Brain infarction following meningioma surgery—incidence, risk factors, and impact on function, seizure risk, and patient-reported quality of life

Abstract

In this study, we seek to explore the incidence of and potential risk factors for postoperative infarctions after meningioma surgery, in addition to the possible association with new neurological deficits, seizures, and health-related quality of life (HRQoL). A single-center cohort study was conducted, where all patients operated for an intracranial meningioma at our institution between 2007 and 2020 were screened for inclusion. Clinical data were prospectively collected in a local tumor registry, and HRQoL was assessed using both generic and disease-specific instruments. In total, 327 meningioma operations were included, and early postoperative MRIs showed peritumoral infarctions in 114 (34.9%). Median infarction volume was 4.5 ml (interquartile range 2.0–9.5) and 43 (37.7%) of the infarctions were rim-shaped, 44 (38.6%) were sector-shaped, 25 (21.9%) were a combination of rim- and sector-shaped, and two (1.8%) were remote infarctions. Permanent neurological deficits were seen in 22 patients (6.7%) and deficits were associated with infarctions (p < 0.001). There was no difference in frequency of registered postoperative epilepsy between patients with versus without infarctions. Patients with infarctions reported more future uncertainty; otherwise, there were no significant differences in disease specific HRQoL between patients with versus without infarctions. In this study, we found that peritumoral infarctions after meningioma resection are common. Most patients with permanent neurological deficits had infarctions. Yet, most infarctions were small, and although sometimes symptomatic on individual level, infarctions did not lead to significant deterioration of HRQoL on group level.

Significance of Early Postoperative Magnetic Resonance Imaging following Intracranial Meningioma Resection

“…Regarding meningiomas, a review of 125 convexity meningioma resections showed that postoperative DWI obtained 24-48 h after surgery demonstrated restriction > 1 cm in 22% of the cases and symptomatic infarction in 11% [12]. Another study reported that early MRI performed within 72 h after meningioma resection detected peritumoral infarction in 34.9% of patients [13]. Our results are consistent with these studies.…”

Postoperative Epileptic Seizures in Children

“…The intrinsic mechanisms of the epileptogenesis would be mainly mediated by the oxidative stress/free radicals formation (caused by extravascular leakage of blood components) and membrane ion imbalance (triggered by hypoxic–ischemic injury) [ 13 , 42 , 43 , 44 ]. Similar mechanisms can be hypothesized in case of the cortical injury resulting from the neurosurgical operation, where the microhemorrhages due to the cortical incision and the local ischemic damage resulting from the coagulation and/or the brain retraction (edema) can induce the aforementioned alterations, even though these modifications do not necessarily cause postoperative seizures [ 26 ]. The surgical incision of the brain can be considered per se as an epileptogenic stimulus.…”

“…These figures quite often are results from studies carried out in the past, the results of which are still cited in recent articles. As mentioned, specific studies in children are missing, with most of the current papers being focused on adults (often on the risks related to surgery for meningiomas) [ 24 , 25 , 26 ] or on the use of ASM prophylaxis [ 27 , 28 , 29 ]. The few studies on children usually comprise mixed series including either children with or without preoperative seizures.…”

Risk factors for postoperative thrombosis-related complications in patients undergoing malignant brain tumor resection: a retrospective cohort study

“…Vasospasms and blood vessel damage during surgery can cause local or extensive ischemia ( 13 , 20 ). In patients with malignant brain tumors, in addition to the tumor compression of peripheral blood vessels or tumor blood steal ( 21 , 22 ), cerebral ischemia may additionally be caused by tumor-induced inflammatory factors released into the periphery during tumor growth. However, the surgical procedure and inflammatory factors-related ischemia usually exist within or around the surgical field ( 23 ).…”