5 cases of epilepsy-like seizures reported during epidermis spinal endoscopy

Transdermal spinal endoscope technology is currently the representative of spinal surgery minimally invasive technology, widely carried out in hospitals at all levels in ChinaTransdermal spinal endoscopy has the advantages of minimally invasive, rapid postoperative recovery, but there are also various complications, such as intraoperative nerve damage, abdominal organ injury,epilepsy-like seizuresAmong them, epilepsy-like seizures are more serious complications in transdermal endoscope technology, the hospital from August 2014 to January 2018 to carry out a total of 328 cases of transdermal spinal endoscope technology, a total of 5 cases of epilepsy-like seizures, the incidence rate of 1.5%, is reported as followsclinical5 cases in this group of general data, including: 2 cases for men and 3 for women; 2 combinedhigh blood pressuredisease1 case using intervertebral hole into the road, responsibility section is: L4/5 intervertebral disc4 cases using the vertebral plate into the road, the responsibility section is L5S1 intervertebral discCases 6, 20, 36, 85, 193There is no history of brain injury or epilepsyNone of the patients had intervertebral disc imagingsurgical method (1) intervertebral hole into the road: reclining position, using hemp and reinforcement, C-arm perspective set puncture point, line local anesthesia, C-arm perspective downward responsibility section intervertebral disc puncture, positioning needle puncture lower vertebrae back upper edgeMake about 1cm incision, with the guide wire replacement puncture needle, step-by-step expansion of soft tissue, along the guide wire with bone drill step by step to grind out part of the joint protrusion, intervertebral hole formingPlace the work sleeve and spinal endoscopeRemove protruding, de-emerging or free discs from the mirror; (2) intervertebral plate into the road: reclining position, using hemp and reinforcement , and small doses of epidural anesthesiaC-arm perspective lower body table positioning surgical section, in the surgical section after the middle line open about 2.0 to 2.5cm as a puncture point, puncture success in the epidural outside the injection of 3 ml lidocain, make a length of about 1cm incision, cut the deep fascia, the pencil head-like expansion tube to the yellow ligament shallow surface, C-arm perspective pencil head position, step by step expansion of the soft tissue into the work pipeRemove the dilating tube, place it in the endoscope, bite the yellow ligament seludes under the mirror, and remove the protruding, de-emerging or free discDuring the operation, patients gradually appear neck soreness, progressive exacerbation, and further headache, irritability, convulsions, lower limb seduminous clonoclonies, vision, blood pressure increase and other symptoms1 patient developed muscle straightening spasms and developed into the whole body, with blurred consciousness, slow pulse and large flood, slow and deep breathingresults2 cases developed symptoms of seizure-like seizures at the end of surgery, removing the endoscopy, stopping flushing, close monitoring after the symptoms disappeared, and the symptoms of lower back and leg pain disappeared after surgery2 cases of suspended surgery, removal of endoscopy, stop flushing, close monitoring after the disappearance of epilepsy symptoms, the second phase of the use of open surgery in the whole hemp downtheral disc removal1 case of consciousness disorder, deep and slow breathing, after the trachea intubation transferred to the ICU, after surgery the patient did not undergo secondary surgery discharged3 patients with back road and 1 side path patients were found to have ruptured epidurals, and 1 patient with back road did not find abnormal epiduralsAfter the operation there was no residual head and neck pain, incision of the first stage of healing, no cerebrospinal fluid leakagediscussion
ChoiG et albelieve that increased epidural pressure in transdermal spinal endoscope technology is an important cause of seizure-like seizuresThe causes of increased epidural pressure include high flushing pressure during surgery, too fast flushing speed and long surgery time KimSH and others reported a case of rupture disserated epidurals and secondary typical seizures, considering that cerebrospinal fluid leakage caused by cranial cavity gas or flushing fluid into the subcavity of the cobweb, resulting in increased intracranial pressure, which in turn triggered seizure-like seizures In addition, there is also the view that previous personal epilepsy history, family epilepsy history or a history of cranial trauma is also an important reason for epilepsy-like seizures in derithromyccoscopy After the patients were admitted to the hospital, the authors asked the patients in detail about their personal history and family history, and they had no history of cranial brain disease and family history In combination, the author believes that the main reason for this group of patients is the rupture of the epidural sac, flushing fluid from the epidural sac into the subcavity of the cobweb, leading to epileptic seizures At the same time, during surgery flushing fluid causes an increase in epidural pressure may also be the cause of seizure-like seizures in the transdermal spinal endoscope technology, once a seizure-like seizure, surgery can only be discontinued or modified to open surgery Therefore, it is more important to observe the patient's symptoms closely and deal with it in the first time to prevent seizures In order to prevent the flushing fluid from causing the epidural pressure is too high, the flushing fluid height requirements are not higher than the surgical incision 1.5m, if you can ensure a clear field of vision, as far as possible to reduce the height of the flushing fluid Improving the skill level of surgery, reducing the time of surgery, is also an important reason to prevent the occurrence of various complications in surgery Due to the technical level of surgery, 4 cases occurred in the first 100 patients in this group During surgery, when patients begin to appear neck pain and other symptoms, the patient is instructed to move the neck properly, to eliminate the patient's nervousness and anxiety Exclude the possibility of neck pain due to prolonged maintenance of the same posture or psychological factors Once the symptoms cannot be alleviated, the early symptoms of suspected epilepsy-like seizures should be considered, given to reduce the height of the flushing fluid and the flushing speed, thereby reducing the flushing fluid pressure, stop flushing if necessary, suspend the operation, and resume surgery when the symptoms of neck pain of the patient disappear If neck pain can not be alleviated or even aggravated by the above treatment, the operation is suspended or open-ended to remove the disc the patient to discontinue the operation if he or she develops symptoms such as irritability and even muscle spasms Remove the surgical instruments the first time and use the restraint belt if necessary Stressed limbs are prohibited to avoid medically induced fractures or dislocated limbs Prevent accidental lying in the patient Drug sedation and other treatments may be given When patients appear in coma, deep and slow breathing and other symptoms, should consider brain edema, appropriately reduce the temperature of the operating room, give rice, rapid urine dehydration to reduce intracranial pressure Ensure that the airways are clear and, if necessary, trachea intubation Because the operation basically uses local anesthesia, once the symptoms appear, the first time contact the anesthesiologist together with active treatment minimally invasive, safe, fast after surgery and other advantages of the transdermal spinal endoscope technology is currently highly respected reasons This has also led some medical staff and their families to believe that the technology is low risk and less unexpected However, from the clinical follow-up results, the complications of this technique are no less than traditional open surgery, there are also nerve damage, hemorrhage and other serious complications Compared with the open technique, epileptic seizures in surgery are unique complications of the technique, and there are not many reports at present Once it happens, most of the patient's family members do not understand Therefore, patients and their families should be actively communicated before surgery to understand that the technology is also risky After active communication with patients and their families, the group did not have serious medical disputes, but one patient failed to undergo re-surgery