1
|
Hinrichs FL, Brokinkel C, Adeli A, Sporns PB, Hess K, Paulus W, Stummer W, Grauer O, Spille DC, Brokinkel B. Risk factors for preoperative seizures in intracranial meningiomas. J Neurosurg Sci 2023; 67:66-72. [PMID: 33056948 DOI: 10.23736/s0390-5616.20.05068-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND About 25% of patients with intracranial meningioma display seizures at the time of initial presentation. Hence, identification of risk factors for preoperative seizures is crucial during perioperative care of meningioma patients. METHODS Associations of preoperative seizures with clinical, radiological and histological variables were analyzed in 945 patients (689 females, 73% and 256 males, 27%; median age: 58 years) who underwent surgery for primary diagnosed intracranial meningioma. RESULTS Preoperative seizures were found in 189 patients (20%). In univariate analyses, male gender (OR=1.91, 95% CI: 1.37-2.68; P<0.001), grade II/III histology (OR=2.24, 95% CI: 1.46-3.46; P<0.001), brain invasion (OR=2.59, 95% CI: 1.45-4.63; P=001), non-skull base tumor location (OR=3.07, 95% CI: 2.13-4.41; P<0.001), heterogeneous contrast-enhancement (OR=1.60, 95% CI: 1.04-2.46; P=0.031), intratumoral calcifications (OR=1.91, 95% CI: 1.17-3.10; P=0.009), an irregular shape (OR=2.07, 95% CI: 1.32-3.26; P=0.002) as well as tumor (OR=1.01 per ccm, 95% CI: 1.00-1.02; P=0.001) and edema volumes (OR=1.01 per ccm, 95% CI: 1.00-1.01; P<0.001) were correlated with seizures. Semiology was not related to any of the analyzed variables (P>0.05, each). No associations were found between seizures and histological subtype of 832 grade I meningiomas (P=0.391). In multivariate analyses, only non-skull base tumor location (OR=3.12, 95% CI: 1.74-5.59; P<0.001) and a rising peritumoral edema volume (OR=1.01 per ccm, 95% CI: 1.00-1.01; P<0.001) were identified as independent predictors for preoperative seizures. CONCLUSIONS Several mostly radiological variables were identified as risk factors for epilepsy. However, multivariate analyses confirmed only peritumoral edema and non-skull base tumor location as independent predictors for preoperative seizures. None of the variables predicts semiology.
Collapse
Affiliation(s)
- Fynn L Hinrichs
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Caroline Brokinkel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Alborz Adeli
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Peter B Sporns
- Department of Clinical Radiology, University of Münster, Münster, Germany.,Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Hess
- Institute of Neuropathology, University Hospital of Münster, Münster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital of Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Oliver Grauer
- Department of Neurology, Institute for Translational Neurology, University Hospital of Münster, Münster, Germany
| | - Dorothee C Spille
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany -
| |
Collapse
|
2
|
Elbadry Ahmed R, Tang H, Asemota A, Huang L, Boling W, Bannout F. Meningioma Related Epilepsy- Pathophysiology, Pre/postoperative Seizures Predicators and Treatment. Front Oncol 2022; 12:905976. [PMID: 35860576 PMCID: PMC9289540 DOI: 10.3389/fonc.2022.905976] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
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.
