Preoperative tumor-associated epilepsy in patients with supratentorial meningioma: factors influencing seizure outcome after meningioma surgery

Schneider, Matthias; Güresir, Ági; Borger, Valeri; Hamed, Motaz; Rácz, A.; Vatter, Hartmut; Güresir, Erdem; Schuss, Patrick

doi:10.3171/2019.7.jns19455

Cited by 27 publications

(30 citation statements)

References 33 publications

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“…[24][25][26] Higher grade meningiomas are more likely to cause peritumoral brain edema and brain invasion that are reported as risk factors for poor seizure outcomes. 23,27) Higher WHO grades and larger size of tumors were also associated with increased risk of medical complications in this study, probably because more extensive and complicated surgical strategies requiring longer operation time were adopted to achieve a higher EOR in such cases. The location of the tumor showed a significant relation to the type of complication.…”

Section: Discussionmentioning

confidence: 69%

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

Oya

Ikawa

Ichihara

et al. 2021

Neurol. Med. Chir.(Tokyo)

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Although surgical resection is the most preferred treatment for intracranial meningiomas, a detailed analysis of the surgery-related risks based on large population data has not been conducted to date. In this study, we analyzed the nation-wide brain tumor registry to assess the surgical risk factors for intracranial meningiomas to provide information for an optimal treatment strategy. Data of 4081 meningioma patients who underwent initial resection between 2001 and 2008 were extracted from the Brain Tumor Registry of Japan (BTRJ) database and reviewed for postoperative mortality, aggravation of Karnofsky Performance Score (KPS), and complications. The total in-hospital mortality rate was 0.59%. Male sex and tumor size ≥30 mm were independent risk factors for mortality. Among 4081 cases, 4.4% of patients had KPS that were lowered by 20 or more points at the time of discharge after surgery. Age ≥65 years, higher WHO grading, tumor location at the skull base, tumor size ≥30 mm, and non-gross total resections were associated with lowering of KPS scores by 20 or more points. The overall incidence of surgical complications was 19.3%. The rate of occurrence of new postoperative seizure in patients with supratentorial meningioma was 10.9%. All complications except for vascular complications occurred with significantly lower frequencies in asymptomatic patients than in symptomatic patients. Our results provide useful information regarding the surgical risks when surgical intervention is being considered for intracranial meningiomas. Surgery is an important option for asymptomatic meningiomas as the mortality rate and complication rate in the current study were sufficiently low.

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Section: Discussionmentioning

confidence: 69%

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

Oya

Ikawa

Ichihara

et al. 2021

Neurol. Med. Chir.(Tokyo)

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“…Meningioma-associated epilepsy has recently attracted some attention in the neurosurgical community. A non-skull base location, tumour size, peritumoral oedema, malignancy, tumour progression and recurrence, age and sex (as a possible corollary of a higher WHO grade), seizure history and EEG findings, clinical symptoms and surgical complications have all been (variably) associated with the risk of preoperative and postoperative seizures in meningioma patients 1,4,5,15,16,20 . We also investigated if early postoperative neuroimaging following supratentorial meningioma surgery might predict EPS.…”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

Section: Introductionmentioning

confidence: 99%

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

Ersoy

Ridwan

Grote

et al. 2020

Sci Rep

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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...

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“…Epilepsy after meningiomas surgery may be related to meningiomas themselves or craniotomy. It has demonstrated that maximum diameter >1 cm of PTE, WHO grade II and III tumors and low-range resection (Simpson grades III-v) are independent predictors of postoperative poor seizure outcomes (47). Preventive application of antiepileptic therapy remains controversial.…”

Section: Surgerymentioning

confidence: 99%

An Overview of Managements in Meningiomas

Zhao

Hou

et al. 2020

Front. Oncol.

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Meningioma is the most frequent primary tumor of the central nervous system. Important advances have been achieved in the treatment of meningioma in recent decades. Although most meningiomas are benign and have a good prognosis after surgery, clinicians often face challenges when the morphology of the tumor is complicated or the tumor is close to vital brain structures. At present, the longstanding treatment strategies of meningioma are mainly surgery and radiotherapy. The effectiveness of systemic therapy, such as chemotherapy or targeted therapy, has not been confirmed by big data series, and some clinical trials are still in progress. In this review, we summarize current treatment strategies and future research directions for meningiomas.

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Preoperative tumor-associated epilepsy in patients with supratentorial meningioma: factors influencing seizure outcome after meningioma surgery

Cited by 27 publications

References 33 publications

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

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

An Overview of Managements in Meningiomas

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