Predictors of postoperative seizure outcome in supratentorial meningioma

Abstract

OBJECTIVE Meningiomas are the most common primary intracranial tumor. Seizures are common sequelae of meningioma development. Meningioma patients with seizures can be effectively treated with resection, with reports of seizure freedom of 60%–90%. Still, many patients manifest persistent epilepsy. Determining factors associated with worsened seizure outcomes remains critical in improving the quality of life for these patients. The authors sought to identify clinical, radiological, and histological factors associated with worse seizure outcomes in patients with supratentorial meningioma and preoperative seizures. METHODS The authors retrospectively reviewed the charts of 384 patients who underwent meningioma resection from 2008 to 2020. The charts of patients with a documented history of preoperative seizures were further reviewed for clinical, radiological, operative, perioperative, histological, and postoperative factors associated with seizures. Engel class at last follow-up was retrospectively assigned by the authors and further grouped into favorable (class I) and worse (class II–IV) outcomes. Factors were subsequently compared by group using comparative statistics. Univariable and multivariable regression models were utilized to identify independent predictors of worse seizure outcome. RESULTS Fifty-nine patients (15.4%) were found to have preoperative seizures, of whom 57 had sufficient postoperative data to determine Engel class outcome. Forty-two patients (74%) had Engel class I outcomes. The median follow-up was 17 months. Distinct margins on preoperative imaging (p = 0.012), Simpson grade I resection (p = 0.004), postresection ischemia (p = 0.019), WHO grade (p = 0.019), and recurrent disease (p = 0.015) were found to be the strongest predictors of Engel class outcome in univariable logistic regression. MIB-1 index (p = 0.001) and residual volume (p = 0.014) at last follow-up were found to be the strongest predictors of Engel class outcome in univariable generalized linear regression. Postresection ischemia (p = 0.012), WHO grade (p = 0.022), recurrent disease (p = 0.038), and MIB-1 index (p = 0.002) were found to be the strongest independent predictors of Engel class outcomes in multivariable analysis. CONCLUSIONS Postresection ischemia, higher WHO grade, elevated MIB-1 index, and disease recurrence independently predict postresection seizure persistence in patients with supratentorial meningioma. Further understanding of the etiology of these markers may aid in elucidation of this complex disease process and guide management to prevent worse outcomes.

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

“…Unlike a recent study [ 7 ], we did not find an association between infarctions and risk of postoperative epilepsy. However, we did not account for preoperative seizures in the analyses and with longer follow-ups frequencies of seizures would be expected to increase.…”

“…However, a recent publication with 122 patients found that an area with MR restricted diffusion over 1 cm was seen after 22% of meningioma operations and was associated with postoperative deficits [ 16 ]. A recent study found that postoperative ischemia, defined as ischemia/infarction found on postoperative MRI not related to normal postoperative changes within the resection bed, occurred in 13 of 57 (23%) cases and was associated with postoperative seizures [ 7 ].…”

Proliferative Potential, and Inflammatory Tumor Microenvironment in Meningioma Correlate with Neurological Function at Presentation and Anatomical Location—From Convexity to Skull Base and Spine

“…MIB-1 index is an almost unknown variable among the determinants of symptomatic epilepsy in meningioma patients. Only one recent retrospective series investigating 384 meningioma patients revealed that an elevated MIB-1 index is an independent predictor of postsurgical seizure persistence [ 68 ]. Seizure is known to have a negative impact on health-related quality of life in meningioma patients [ 69 ].…”

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

“…More recently, the genetic drivers of epileptogenicity in meningiomas have been investigated. NF2 mutation was shown to be predictive marker for preoperative seizures, which was via an indirect mediation effect with atypical histology and edema ( 25 ). Meningioma originates from arachnoid cap cells and is usually a slow-growing tumor ( 1 ).…”

“…However, there was an associative tendency between subtypes of higher grades (malignant, rhabdoid) with worse postoperative seizure outcomes. The subtypes of lower grades (fibrous, transitional) trended toward improved postoperative outcomes (p = 0.081) ( 25 ). There are no data in the medical literature for the incidental small meningioma, which are not part of the epileptogenic network.…”