Predicting postoperative seizure development in meningiomas – Analyses of clinical, histological and radiological risk factors

• Published in: Clinical neurology and neurosurgery 2021-01, Vol.200, p.106315-106315, Article 106315
• Main Authors: Brokinkel, Benjamin, Hinrichs, Fynn Luca, Schipmann, Stephanie, Grauer, Oliver, Sporns, Peter B., Adeli, Alborz, Brokinkel, Caroline, Hess, Katharina, Paulus, Werner, Stummer, Walter, Spille, Dorothee Cäcilia
• Format: Article
• Language: English
• Subjects: Age; Brain cancer; Convulsions & seizures; Data collection; Epilepsy; Fistula; Hemorrhage; Histology; Hydrocephalus; Magnetic resonance imaging; Meningioma; Microsurgery; MRI; Neurology; Patients; Quality of life; Risk factors; Seizure; Seizures; Software; Surgery; Surgical outcomes; Tumors; Values; Variables
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106315

•Seizures after meningioma surgery are common, but risk factors are sparse.•Clinical factors (age, Karnofsky Score) are related with seizure risk.•Imaging characteristics (tumor location/characteristics) improve seizure prediction.•Surgical complications strongly impact the risk of seizures. Seizures after meningioma surgery are common, with a distinct impact on postoperative life quality. Sufficient risk factors for seizure development are sparsely known but needed to improve perioperative patient counseling and, eventually, antiepileptic treatment. Correlations between clinical, radiological and histological variables and the onset of new seizures following surgery for initially diagnosed cranial meningioma were retrospectively analyzed in uni- and multivariate analyses. 752 preoperatively seizure-naïve patients (569 females, 76 % and 183 males, 24 %) with a median age of 57 years were included. Postoperative seizures occurred in 69 cases (9 %). In univariate analyses, seizures were correlated with preoperative Karnofsky Score < 80 (OR: 1.91, 95 % CI 1.01−3.59; p = .045), convexity/parasagittal tumor location (OR: 1.77, 95 % CI 1.06−2.95; p = .030), heterogenous contrast-enhancement of the tumor (OR: 2.24, 95 % CI 1.14−4.39; p = .019) and intratumoral calcifications (OR: 3.35, 95 % CI 1.59−7.05; p = .001). Multivariable analyses revealed age at the time of surgery (OR: 1.04, 95 % CI 1.01−1.07; p = .009) and intratumoral calcifications on preoperative imaging (OR: 3.70, 95 % CI 1.73−7.92; p = .001) as risk factors for postoperative seizures. Based on multivariate analyses, a score for discrimination of patients at low (3 %), intermediate (11 %) and high risk (17 %) of postoperative seizures (AUC: 0.7, p < .001) was conducted. In subgroup analyses, postoperative hemorrhage (OR: 2.90, 95 % CI 1.13–7.46; p = .028) and hydrocephalus (OR: 3.65, 95 % CI 1.48–9.01; p = .005) were correlated with postoperative seizures. Risk factors for postoperative seizures after meningioma surgery are sparse and can be basically taken from preoperative imaging. Among surgical complications, postoperative hemorrhage and hydrocephalus are strong seizure predictors.