Early postoperative seizures (EPS) in patients undergoing brain tumour surgery

Abstract

early postoperative seizures (epS) are a common complication of brain tumour surgery. this paper investigates risk factors, management and clinical relevance of epS. We retrospectively analysed the occurrence of EPS, clinical and laboratory parameters, imaging and histopathological findings in a cohort of 679 consecutive patients who underwent craniotomies for intracranial tumours between 2015 and 2017. EPS were observed in 34/679 cases (5.1%), with 14 suffering at least one generalized seizure. patients with epS had a worse postoperative Karnofsky performance index (Kpi; with epS, KPI < 70 vs. 70-100: 11/108, 10.2% vs. 23/571, 4.0%; p = 0.007). Preoperative seizure history was a predictor for EPS (none vs. 1 vs. ≥ 2 seizures: p = 0.037). Meningioma patients had the highest EPS incidence (10.1%, p < 0.001). Cranial imaging identified a plausible cause in most cases (78.8%). In 20.6%, EPS were associated with a persisting new neurological deficit that could not otherwise be explained. 34.6% of the EPS patients had recurrent seizures within one year. EPS require an emergency work-up. Multiple EPS and recurrent seizures are frequent, which indicates that EPS may also reflect a more chronic condition i.e. epilepsy. EPS are often associated with persisting neurological worsening. Early postoperative seizures (EPS) are a common complication of brain tumour surgery. EPS are often categorized as acute symptomatic seizures 1,2. They are usually felt to reflect acute medical or surgical conditions that may require emergency treatment. This includes haemorrhages, infectious complications and electrolyte disturbances, but also systemic infections and cardiopulmonary disorders resulting in hypotension and hypoxia. Hence, EPS may have potentially severe consequences. They may result in significant and often persisting (neurological) morbidity and reduced quality of life. Furthermore, they usually prolong the patient's hospital stay. Potential negative consequences include a delayed transfer for rehabilitation therapy, an overall prolonged rehabilitation and, importantly, delayed adjuvant therapy. This latter aspect is of considerable importance e.g. in patients with gliomas and metastasis who will often not realize the benefits of surgery if adjuvant therapy is withhold. In addition, many patients with brain metastases require more or less urgent treatment for their systemic disease. There is also the issue of distinguishing between incidental or acute symptomatic seizures with no or a very low risk of recurrent seizures and true postoperative chronic epilepsy 1-3. The latter condition requires chronic treatment with antiepileptic drugs and comes with relevant socioeconomic sequelae such as restriction of driving privileges. This may be a particularly important issue for patients with benign tumours such as many meningiomas who have a good chance of a surgical cure of their tumour. In such cases, the risk of recurrent seizures may well be their only (neurological) health concern 4,5. There is a growing interest in tumour-assoc...

Surgical Treatment of Cerebellar Metastases: Survival Benefits, Complications and Timing Issues

“…New or aggravated major (CTCAE graded III–V) neurological deficits ≥30 days were observed in six (8.2%) cases ( Table 3 ). Seven transient (<30 days) major deficits were seen in an additional five cases (6.8%) including early postoperative seizures [ 24 ] in two and somnolence resulting from pneumocephalus and/or hydrocephalus in four patients. Overall, ten patients (13.7%) incurred a CTCAE grades III–V surgical complication.…”

Case Report: Late-Onset Temporal Lobe Epilepsy Following Subarachnoid Hemorrhage: An Interplay Between Pre-existing Cortical Development Abnormality and Tissue Damage

“…Many patients, like ours, will present with recurrent seizures that develop following the diagnosis of an insult, such as stroke, head trauma, or tumors ( 15 – 21 ). The current use of terms such as “post-stroke epilepsy,” “post-traumatic epilepsy,” and “brain tumor-related epilepsy” can guide our management decisions and allows us to provide patients and families an overview of the predicted outcome.…”

Safety of intravenous tranexamic acid in patients undergoing supratentorial meningiomas resection: protocol for a randomised, parallel-group, placebo control, non-inferiority trial

“…The postoperative seizure was reported in 11.0%-26.2% meningiomas resection patients, and among which, about 30%-40% were early postoperative seizure (EPS) occurred within 7 days after surgery. [19][20][21] History of epilepsy, tumour recurrence, frontoparietal location and peritumoral oedema was reported to be associated with EPS. 20 22 23 However, there is no prospective study focusing on the effect of tranexamic acid on EPS in patients undergoing meningioma resections, though TXA was proved of reducing intraoperative haemorrhage volume in traumatic brain injury surgery, paediatric craniosynostosis surgery and meningioma resection.…”

“…The primary endpoint is the cumulative incidence of EPS, defined as a transient occurrence of involuntary movements, abnormal sensory phenomena or an altered mental status that could not otherwise be explained within 7 days after surgery. 21 If an EPS could not be diagnosed on clinical grounds alone, acute electroencephalograms (EEG) will be performed within 24 hours of event occurrence to confirm the diagnosis. If the EEG showed evidence of interictal or seizure activity, the event will be Open access defined as EPS.…”