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Goertz L, Bernards N, Muders H, Hamisch C, Goldbrunner R, Krischek B. Incidence and Clinical Presentation of Pre- and Postoperative Seizures in Patients With Posterior Fossa Meningiomas. Cureus 2024; 16:e52474. [PMID: 38371129 PMCID: PMC10873762 DOI: 10.7759/cureus.52474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Seizures are a common symptom of supratentorial meningiomas with pre- and postoperative seizure rates of approximately 30% and 12%, respectively, especially in parasagittal and convexity meningiomas. Less is known about the association between seizures and posterior fossa meningiomas. This study evaluates the prevalence, potential causes, and outcomes of seizures in patients who have undergone surgery for posterior fossa meningioma. METHODS This is a retrospective, observational, single-center study of consecutive patients who underwent surgical resection of posterior fossa meningiomas between 2009 and 2017. We retrospectively identified patients with seizures and analyzed patient demographics, tumor characteristics, and procedural characteristics. RESULTS A total of 44 patients (mean age: 59.8 ± 13.5 years) were included. Twenty-six tumors were located at the cerebellar convexity and tentorium (59.1%), 12 at the cerebellopontine angle (27.3%), four at the clivus (9.1%), and two at the foramen magnum (4.5%). Seizures were the presenting symptom of cerebellar meningioma in two patients. Patients were seizure-free after surgery. Three patients had their first seizure after surgery (interval between surgery and first seizure: two days to 17 months). Analysis of these three patients revealed possible causes of postoperative seizures: radiation necrosis and edema, hyponatremia, and preoperative hydrocephalus. In all patients with postoperative seizures, long-term seizure control was achieved with the administration of antiepileptic drugs. CONCLUSIONS The incidence of seizures in patients with posterior fossa meningiomas is relatively low. Antiepileptic drugs can help to achieve seizure control.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Nora Bernards
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Hannah Muders
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Christina Hamisch
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Roland Goldbrunner
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
| | - Boris Krischek
- Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DEU
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Batista S, Bertani R, Palavani LB, de Barros Oliveira L, Borges P, Koester SW, Paiva WS. Postoperative Seizure Prophylaxis in Meningioma Resection: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3415. [PMID: 37998550 PMCID: PMC10670536 DOI: 10.3390/diagnostics13223415] [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: 06/12/2023] [Revised: 09/11/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Seizures in the early postoperative period may impair patient recovery and increase the risk of complications. The aim of this study is to determine whether there is any advantage in postoperative seizure prophylaxis following meningioma resection. METHODS This systematic review was conducted in accordance with PRISMA guidelines. PUBMED, Web of Science, Embase, Science Direct, and Cochrane were searched for papers until April 2023. RESULTS Among nine studies, a total of 3249 patients were evaluated, of which 984 patients received antiepileptic drugs (AEDs). No significant difference was observed in the frequency of seizure events between patients who were treated with antiepileptic drugs (AEDs) and those who were not. (RR 1.22, 95% CI 0.66 to 2.40; I2 = 57%). Postoperative seizures occurred in 5% (95% CI: 1% to 9%) within the early time period (<7 days), and 9% (95% CI: 1% to 17%) in the late time period (>7 days), with significant heterogeneity between the studies (I2 = 91% and 97%, respectively). In seizure-naive patients, the rate of postoperative seizures was 2% (95% CI: 0% to 6%) in the early period and increased to 6% (95% CI: 0% to 15%) in the late period. High heterogeneity led to the use of random-effects models in all analyses. CONCLUSIONS The current evidence does not provide sufficient support for the effectiveness of prophylactic AED medications in preventing postoperative seizures in patients undergoing meningioma resection. This underscores the importance of considering diagnostic criteria and conducting individual patient analysis to guide clinical decision-making in this context.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Raphael Bertani
- Department of Neurosurgery, São Paulo University, Sao Paulo 05508-220, Brazil; (R.B.)