Collapse
Affiliation(s)
- Rasha Elbadry Ahmed
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Hailiang Tang
- Department of Neurosurgery, Huasha Hospital, Fudan University, Shanghai, China
| | - Anthony Asemota
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Lei Huang
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, United States
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, United States
| | - Warren Boling
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, United States
- *Correspondence: Warren Boling, ; Firas Bannout,
| | - Firas Bannout
- Department of Neurology, Loma Linda University Medical Center, Loma Linda, CA, United States
- *Correspondence: Warren Boling, ; Firas Bannout,
| |
Collapse
|
3
|
Thurin E, Rydén I, Skoglund T, Smits A, Gulati S, Hesselager G, Bartek J, Henriksson R, Salvesen Ø, Jakola AS. Impact of meningioma surgery on use of antiepileptic, antidepressant, and sedative drugs: A Swedish nationwide matched cohort study. Cancer Med 2021; 10:2967-2977. [PMID: 33773085 PMCID: PMC8085957 DOI: 10.1002/cam4.3868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/30/2020] [Accepted: 03/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background Meningioma is the most common primary intracranial tumor and surgery is the main treatment modality. As death from lack of tumor control is rare, other outcome measures like anxiety, depression and post‐operative epilepsy are becoming increasingly relevant. In this nationwide registry‐based study we aimed to describe the use of antiepileptic drugs (AED), antidepressants and sedatives before and after surgical treatment of an intracranial meningioma compared to a control population, and to provide predictors for continued use of each drug‐group two years after surgery. Methods All adult patients with histopathologically verified intracranial meningiomas were identified in the Swedish Brain Tumor Registry and their data were linked to relevant national registries after assigning five matched controls to each patient. We analyzed the prescription patterns of antiepileptic drugs (AED), antidepressants and sedative drugs in the two years before and the two years following surgery. Results For the 2070 patients and 10312 controls identified the use of AED, antidepressants and sedatives was comparable two years before surgery. AED use at time of surgery was higher for patients than for controls (22.2% vs. 1.9%, p < 0.01), as was antidepressant use (12.9% vs. 9.4%, p < 0.01). Both AED and antidepressant use remained elevated after surgery, with patients having a higher AED use (19.7% vs. 2.3%, p < 0.01) and antidepressant use (14.8% vs. 10.6%, p < 0.01) at 2 years post‐surgery. Use of sedatives peaked for patients at the time of surgery (14.4% vs. 6.1%, p < 0.01) and remained elevated at two years after surgery with 9.9% versus 6.6% (p < 0.01). For all the studied drugs, previous drug use was the strongest predictor for use 2 years after surgery. Conclusion This nationwide study shows that increased use of AED, antidepressants and sedatives in patients with meningioma started perioperatively, and remained elevated two years following surgery.
Collapse
Affiliation(s)
- Erik Thurin
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Isabelle Rydén
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Thomas Skoglund
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anja Smits
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Sasha Gulati
- Department of Neurosurgery, St.Olavs University Hospital HF, Trondheim, Norway.,Institute of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Göran Hesselager
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Roger Henriksson
- Department of Radiation Sciences & Oncology, University of Umeå, Umea, Sweden
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asgeir S Jakola
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurosurgery, St.Olavs University Hospital HF, Trondheim, Norway
| |
Collapse
|
4
|
Jiao Y, Li H, Fu W, Weng J, Huo R, Wang Y, Wang S, Jiang T, Cao Y, Zhao JZ. Classification of brain arteriovenous malformations located in motor-related areas based on location and anterior choroidal artery feeding. Stroke Vasc Neurol 2021; 6:441-448. [PMID: 33593985 PMCID: PMC8485233 DOI: 10.1136/svn-2020-000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Surgical management of arteriovenous malformations (AVMs) involving motor cortex or fibre tracts (M-AVMs) is challenging. This study aimed to construct a classification system based on nidus locations and anterior choroidal artery (AChA) feeding to pre-surgically evaluate motor-related and seizure-related outcomes in patients undergoing resection of M-AVMs. Methods and materials A total of 125 patients who underwent microsurgical resection of M-AVMs were retrospectively reviewed. Four subtypes were identified based on nidus location: (I) nidus involving the premotor area and/or supplementary motor areas; (II) nidus involving the precentral gyrus; (III) nidus involving the corticospinal tract (CST) and superior to the posterior limb of the internal capsule; (IV) nidus involving the CST at or inferior to the level of posterior limb of the internal capsule. In addition, we divided type IV into type IVa and type IVb according to the AChA feeding. Surgical-related motor deficit (MD) evaluations were performed 1 week (short-term) and 6 months (long-term) after surgery. Results The type I patients exhibited the highest incidence (62.0%) of pre-surgical epilepsy among the four subtypes. Multivariate analysis showed that motor-related area subtypes (p=0.004) and diffuse nidus (p=0.014) were significantly associated with long-term MDs. Long-term MDs were significantly less frequent in type I than in the other types. Type IV patients acquired the highest proportion (four patients, 25.0%) of long-term poor outcomes (mRS >2). Type IVb patients showed a significantly higher incidence of post-surgical MDs than type IVa patients (p=0.041). The MDs of type III or IV patients required more recovery time. Of the 62 patients who had pre-surgical seizures, 90.3% (56/62) controlled their seizures well and reached Engel class I after surgery. Conclusions Combining the consideration of location and AChA feeding, the classification for M-AVMs is a useful approach for predicting post-surgical motor function and decision-making.
