J Korean Neurosurg Soc.  2015 Nov;58(5):462-466. 10.3340/jkns.2015.58.5.462.

What Should Be Considered to Cause the Early Post-Craniotomy Seizure: Antibiotics (Cefazolin) Irrigation

• Jang JH
• Song KS
• Bang JS
• Oh CW
• Kwon OK
• Chung YS

• KMID: 2191412
• DOI: http://doi.org/10.3340/jkns.2015.58.5.462

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%.
CONCLUSION
Intraoperative cefazolin irrigation must be avoided in patients undergoing craniotomy, especially for clipping of unruptured aneurysms, because of the increased risk of early PCS.

Keyword

Cefazolin; Intraoperative irrigation; Craniotomy; Postoperative seizure; Surgical clipping

MeSH Terms

Aneurysm
Anti-Bacterial Agents*
Cefazolin
Craniotomy
Humans
Incidence
Logistic Models
Seizures*
Anti-Bacterial Agents
Cefazolin

Reference

1. Akula KK, Dhir A, Kulkarni SK. Pro-convulsant effect of cefazolin sodium against pentylenetetrazol- or picrotoxin-induced convulsions in mice. Indian J Exp Biol. 2007; 45:720–725. PMID: 17877149.

2. Arkaravichien W, Tamungklang J, Arkaravichien T. Cefazolin induced seizures in hemodialysis patients. J Med Assoc Thai. 2006; 89:1981–1983. PMID: 17205885.

3. Boswell MV, Wolfe JR. Intrathecal cefazolin-induced seizures following attempted discography. Pain Physician. 2004; 7:103–106. PMID: 16868620.

4. De Sarro A, De Sarro GB, Ascioti C, Nisticó G. Epileptogenic activity of some beta-lactam derivatives : structure-activity relationship. Neuropharmacology. 1989; 28:359–365. PMID: 2747848.

5. De Sarro A, Zappalá M, Chimirri A, Grasso S, De Sarro GB. Quinolones potentiate cefazolin-induced seizures in DBA/2 mice. Antimicrob Agents Chemother. 1993; 37:1497–1503. PMID: 8395790.

6. Gardner P, Leipzig T, Phillips P. Infections of central nervous system shunts. Med Clin North Am. 1985; 69:297–314. PMID: 3990436.

7. Höffler D, Demers HG, Niemeyer R. [Neurotoxicity of modern cephalosporins]. Dtsch Med Wochenschr. 1986; 111:197–198. PMID: 3943473.

8. James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurgery. 1980; 7:459–463. PMID: 7003434.

9. Kamei C, Sunami A, Tasaka K. Epileptogenic activity of cephalosporins in rats and their structure-activity relationship. Epilepsia. 1983; 24:431–439. PMID: 6873002.

10. Lee Y, Pyun SB, Park EK, Youn SW. Persistent dysarthria after cefazolin-induced status epilepticus. Brain Inj. 2009; 23:846–851. PMID: 19697174.

11. Lin CS, Cheng CJ, Chou CH, Lin SH. Piperacillin/tazobactam-induced seizure rapidly reversed by high flux hemodialysis in a patient on peritoneal dialysis. Am J Med Sci. 2007; 333:181–184. PMID: 17496739.

12. Manzella JP, Paul RL, Butler IL. CNS toxicity associated with intraventricular injection of cefazolin. Report of three cases. J Neurosurg. 1988; 68:970–971. PMID: 3373292.

13. Martin ES 3rd, Bagwell JT, Bush-Veith S, Renger H Jr. Seizures after intraventricular cefazolin administration. Clin Pharm. 1992; 11:104–105. PMID: 1551295.

14. McLaurin RL. Treatment of infected ventricular shunts. Childs Brain. 1975; 1:306–310. PMID: 1175443.

15. Michenfelder JD, Cucchiara RF, Sundt TM Jr. Influence of intraoperative antibiotic choice on the incidence of early postcraniotomy seizures. J Neurosurg. 1990; 72:703–705. PMID: 2324795.

16. Nisticò G, De Sarro GB, Naccari F, Musolino R, Rotiroti D, Gallitto G, et al. Cefazolin : a valid model of experimental epilepsy? Monogr Neural Sci. 1980; 5:14–19. PMID: 7322147.

17. Park KS, Lee YW. The effect of topical application of antibiotics on the cerebral cortex. J Korean Neurosurg Soc. 1981; 10:39–52.

18. Schliamser SE, Cars O, Norrby SR. Neurotoxicity of beta-lactam antibiotics : predisposing factors and pathogenesis. J Antimicrob Chemother. 1991; 27:405–425. PMID: 1856121.

19. Wald SL, McLaurin RL. Cerebrospinal fluid antibiotic levels during treatment of shunt infections. J Neurosurg. 1980; 52:41–46. PMID: 7350279.

20. Yost RL, Lee JD, O'Leary JP. Convulsions associated with sodium cefazolin : a case report. Am Surg. 1977; 43:417–420. PMID: 869336.

21. Yu QH, Kitazumi K, Kamei C, Tasaka K. Epileptogenic activity induced by intravenous injection of certain cephalosporins in rats. J Pharmacobiodyn. 1984; 7:586–592. PMID: 6512680.