| | - Lucca B. Palavani
- Faculty of Medicine, Max Planck University Center, Indaiatuba 13343-060, Brazil
| | | | - Pedro Borges
- Faculty of Medicine, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro 21310-310, Brazil;
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Pauletto G, Nilo A, Pez S, Zonta ME, Bagatto D, Isola M, Verriello L, Valente M, Skrap M, Ius T. Meningioma-Related Epilepsy: A Happy Ending? J Pers Med 2023; 13:1124. [PMID: 37511737 PMCID: PMC10381126 DOI: 10.3390/jpm13071124] [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: 04/14/2023] [Revised: 05/21/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: More than one-third of patients with meningiomas experience at least one seizure during the course of their disease, and in the 20-50% of cases, seizure represents the onset symptom. After surgery, up to 30% of patients continue to have seizures, while others may experience them later; (2) Methods: The study analyzed retrospectively the risk factors for pre-operative seizures in a large cohort of 358 patients who underwent surgery for newly diagnosed brain meningioma; (3) Results: We identified age, peritumor edema, and location as risk factors for seizure at the onset. Patients with seizures differed from patients without seizures for the following characteristics: younger average age, lower pre-operative Karnofsky Performance Status (KPS), location on the convexity, lower Simpson Grade, lower incidence of pre-operative neurological deficits, and higher incidence of pre-operative peritumor edema. After 24 months, 88.2% of patients were classified as Engel class Ia, and no correlation with disease progression was observed; (4) Conclusions: Meningioma-related epilepsy has generally a positive outcome following surgery and it seems not to be linked to disease progression, even if further studies are needed.
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Affiliation(s)
- Giada Pauletto
- Neurology Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Sara Pez
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | | | - Daniele Bagatto
- Neuroradiology Unit, Department of Diagnostic Imaging, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Miriam Isola
- Division of Medical Statistics, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Miran Skrap
- Neurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
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Dincer A, Jalal MI, Gupte TP, Vetsa S, Vasandani S, Yalcin K, Marianayagam N, Blondin N, Corbin Z, McGuone D, Fulbright RK, Erson-Omay Z, Günel M, Moliterno J. The clinical and genomic features of seizures in meningiomas. Neurooncol Adv 2023; 5:i49-i57. [PMID: 37287582 PMCID: PMC10243847 DOI: 10.1093/noajnl/vdac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Meningiomas are the most common central nervous system tumors. Although these tumors are extra-axial, a relatively high proportion (10%-50%) of meningioma patients have seizures that can substantially impact the quality of life. Meningiomas are believed to cause seizures by inducing cortical hyperexcitability that results from mass effect and cortical irritation, brain invasion, or peritumoral brain edema. In general, meningiomas that are associated with seizures have aggressive features, with risk factors including atypical histology, brain invasion, and higher tumor grade. Somatic NF2 mutated meningiomas are associated with preoperative seizures, but the effect of the driver mutation is mediated through atypical features. While surgical resection is effective in controlling seizures in most patients with meningioma-related epilepsy, a history of seizures and uncontrolled seizures prior to surgery is the most significant predisposing factor for persistent postoperative seizures. Subtotal resection (STR) and relatively larger residual tumor volume are positive predictors of postoperative seizures. Other factors, including higher WHO grade, peritumoral brain edema, and brain invasion, are inconsistently associated with postoperative seizures, suggesting they might be crucial in the development of an epileptogenic focus, but do not appear to play a substantial role after seizure activity has been established. Herein, we review and summarize the current literature surrounding meningioma-related epilepsy and underscore the interaction of multiple factors that relate to seizures in patients with meningioma.