Collapse
Affiliation(s)
- Yuming Jiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Weilun Fu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jiancong Weng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ran Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ji Zong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| |
Collapse
|
5
|
Li L, Song M, Zhang C, Qian Z, Li Y, Li R, Li C, Yang Z, Zhou D. Hemangiopericytomas: Spatial Intracranial Location in a Voxel-Based Mapping Study. J Neuroimaging 2020; 30:370-377. [PMID: 32237258 DOI: 10.1111/jon.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE To investigate the preferred location of intracranial hemangiopericytomas (IHPCs) with voxel-based mapping and 3-dimensional reconstruction from MRI data. METHODS Gadolinium-enhanced tumors of 258 primary and single IHPCs were segmented semi-automatically, followed by manual checking and editing of boundaries. The lesions were registered to Montreal Neurological Institute standard anatomical space, and heat-map and 3-dimensional rendered frequency images were generated. All tumors were then superimposed on the Anatomical Automatic Labeling (AAL) template to further investigate the difference in the tumor location based on the voxel-wise frequency of occurrence with respect to laterality, sex, age, and pathologic grade. RESULTS The 3-dimensional rendered images show that the tumors commonly located in the posterior cranial cavity, surrounding the tentorium. The posterior third of the superior sagittal sinus and the confluence of sinuses were commonly affected. According to the analysis of tumor occurrence frequency in the AAL template, IHPCs were mainly observed in the limbic lobe, occipital lobe, and cerebellum. Tumors in younger patients preferentially located in the right occipital region (P = .027), whereas those with higher pathological grade more often located in the left parietal lobe (P = .034). CONCLUSIONS This is the first voxel-based study to explore the predilection site of IHPCs. Our study suggests that these tumors commonly affect the posterior cranial cavity, adjoining the tentorium and venous sinus. Further research is needed to investigate the possible factors underlying these topographic preferences.
Collapse
Affiliation(s)
- Lianwang Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Ming Song
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Chuanbao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zenghui Qian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Runting Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Chao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhengyi Yang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Dabiao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| |
Collapse
|
6
|
Abstract
More than one-third of patients with meningiomas will experience seizures at some point in their disease. Despite this, meningioma-associated epilepsy remains significantly understudied, as most investigations focus on tumor progression, extent of resection, and survival. Due to the impact of epilepsy on the patient's quality of life, identifying predictors of preoperative seizures and postoperative seizure freedom is critical. In this chapter, we review previously reported rates and predictors of seizures in meningioma and discuss surgical and medical treatment options. Preoperative epilepsy occurs in approximately 30% of meningioma patients with peritumoral edema on neuroimaging being one of the most significant predictor of seizures. Other associated factors include age <18, male gender, the absence of headache, and non-skull base tumor location. Following tumor resection, approximately 70% of individuals with preoperative epilepsy achieve seizure freedom. Variables associated with persistent seizures include a history of preoperative epilepsy, peritumoral edema, skull base tumor location, tumor progression, and epileptiform discharges on postoperative electroencephalogram. In addition, after surgery, approximately 10% of meningioma patients without preoperative epilepsy experience new seizures. Variables associated with new postoperative seizures include tumor progression, prior radiation exposure, and gross total tumor resection. Both pre- and postoperative meningioma-related seizures are often responsive to antiepileptic drugs (AEDs), although AED prophylaxis in the absence of seizures is not recommended. AED selection is based on current guidelines for treating focal seizures with additional considerations including efficacy in tumor-related epilepsy, toxicities, and potential drug-drug interactions. Continued investigation into medical and surgical strategies for preventing and alleviating epilepsy in meningioma is warranted.
Collapse
Affiliation(s)
- Stephen C Harward
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.
| |
Collapse
|
7
|
Xue H, Sveinsson O, Bartek J, Förander P, Skyrman S, Kihlström L, Shafiei R, Mathiesen T, Tomson T. Long-term control and predictors of seizures in intracranial meningioma surgery: a population-based study. Acta Neurochir (Wien) 2018; 160:589-596. [PMID: 29327143 DOI: 10.1007/s00701-017-3434-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this retrospective study was to investigate the long-term seizure control and antiepileptic drug (AED) prescriptions, as well as identifying predictors of seizure(s) before and after surgery in a population-based cohort of operated intracranial meningioma patients. METHODS A total of 113 consecutive adult (> 18 years old) patients with newly diagnosed meningioma operated at the Karolinska University Hospital between 2006 and 2008 were included and followed up until the end of 2015. Data on seizure activity and AED prescriptions were obtained through chart review and telephone interview. Logistic regression and survival analysis were applied to identify risk factors for pre- and postoperative seizures. RESULTS A total of 21/113 (18.6%) patients experienced seizures before surgery of which 8/21 (38.1%) went on to become seizure-free after surgery. Thirteen (14%) patients experienced new-onset seizures after surgery. The regression analysis revealed tumor diameter ≥ 3.5 cm as a risk factor for preoperative seizures (OR 3.83, 95% CI 1.14-12.87). Presence of headache (OR 0.19, 95% CI 0.05-0.76) and skull base tumor location (OR 0.14, 95% CI 0.04-0.44) decreased the risk of preoperative seizures. Postoperative seizures were associated with tumor diameter ≥ 3.5 cm (OR 2.65, 95% CI 1.06-6.62) and history of preoperative seizures (OR 3.50, 95% CI 1.55-7.90). CONCLUSION Seizures are common before and after intracranial meningioma surgery. Approximately one third of patients with preoperative seizures become seizure-free on long-term follow-up after surgery, while 14% experienced new-onset seizures after surgery. Larger tumor size, absence of headache, and non-skull base location were associated with preoperative seizures, while tumor size and preoperative seizures were associated with postoperative seizures.
