative seizure, the lower rate of transient neurologic deficit and intraoperative events suggests prophylactic fosphenytoin may improve safety of awake craniotomy with DCS compared to levetiracetam.
METHODS: We performed a retrospective analysis of consecutive adult and pediatric awake craniotomy cases from 2018 to 2024 who received either 1 g LEV or 10 mg/kg FOS at the start of surgery. Data was collected on intraoperative events including seizure and new neurologic deficits during mapping, aborted stimulation mapping, and 24-hour neurologic deficits and seizures. A composite outcome was counted if one or more of the complications occurred.
RESULTS: 112 patients met inclusion criteria; 61 (55 %) were included in the LEV group and 51 (45 %) were included in the FOS group. There was no significant difference in number of recorded or clinical intraoperative seizure between treatment groups (p = 0.925). There were no observed side effects from FOS or LEV prophylaxis. FOS was the factor most associated with all the outcomes of interest, followed by home ASM regimen (other and LEV), year of surgery, GBM, and preoperative seizures. In a multivariable model of these top variables, only prophylactic FOS was significantly associated with lower odds of composite events (OR = 0.20, 95 % CI 0.05-0.65, p = 0.011), intraoperative events (OR = 0.26, 95 % CI 0.06-0.91, p = 0.045) and 24-hour deficits (OR = 0.25, 95 % CI 0.07-0.79, p = 0.024). FOS prophylaxis was significantly associated with reduced risk of transient neurologic deficits (OR = 0.20, 95 % CI 0.04-0.82, p = 0.036).
CONCLUSION: Though there was no difference in rate of intraoperative and postoperative seizure, the lower rate of transient neurologic deficit and intraoperative events suggests prophylactic fosphenytoin may improve safety of awake craniotomy with DCS compared to levetiracetam.