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Affiliation(s)
- Alper Dincer
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Muhammad I Jalal
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Trisha P Gupte
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Kanat Yalcin
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Nicholas Blondin
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zachary Corbin
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Declan McGuone
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert K Fulbright
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Murat Günel
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Moliterno
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
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McKevitt C, Marenco-Hillembrand L, Bamimore M, Chandler R, Otamendi-Lopez A, Almeida JP, Quiñones-Hinojosa A, Chaichana KL. Predictive factors for post operative seizures following meningioma resection in patients without preoperative seizures: a multicenter retrospective analysis. Acta Neurochir (Wien) 2023; 165:1333-1343. [PMID: 36977866 DOI: 10.1007/s00701-023-05571-0] [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: 12/01/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Meningiomas are the most common primary brain tumor and represent 35% of all intracranial neoplasms. However, in the early post-operative period approximate 3-5% of patients experience an acute symptomatic seizure. Establishing risk factors for postoperative seizures will identify those patients without preoperative seizures at greatest risk of postoperative seizures and may guide antiseizure medications (ASMs) management. METHODS Adult seizure naïve patients who underwent primary resection of a World Health Organization (WHO) Grade 1-3 meningioma at the three Mayo Clinic Campuses between 2012-2022 were retrospectively reviewed. Multivariate regression analyses were used to identify radiological, surgical, and management features with the development of new-onset seizures in patients undergoing meningioma resection. RESULTS Of 113 seizure naïve patients undergoing meningioma resection 11 (9.7%) experienced a new-onset post-operative seizure. Tumor volume ≥ 25 cm3 (Odds Ratio (OR) 5.223, 95% Confidence Interval (CI) 1.546 - 17.650, p = 0.008) and cerebral convexity meningiomas (OR 4.742, 95% CI 1.255 - 14.336, p = 0.016) were most associated with new onset postoperative seizures in multivariate analysis. ASMs and corticosteroid therapies did not display a significant difference among those with and without a new onset postoperative seizure. CONCLUSION In the current study, a larger tumor volume (≥ 25 cm3) and/or convexity meningiomas predicted the development of new onset post-operative seizures. Those who present with these factors should be counseled for their increased risk of new onset post-operative seizures and may benefit from prophylactic ASMs therapy.
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Affiliation(s)
- Chase McKevitt
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Lina Marenco-Hillembrand
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael Bamimore
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
- Department of Neurological Surgery, Cooper University Health Care, 1 Cooper Plz, Camden, NJ, 08103, USA
| | - Rosemary Chandler
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Andrea Otamendi-Lopez
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Kaisorn L Chaichana
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Abzalova DI, Sinkin MV, Yakovlev AA, Prirodov AV, Guekht AB. [Risk factors for de novo generalized tonic-clonic seizures in patients with supratentorial meningiomas after neurosurgical treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:69-74. [PMID: 37966442 DOI: 10.17116/jnevro202312310169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To identify risk factors for de novo epileptic seizures in the early postoperative period in patients with supratentorial meningiomas. MATERIAL AND METHODS A retrospective case-control study was conducted in a ratio of 3 to 1. The case histories of all patients with supratentorial meningiomas that met the inclusion and exclusion criteria, who underwent surgical removal of the neoplasm in 01.01.17 to 12.31.20, were studied in the neurosurgical department of the Research Institute of Emergency Medicine named after N.V. Sklifosovsky. Of 133 patients without epileptic seizures and a history of taking antiepileptic drugs before surgery, 10% (n=14) had a de novo generalized tonic-clonic seizure in the early postoperative period. Among the remaining 119 patients, 42 patients were selected to form the control group, similar in age, localization and volume of the tumor with patients in the main group. In all patients, the clinical condition, the results of preoperative and postoperative neuroimaging with contrast enhancement, the course of the intraoperative period, as well as the duration and outcomes of hospitalization were assessed. RESULTS The risk factors for the development of de novo seizures were an increase in the volume of cerebral edema compared with the preoperative one according to postoperative CT data and the development of hemorrhagic transformation of cerebral edema. CONCLUSION A prospective study is needed to determine risk factors for de novo seizures and determine prophylactic treatment.