Collapse
|
8
|
|
9
|
Hamasaki T, Yamada K, Kitajima M, Kuratsu JI. Flatness of the infratentorial space associated with hemifacial spasm. Acta Neurochir (Wien) 2016; 158:1405-12. [PMID: 27179978 DOI: 10.1007/s00701-016-2831-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/28/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Whether a difference in morphology of the infratentorial space is associated with hemifacial spasm is not well understood. The aim of this study was to analyze the three-dimensional conformation of the infratentorial space and evaluate any possible contribution of morphological characteristics to the development of neurovascular compression leading to hemifacial spasm. METHODS We enrolled 25 patients with hemifacial spasm and matched them by age and sex to controls. The extent of the three-dimensional axes and the volume of the infratentorial space were measured using image analysis software for three-dimensional MRI. We evaluated the correlation between a morphological difference in the infratentorial space and changes in vascular configuration in the brain stem. RESULTS We found no statistical difference in volumetric analyses. The mean aspect ratio on the coronal plane (the ratio of the Z to X extent) of the infratentorial space in patients with hemifacial spasm was significantly lower (p < 0.01) than that in controls, as was the mean aspect ratio on the sagittal plane (the ratio of Z to Y extent, p < 0.01). A smaller sagittal aspect ratio was correlated (p < 0.05) with greater lateral deviation of the basilar artery. CONCLUSIONS Our results suggest that flatness of the superior-inferior dimension of the infratentorial space is an anatomical feature that characterizes patients with hemifacial spasm. We hypothesize that this unique structural variation may exaggerate the lateral deviation of the vertebrobasilar arteries due to arteriosclerosis and exacerbate the space competition among vessels and cranial nerves.
Collapse
Affiliation(s)
- Tadashi Hamasaki
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Kazumichi Yamada
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Mika Kitajima
- Department of Diagnostic Radiology, Kumamoto University Medical School, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Jun-Ichi Kuratsu
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| |
Collapse
|
10
|
Tanti MJ, Marson AG, Chavredakis E, Jenkinson MD. The impact of epilepsy on the quality of life of patients with meningioma: A systematic review. Br J Neurosurg 2015; 30:23-8. [PMID: 26982950 DOI: 10.3109/02688697.2015.1080215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Quality of life (QoL) is regarded as an important outcome measure in meningioma, and studies have investigated the role of various clinical and demographic factors. Epilepsy is known to impair quality of life but the impact of epilepsy on quality of life in a meningioma population is not well defined. The aim of this systematic review is to identify and summarise the current literature on meningioma, epilepsy and quality of life. A PubMed search was performed that identified 162 articles. Only 4 articles relevant to meningioma, epilepsy and QoL were found and each were analysed in terms of design, data, findings and conclusions. Each article was different in terms of study population, aims and outcome measure, but all suggest that epilepsy has an impact on quality of life. Anti-epileptic drugs, uncontrolled seizures and cognitive dysfunction may be particularly significant. The identified articles were weakened by small sample size, short follow-up, a lack of recorded epilepsy variables and the use of quality of life measures that are either too specific or not validated. Future studies are warranted to improve understanding in this topic, aid clinical decisions and improve QoL in these patients.
