Seizures in supratentorial meningioma: a systematic review and meta-analysis

Englot, Dario J.; Magill, Stephen T.; Han, Seunggu J.; Chang, Edward F.; Berger, Mitchel S.; McDermott, Michael W.

doi:10.3171/2015.4.jns142742

Cited by 127 publications

(156 citation statements)

References 69 publications

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“…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.…”

Section: Discussionmentioning

confidence: 78%

“…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.…”

Section: Brain Invasion and The Risk Of Preoperative Seizuresmentioning

confidence: 99%

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Brain invasion and the risk of seizures in patients with meningioma

Heß

Spille²,

Adeli

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Identification of risk factors for perioperative epilepsy remains crucial in the care of patients with meningioma. Moreover, associations of brain invasion with clinical and radiological variables have been largely unexplored. The authors hypothesized that invasion of the cortex and subsequent increased edema facilitate seizures, and they compared radiological data and perioperative seizures in patients with brain-invasive or noninvasive meningioma. METHODS Correlations of brain invasion with tumor and edema volumes and preoperative and postoperative seizures were analyzed in univariate and multivariate analyses. RESULTS Totals of 108 (61%) females and 68 (39%) males with a median age of 60 years and harboring totals of 92 (52%) grade I, 79 (45%) grade II, and 5 (3%) grade III tumors were included. Brain invasion was found in 38 (22%) patients and was absent in 138 (78%) patients. The tumors were located at the convexity in 72 (41%) patients, at the falx cerebri in 26 (15%), at the skull base in 69 (39%), in the posterior fossa in 7 (4%), and in the ventricle in 2 (1%); the median tumor and edema volumes were 13.73 cm (range 0.81-162.22 cm) and 1.38 cm (range 0.00-355.80 cm), respectively. As expected, edema volume increased with rising tumor volume (p < 0.001). Brain invasion was independent of tumor volume (p = 0.176) but strongly correlated with edema volume (p < 0.001). The mean edema volume in noninvasive tumors was 33.0 cm, but in invasive tumors, it was 130.7 cm (p = 0.008). The frequency of preoperative seizures was independent of the patients' age, sex, and tumor location; however, the frequency was 32% (n = 12) in patients with invasive meningioma and 15% (n = 21) in those with noninvasive meningioma (p = 0.033). In contrast, the probability of detecting brain invasion microscopically was increased more than 2-fold in patients with a history of preoperative seizures (OR 2.57, 95% CI 1.13-5.88; p = 0.025). In univariate analyses, the rate of preoperative seizures correlated slightly with tumor volume (p = 0.049) but strongly with edema volume (p = 0.014), whereas seizure semiology was found to be independent of brain invasion (p = 0.211). In multivariate analyses adjusted for age, sex, tumor location, tumor and edema volumes, and WHO grade, rising tumor volume (OR 1.02, 95% CI 1.00-1.03; p = 0.042) and especially brain invasion (OR 5.26, 95% CI 1.52-18.15; p = 0.009) were identified as independent predictors of preoperative seizures. Nine (5%) patients developed new seizures within a median follow-up time of 15 months after surgery. Development of postoperative epilepsy was independent of all clinical variables, including Simpson grade (p = 0.133), tumor location (p = 0.936), brain invasion (p = 0.408), and preoperative edema volume (p = 0.081), but was correlated with increasing preoperative tumor volume (p = 0.004). Postoperative seizure-free rates were similar among patients with invasive and those with noninvasive meningioma (p = 0.372). CONCLUSIONS Brain invasion was identified as a new an...

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Section: Discussionmentioning

confidence: 78%

Section: Brain Invasion and The Risk Of Preoperative Seizuresmentioning

confidence: 99%

Brain invasion and the risk of seizures in patients with meningioma

Heß

Spille²,

Adeli

et al. 2019

Journal of Neurosurgery

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“…4–8 Seizures occur commonly among patients with supratentorial meningiomas, both pre- and postoperatively. 9 Recurrent seizures negatively impact patient quality of life, 10 affecting ability to drive, 11 employment, and independence, and can lead to significant comorbidities. 10,12–14 As such, seizure freedom represents an important outcome measure following meningioma resection, and one that has been relatively understudied.…”

mentioning

confidence: 99%

“…15–18 A recent meta-analysis of seizures in supratentorial meningioma found only 9 studies in the last 35 years, most relatively small in sample size, with detailed information regarding risk factors for seizure associated with meningiomas. 9 Pooling available data from 39 studies of seizure rates in meningioma, the authors reported a preoperative seizure rate of 29% of patients with supratentorial meningioma. For patients with preoperative seizures, seizure freedom was achieved in 69% of patients.…”

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confidence: 99%

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

et al. 2017

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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.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Olfactory dysfunction represents a main symptom in olfactory groove meningiomas (OGM). Besides this, olfactory function has been sparsely investigated in patients suffering from supratentorial meningiomas. Here, the authors explore pre‐ and postoperative variables associated with olfactory dysfunction in supratentorial meningioma patients. This is a retrospective study on supratentorial meningioma patients who underwent meningioma resection between January 2015 and January 2016. Preoperative and postoperative olfactory performance was quantified using a lateralized sniffin' stick odor identification test. Meningiomas affecting the olfactory system (n = 23) were compared to meningiomas in other locations among the control group (n = 40). Meningiomas that affected the olfactory system had odds of 3.6 and 3.7 in being associated with ipsilateral (lesional) and bilateral anosmia, respectively. Subgroup analysis revealed that meningiomas causing a midline shift across the frontal base and older age represented risk factors for preoperative anosmia. The odds of experiencing acquired postoperative ipsilateral anosmia were significantly increased in olfactory system affecting meningiomas (OR 11.1). Subgroup analysis highlighted OGMs to represent the predominant location associated with deterioration. General surgical complications predisposed patients to loss of contralateral (OR 12.3) and bilateral olfactory function (OR 27.8). Older age and meningiomas causing a midline shift across the frontal base predispose patients to preoperative olfactory dysfunction. Resection of OGMs and surgical complications are risk factors for postoperative olfactory deterioration to anosmia. Likely, olfactory dysfunction is underrecognized even in OGMs. In OGM surgery, however, preoperative lateralized testing might be critical to selecting an appropriate surgical route to preserve olfactory function. Clin. Anat. 32:524–533, 2019. © 2019 Wiley Periodicals, Inc.

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Seizures in supratentorial meningioma: a systematic review and meta-analysis

Cited by 127 publications

References 69 publications

Brain invasion and the risk of seizures in patients with meningioma

Brain invasion and the risk of seizures in patients with meningioma

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

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

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