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Affiliation(s)
- D I Abzalova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - M V Sinkin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A A Yakovlev
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - A V Prirodov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A B Guekht
- Scientific and Practical Psychoneurological Center, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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Prevalence of seizures in brain tumor: A meta-analysis. Epilepsy Res 2022; 187:107033. [DOI: 10.1016/j.eplepsyres.2022.107033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
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Wach J, Güresir Á, Vatter H, Herrlinger U, Becker A, Toma M, Hölzel M, Güresir E. Low-Dose Acetylsalicylic Acid Treatment in Non-Skull-Base Meningiomas: Impact on Tumor Proliferation and Seizure Burden. Cancers (Basel) 2022; 14:cancers14174285. [PMID: 36077817 PMCID: PMC9454729 DOI: 10.3390/cancers14174285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
MIB-1 index is an important predictor of meningioma progression and was found to be correlated with COX-2 expression. However, the impact of low-dose acetylsalicylic acid (ASA) on MIB-1 index and clinical symptoms is unclear. Between 2009 and 2022, 710 patients with clinical data, tumor-imaging data, inflammatory laboratory (plasma fibrinogen, serum C-reactive protein) data, and neuropathological reports underwent surgery for primary cranial WHO grade 1 and 2 meningioma. ASA intake was found to be significantly associated with a low MIB-1 labeling index in female patients ≥ 60 years. Multivariable analysis demonstrated that female patients ≥ 60 years with a non-skull-base meningioma taking ASA had a significantly lower MIB-1 index (OR: 2.6, 95%: 1.0–6.6, p = 0.04). Furthermore, the intake of ASA was independently associated with a reduced burden of symptomatic epilepsy at presentation in non-skull-base meningiomas in both genders (OR: 3.8, 95%CI: 1.3–10.6, p = 0.03). ASA intake might have an anti-proliferative effect in the subgroup of elderly female patients with non-skull-base meningiomas. Furthermore, anti-inflammatory therapy seems to reduce the burden of symptomatic epilepsy in non-skull-base meningiomas. Further research is needed to investigate the role of anti-inflammatory therapy in non-skull-base meningiomas.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-16521
| | - Ági Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, 53127 Bonn, Germany
| | - Marieta Toma
- Institute of Pathology, University Hospital Bonn, 53127 Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
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Gadot R, Khan AB, Patel R, Goethe E, Shetty A, Hadley CC, V JCB, Harmanci AS, Klisch TJ, Yoshor D, Sheth SA, Patel AJ. Predictors of postoperative seizure outcome in supratentorial meningioma. J Neurosurg 2022; 137:515-524. [PMID: 35099915 DOI: 10.3171/2021.9.jns211738] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Ron Gadot
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - A Basit Khan
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Rajan Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Eric Goethe
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Arya Shetty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | | | - James C Bayley V
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Akdes S Harmanci
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Tiemo J Klisch
- 2Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
| | - Daniel Yoshor
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
- 2Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
- 4Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Seizure prophylaxis in meningiomas: a systematic review and meta-analysis. NEUROLOGÍA (ENGLISH EDITION) 2022; 38:291-302. [PMID: 35781420 DOI: 10.1016/j.nrleng.2022.03.002] [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: 04/17/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION No formal indication currently exists for seizure prophylaxis in neurosurgical oncology patients. Neither have specific recommendations been made on the use of antiepileptic drugs (AED) in seizure-free patients with meningiomas scheduled for surgery. AEDs are generally prescribed on a discretionary basis, taking into consideration a range of clinical and radiological risk factors. We present a systematic review and meta-analysis exploring the effectiveness of antiepileptic prophylaxis in patients with meningioma and no history of seizures. METHODS We performed a systematic review of the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and clinicaltrials.gov databases. Of a total of 4368 studies initially identified, 12 were selected for extraction of data and qualitative analysis. Based on the clinical data presented, we were only able to include 6 studies in the meta-analysis. We performed heterogeneity studies, calculated a combined odds ratio, evaluated publication bias, and conducted a sensitivity analysis. RESULTS AED prophylaxis in patients with meningioma and no history of seizures did not significantly reduce the incidence of post-operative seizures in comparison to controls (Mantel-Haenszel combined odds ratio, random effects model: 1.26 [95% confidence interval, 0.60-2.78]; 2041 patients). However, we are unable to establish a robust recommendation against this treatment due to the lack of prospective studies, the presence of selection bias in the studies reviewed, the likelihood of underestimation of seizure frequency during follow-up, and the strong influence of one study on the overall effect. CONCLUSIONS Despite the limitations of this review, the results of the meta-analysis do not support the routine use of seizure prophylaxis in patients with meningioma and no history of seizures.
