Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

Abstract

BACKGROUND Risk factors for pre- and postoperative seizures in supratentorial meningiomas are understudied compared to other brain tumors. OBJECTIVE To report seizure frequency and identify factors associated with pre- and postoperative seizures in a large single-center population study of patients undergoing resection of supratentorial meningioma. METHODS Retrospective chart review of 1033 subjects undergoing resection of supratentorial meningioma at the author’s institution (1991–2014). Multivariate regression was used to identify variables significantly associated with pre- and postoperative seizures. RESULTS Preoperative seizures occurred in 234 (22.7%) subjects. At 5 years postoperative, probability of seizure freedom was 89.9% among subjects without preoperative seizures and 62.2% with preoperative seizures. Multivariate analysis identified the following predictors of preoperative seizures: presence of ≥1 cm peritumoral edema (odds ratio [OR]: 4.45, 2.55–8.50), nonskull base tumor location (OR: 2.13, 1.26–3.67), greater age (OR per unit increase: 1.03, 1.01–1.05), while presenting symptom of headache (OR: 0.50, 0.29–0.84) or cranial nerve deficit (OR: 0.36, 0.17–0.71) decreased odds of preoperative seizures. Postoperative seizures after discharge were associated with preoperative seizures (OR: 5.70, 2.57–13.13), in-hospital seizure (OR: 4.31, 1.28–13.67), and among patients without preoperative seizure, occurrence of medical or surgical complications (OR 3.39, 1.09–9.48). Perioperative anti-epileptic drug use was not associated with decreased incidence of postoperative seizures. CONCLUSIONS Nonskull base supratentorial meningiomas with surrounding edema have the highest risk for preoperative seizure. Long-term follow-up showing persistent seizures in meningioma patients with preoperative seizures raises the possibility that these patients may benefit from electrocorticographic mapping of adjacent cortex and resection of noneloquent, epileptically active cortex.

Brain invasion and the risk of seizures in patients with meningioma

“…Correspondingly, seizures were more common in patients with a high-grade than in those with a benign meningioma. Moreover, as expected from previous series results, 4,6,12,23 rising edema and tumor volumes were positively correlated in univariate tests with an increasing incidence of preoperative seizures. However, in multivariate analyses, only increasing tumor volume (but not edema volume) remained significantly correlated with the incidence of preoperative seizures.…”

“…Moreover, Mantle et al 11 reported a strong association between brain-invasive growth and PTBE, which is one of the main risk factors for the development of perioperative seizures. 4,6,12,23 In the same series, the authors found a 20% increase in the incidence of brain invasion with each 1-cm increase in edema. 11 Disruption of cortical integrity by infiltrating meningioma cells with subsequent astrocytic response 24 might also impair neurological function and contribute to an increased risk of seizures in patients with brain-invasive meningioma.…”

“…The frequency of preoperative seizures in our study was 19%, which is in line with the broad range of incidences reported from previous analyses. 4,6,12,23 According to findings in macroscopically detected brain-invasive meningiomas, 5 the incidence of preoperative seizures was distinctly higher in patients with a microscopically detected brain-invasive meningioma than in those with a noninvasive meningioma. Correspondingly, seizures were more common in patients with a high-grade than in those with a benign meningioma.…”

“…mprovIng the prediction of perioperative seizures remains crucial in the neurosurgical and neurological care of patients with meningioma. 4 Brain invasion by meningiomas is characterized by tonguelike infiltration of tumor cells into the underlying parenchyma and breakdown of the arachnoid layer. 15,20 Several studies have found a subsequent strong astrocytic response and alterations of the adjacent cortex, 7,13,17,18,24 and brain invasion was found to correlate with increased peritumoral brain edema (PTBE); 11 both of these factors possibly affect cortical function and therefore seizure development.…”

Perioperative olfactory dysfunction in patients with meningiomas of the anteromedial skull base

“…Patients suffering from intracranial meningioma may be diagnosed incidentally from nonspecific symptoms such as headaches or seizures. Depending on localization, size, and peritumoral edema, meningioma patients may display specific focal neurologic deficits (Englot et al, ; Chen et al, ; Hendrix et al, , ; Wu et al, ). Olfactory groove meningiomas (OGMs) represent the prototypical meningioma lesion causing olfactory dysfunction.…”