Collapse
Affiliation(s)
- Matthew J Tanti
- a The Walton Centre NHS Foundation Trust , Lower Lane, Fazakerley, Liverpool , UK
| | - Anthony G Marson
- a The Walton Centre NHS Foundation Trust , Lower Lane, Fazakerley, Liverpool , UK.,b Institute of Translational Medicine, University of Liverpool , Liverpool , UK
| | - Emmanuel Chavredakis
- a The Walton Centre NHS Foundation Trust , Lower Lane, Fazakerley, Liverpool , UK
| | - Michael D Jenkinson
- a The Walton Centre NHS Foundation Trust , Lower Lane, Fazakerley, Liverpool , UK.,b Institute of Translational Medicine, University of Liverpool , Liverpool , UK
| |
Collapse
|
11
|
Xue H, Sveinsson O, Tomson T, Mathiesen T. Intracranial meningiomas and seizures: a review of the literature. Acta Neurochir (Wien) 2015; 157:1541-8. [PMID: 26163256 DOI: 10.1007/s00701-015-2495-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/23/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Seizures are a common manifestation of brain tumors, but literature on the incidence of seizures before and after surgery for meningiomas is limited, and principles for use of antiepileptic drugs (AEDs) are controversial. METHODS This review is based on a MEDLINE search for articles from 1994 to 2014 describing intracranial meningioma and seizures or epilepsy, and AEDs treatment during and after surgery. RESULTS Up to 40 % of patients with symptomatic meningiomas present with seizures before operation. Tumor removal usually results in seizure control, but around 20 % of patients continue to have or develop new-onset seizures after surgery. Risk factors for seizures after surgery include preoperative seizures, tumor location, and extent of tumor removal. There are no solid data to support routine pre- or postoperative AED prophylaxis in seizure-free patients, and the decision to treat and the selection of AEDs should follow the general principles of treatment of focal epilepsies. CONCLUSIONS Seizures are a common manifestation of meningiomas, but about 80 % patients with preoperative seizures can be seizure free after tumor removal. Prospective controlled AED trials specifically on meningioma patients are much needed.
Collapse
|
12
|
Cowie CJ, Cunningham MO. Peritumoral epilepsy: relating form and function for surgical success. Epilepsy Behav 2014; 38:53-61. [PMID: 24894847 PMCID: PMC4265733 DOI: 10.1016/j.yebeh.2014.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 10/28/2022]
Abstract
Seizures are a prominent symptom in patients with both primary and secondary brain tumors. Medical management of seizure control in this patient group is problematic as the mechanisms linking tumorigenesis and epileptogenesis are poorly understood. It is possible that several mechanisms contribute to tumor-associated epileptic zone formation. In this review, we discuss key candidates that may be implicated in peritumoral epileptogenesis and, in so doing, hope to highlight areas for future research. Furthermore, we summarize the current role of antiepileptic medications in this type of epilepsy and examine the changes in surgical practice which may lead to improved seizure rates after tumor surgery. Lastly, we speculate on possible future preoperative and intraoperative considerations for improving seizure control after tumor resection.
Collapse
Affiliation(s)
- Christopher J.A. Cowie
- Department of Neurosurgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK,Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, UK
| | - Mark O. Cunningham
- Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, UK,Corresponding author at: Institute of Neuroscience, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK. Tel.: + 44 191 2088935.
| |
Collapse
|
13
|
Hamasaki T, Yamada K, Kuratsu JI. Seizures as a presenting symptom in neurosurgical patients: A retrospective single-institution analysis. Clin Neurol Neurosurg 2013; 115:2336-40. [DOI: 10.1016/j.clineuro.2013.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/22/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022]
|
14
|
Zheng Z, Chen P, Fu W, Zhu J, Zhang H, Shi J, Zhang J. Early and late postoperative seizure outcome in 97 patients with supratentorial meningioma and preoperative seizures: a retrospective study. J Neurooncol 2013; 114:101-9. [PMID: 23703298 DOI: 10.1007/s11060-013-1156-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/12/2013] [Indexed: 11/25/2022]
Abstract
We identified factors associated with early and late postoperative seizure control in patients with supratentorial meningioma plus preoperative seizures. In this retrospective study, univariate analysis and multivariate logistic regression analysis compared 24 clinical variables according to the occurrence of early (≤1 week) or late (>1 week) postoperative seizures. Sixty-two of 97 patients (63.9 %) were seizure free for the entire postoperative follow-up period (29.5 ± 11.8 months), while 13 patients (13.4 %) still had frequent seizures at the end of follow-up. Fourteen of 97 patients (14.4 %) experienced early postoperative seizures, and emergence of new postoperative neurological deficits was the only significant risk factor (odds ratio = 7.377). Thirty-three patients (34.0 %) experienced late postoperative seizures at some time during follow-up, including 12 of 14 patients with early postoperative seizures. Associated risk factors for late postoperative seizures included tumor progression (odds ratio = 7.012) and new permanent postoperative neurological deficits (odds ratio = 4.327). Occurrence of postoperative seizures in patients with supratentorial meningioma and preoperative seizure was associated with new postoperative neurological deficits. Reduced cerebral or vascular injury during surgery may lead to fewer postoperative neurological deficits and better seizure outcome.
Collapse
Affiliation(s)
- Zhe Zheng
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|