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Cai Q, Wu Y, Wang S, Huang T, Tian Q, Wang J, Qin H, Feng D. Preoperative antiepileptic drug prophylaxis for early postoperative seizures in supratentorial meningioma: a single-center experience. J Neurooncol 2022; 158:59-67. [DOI: 10.1007/s11060-022-04009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
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12
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Li S, Yan X, Li R, Zhang X, Ma T, Zeng M, Dong J, Wang J, Liu X, Peng Y. Safety of intravenous tranexamic acid in patients undergoing supratentorial meningiomas resection: protocol for a randomised, parallel-group, placebo control, non-inferiority trial. BMJ Open 2022; 12:e052095. [PMID: 35110315 PMCID: PMC8811564 DOI: 10.1136/bmjopen-2021-052095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Growing evidence recommends antifibrinolytic agent tranexamic acid (TXA) to reduce blood loss and transfusions rate in various surgical settings. However, postoperative seizure, as one of the major adverse effects of TXA infusion, has been a concern that restricts its utility in neurosurgery. METHODS AND ANALYSIS This is a randomised, placebo-controlled, non-inferiority trial. Patients with supratentorial meningiomas and deemed suitable for surgical resection will be recruited in the trial. Patients will be randomised to receive either a single administration of 20 mg/kg TXA or a placebo of the same volume with a 1:1 allocation ratio after anaesthesia induction. The primary endpoint is the cumulative incidence of early postoperative seizures within 7 days after craniotomy. Secondary outcomes include the incidence of non-seizure complications, changes of haemoglobin level from baseline, intraoperative blood loss, erythrocyte transfusion volume, Karnofsky Performance Status, all-cause mortality, and length of stay, and total hospitalisation cost. ETHICS AND DISSEMINATION This trial is registered at ClinicalTrial.gov and approved by the Chinese Ethics Committee of Registering Clinical Trials (ChiECRCT20200224). The findings will be disseminated in peer-reviewed journals and presented at national or international conferences relevant to subject fields. TRIAL REGISTRATION NUMBER NCT04595786.
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Affiliation(s)
- Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiang Yan
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ruowen Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingyue Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingting Ma
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia Dong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Juan Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyuan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Walbert T, Harrison RA, Schiff D, Avila EK, Chen M, Kandula P, Lee JW, Le Rhun E, Stevens GHJ, Vogelbaum MA, Wick W, Weller M, Wen PY, Gerstner ER. SNO and EANO practice guideline update: Anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Neuro Oncol 2021; 23:1835-1844. [PMID: 34174071 DOI: 10.1093/neuonc/noab152] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To update the 2000 American Academy of Neurology (AAN) practice parameter on anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. METHODS Following the 2017 AAN methodologies, a systematic literature review utilizing PubMed, EMBASE, Cochrane, and Web of Science databases was performed. The studies were rated based on the AAN therapeutic or causation classification of evidence (Class I-IV). RESULTS Thirty-seven articles were selected for final analysis. There were limited high level, Class I studies and mostly Class II and III studies. The AAN affirmed the value of these guidelines. RECOMMENDATIONS In patients with newly diagnosed brain tumors who have not had a seizure, clinicians should not prescribe anti-epileptic drugs (AEDs) to reduce the risk of seizures (Level A). In brain tumor patients undergoing surgery, there is insufficient evidence to recommend prescribing AEDs to reduce the risk of seizures in the peri- or postoperative period (Level C). There is insufficient evidence to support prescribing valproic acid or levetiracetam with the intent to prolong progression-free or overall survival (Level C). Physicians may consider use of levetiracetam over older AEDs to reduce side effects (Level C). There is insufficient evidence to support using tumor location, histology, grade, molecular/imaging features, when deciding whether or not to prescribe prophylactic AEDs (Level U).
