Meningioma Related Epilepsy- Pathophysiology, Pre/postoperative Seizures Predicators and Treatment

Abstract

Meningiomas are the most common primary brain tumors accounting for about 30% of all brain tumors. The vast majority of meningiomas are slow-growing and of benign histopathology rendering them curable by surgery alone. Symptomatic lesions depend on the location with signs of mass effect or neurological deficits. Seizures are the presenting symptoms in approximately 30% of cases, which negatively affect quality of life, limit independence, impair cognitive functioning, as well as increase the risk for psychiatric comorbidities including depression. Although surgical resection may offer seizure freedom in 60-90% of meningiomas, seizures persist after surgical resection in approximately 12-19% of patients. Anti-seizure medications (ASMs) are employed in management, however, are limited by adverse neurocognitive side-effects and inefficacy in some patients. The potential predictors of pre- and post-operative seizures in meningioma patients have been identified in the literature. Understanding various factors associated with seizure likelihood in meningioma patients can help guide more effective seizure control and allow for better determination of risk before and after surgery.

Variability in the Arterial Supply of Intracranial Meningiomas: An Anatomic Study

“…The mechanism underlying preoperative seizures in patients harboring meningiomas is a current topic of investigation. 32 We observed that a lower number of arterial feeders trended toward a positive association with the likelihood of seizure on presentation, controlling for tumor grade, size, and PTBE. This may be the corollary of studies in gliomas, showing that tumor hypoxia lowers peritumoral pH and seizure threshold.…”

Postoperative Epileptic Seizures in Children

“…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.…”

The Natural History and Treatment of Meningiomas: An Update

“…52 53 Seizure is another common presenting symptom in 30% of meningioma patients, with surgical resection offering 60 to 90% seizure freedom with a 12 to 19% rate of de novo seizures. 54 Factors predicting preoperative seizures in meningioma patients are supratentorial (non-skull base) tumor location (mostly convexity and parasagittal) and perilesional edema on imaging. Tumor grading is another strong predictor; WHO grades 2 and 3 had a preoperative seizure occurrence of 31% compared to 15% of noninvasive meningiomas (WHO grade 1).…”

“…Tumor grading is another strong predictor; WHO grades 2 and 3 had a preoperative seizure occurrence of 31% compared to 15% of noninvasive meningiomas (WHO grade 1). 54,55 Patients with parasagittal and brain convexity meningiomas can present with paresis or paralysis of the affected contralateral limb. Patients with sphenoid ridge meningiomas with the involvement of the supraorbital fissure or the cavernous sinus can present with cranial nerve palsies and seizures.…”