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Affiliation(s)
- Tobias Walbert
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | | | - David Schiff
- University of Virginia Health System, Charlottesville, VA, USA
| | - Edward K Avila
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Merry Chen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Padmaja Kandula
- Division of Clinical Neurophysiology and Epilepsy, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York USA
| | | | - Emilie Le Rhun
- Departments of Neurology and Neurosurgery, Brain Tumor Center & Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Glen H J Stevens
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Wolfgang Wick
- Neurology Clinic and Neurooncology Program, Heidelberg University and German Cancer Research Center, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elizabeth R Gerstner
- Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA and Harvard Medical School, Boston, MA, USA
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Baumgarten P, Sarlak M, Monden D, Spyrantis A, Bernatz S, Gessler F, Dubinski D, Hattingen E, Marquardt G, Strzelczyk A, Rosenow F, Harter PN, Seifert V, Freiman TM. Early and Late Postoperative Seizures in Meningioma Patients and Prediction by a Recent Scoring System. Cancers (Basel) 2021; 13:cancers13030450. [PMID: 33504023 PMCID: PMC7865990 DOI: 10.3390/cancers13030450] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Seizures are among the most common symptoms of meningioma patients even after surgery. This study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified version of a score to predict postoperative seizures on an independent cohort. The data underline that there are distinct factors identifying patients with a high risk of postoperative seizures following meningioma surgery which has been already shown before. We could further show that the high proportion of 43% of postoperative seizures occur as late seizures which are more dangerous because they may happen out of hospital. The modified STAMPE2 score could predict postoperative seizures when reaching very high scores but was not generally transferable to our independent cohort. Abstract Seizures are among the most common symptoms of meningioma. This retrospective study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified STAMPE2 score. In 556 patients who underwent meningioma surgery, we correlated different risk factors with the occurrence of postoperative seizures. A modified STAMPE2 score was applied. Risk factors for preoperative seizures were edema (p = 0.039) and temporal location (p = 0.038). For postoperative seizures preoperative tumor size (p < 0.001), sensomotory deficit (p = 0.004) and sphenoid wing location (p = 0.032) were independent risk factors. In terms of postoperative status epilepticus; sphenoid wing location (p = 0.022), tumor volume (p = 0.045) and preoperative seizures (p < 0.001) were independent risk factors. Postoperative seizures lead to a KPS deterioration and thus an impaired quality of life (p < 0.001). Late seizures occurred in 43% of patients with postoperative seizures. The small sub-cohort of patients (2.7%) with a STAMPE2 score of more than six points had a significantly increased risk for seizures (p < 0.001, total risk 70%). We concluded that besides distinct risk factors, high scores of the modified STAMPE2 score could estimate the risk of postoperative seizures. However, it seems not transferable to our cohort
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Affiliation(s)
- Peter Baumgarten
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
- Correspondence: ; Tel.: +49-(0)69-6301-5295
| | - Mana Sarlak
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Daniel Monden
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Andrea Spyrantis
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Simon Bernatz
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.B.); (P.N.H.)
| | - Florian Gessler
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany;
| | - Gerhard Marquardt
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (A.S.); (F.R.)
- Department of Neurology, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (A.S.); (F.R.)
- Department of Neurology, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
| | - Patrick N. Harter
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.B.); (P.N.H.)
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
- German Cancer Consortium (DKTK) Partner Site Frankfurt/Mainz, 60528 Frankfurt am Main, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Frankfurt Cancer Institute (FCI), 60528 Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Thomas M. Freiman
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
- Epilepsy Center Frankfurt Rhine-Main, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (A.S.); (F.R.)
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
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Gong J, Li LM, Zheng WJ, Chen YZ, Hu ZH, Liao W, Lin QC, Zhu YH, Huang HT, Lin SH. Predictive Factors of Postoperative Peritumoral Brain Edema after Meningioma Resection. Neurol India 2021; 69:1682-1687. [DOI: 10.4103/0028-3886.333500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Yang M, Cheng YR, Zhou MY, Wang MW, Ye L, Xu ZC, Feng ZH, Ma XT. Prophylactic AEDs Treatment for Patients With Supratentorial Meningioma Does Not Reduce the Rate of Perioperative Seizures: A Retrospective Single-Center Cohort Study. Front Oncol 2020; 10:568369. [PMID: 33344228 PMCID: PMC7746868 DOI: 10.3389/fonc.2020.568369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/03/2020] [Indexed: 01/10/2023] Open
Abstract
Meningiomas, the most common brain tumor, inevitably require surgical treatment. However, the efficacy of prophylactic antiepileptic drugs (AEDs), in reducing the frequency of new-onset seizures during the perioperative period remains controversial. To further clarify if prophylactic antiepileptic drug treatment for patients with meningioma had value, we reviewed the medical records of 186 supratentorial meningioma patients who were operated at our hospital between 2016 and 2018. SPSS 24.0 software was used for statistical analysis. The results of univariate analysis showed that factors including age, sex, the course of the disease (years), maximum cross-sectional area of the tumor, location of the tumor, multiple or single tumors, adjacent to the cortex, peritumoral brain edema, World Health Organization classification, and peritumoral adhesion were not associated with perioperative seizures (P >0.05). Furthermore, the results of multivariate analysis revealed hydrocephalus (OR 4.87 P = 0.05) and non-skull base location (OR 1.88 P = 0.04) were significant risk factors for perioperative in-hospital seizures. Prophylactic valproic acid treatment did not contribute to the alleviation of perioperative seizures (OR 1.76 P = 0.04). However, Multivariate logistic regression analyses excluding the patients with seizures before operation confirmed prophylactic valproic acid treatment did not reduce the frequency of seizures during the perioperative period (OR 1.84 P = 0.04). Taken together, the data suggest that prophylactic valproic acid treatment for patients with supratentorial meningioma does not reduce the rate of perioperative seizures.
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Affiliation(s)
- Ming Yang
- Neurosurgical Department, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yong-Ran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Meng-Yun Zhou
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Ming-Wei Wang
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Lan Ye
- The Medical Function Laboratory of Experimental Teaching Center of Basic Medicine, Guizhou Medical University, Guiyang, China
| | - Zu-Cai Xu
- Neurological Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhan-Hui Feng
- Neurological Department, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xun-Tai Ma
- Neurological Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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17
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Gupte TP, Li C, Jin L, Yalcin K, Youngblood MW, Miyagishima DF, Mishra-Gorur K, Zhao AY, Antonios J, Huttner A, McGuone D, Blondin NA, Contessa JN, Zhang Y, Fulbright RK, Gunel M, Erson-Omay Z, Moliterno J. Clinical and genomic factors associated with seizures in meningiomas. J Neurosurg 2020; 135:835-844. [PMID: 33276341 DOI: 10.3171/2020.7.jns201042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The association of seizures with meningiomas is poorly understood. Moreover, any relationship between seizures and the underlying meningioma genomic subgroup has not been studied. Herein, the authors report on their experience with identifying clinical and genomic factors associated with preoperative and postoperative seizure presentation in meningioma patients. METHODS Clinical and genomic sequencing data on 394 patients surgically treated for meningioma at Yale New Haven Hospital were reviewed. Correlations between clinical, histological, or genomic variables and the occurrence of preoperative and postoperative seizures were analyzed. Logistic regression models were developed for assessing multiple risk factors for pre- and postoperative seizures. Mediation analyses were also conducted to investigate the causal pathways between genomic subgroups and seizures. RESULTS Seventeen percent of the cohort had presented with preoperative seizures. In a univariate analysis, patients with preoperative seizures were more likely to have tumors with a somatic NF2 mutation (p = 0.020), WHO grade II or III tumor (p = 0.029), atypical histology (p = 0.004), edema (p < 0.001), brain invasion (p = 0.009), and worse progression-free survival (HR 2.68, 95% CI 1.30-5.50). In a multivariate analysis, edema (OR 3.11, 95% CI 1.46-6.65, p = 0.003) and atypical histology (OR 2.00, 95% CI 1.03-3.90, p = 0.041) were positive predictors of preoperative seizures, while genomic subgroup was not, such that the effect of an NF2 mutation was indirectly mediated through atypical histology and edema (p = 0.012). Seizure freedom was achieved in 83.3% of the cohort, and only 20.8% of the seizure-free patients, who were more likely to have undergone gross-total resection (p = 0.031), were able to discontinue antiepileptic drug use postoperatively. Preoperative seizures (OR 3.54, 95% CI 1.37-9.12, p = 0.009), recurrent tumors (OR 2.89, 95% CI 1.08-7.74, p = 0.035), and tumors requiring postoperative radiation (OR 2.82, 95% CI 1.09-7.33, p = 0.033) were significant predictors of postoperative seizures in a multivariate analysis. CONCLUSIONS Seizures are relatively common at meningioma presentation. While NF2-mutated tumors are significantly associated with preoperative seizures, the association appears to be mediated through edema and atypical histology. Patients who undergo radiation and/or have a recurrence are at risk for postoperative seizures, regardless of the extent of resection. Preoperative seizures may indeed portend a more potentially aggressive molecular entity and challenging clinical course with a higher risk of recurrence.
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Affiliation(s)
- Trisha P Gupte
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Chang Li
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
- 3Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha
- 4The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Lan Jin
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
- 5Surgery
- 6Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut; and
| | - Kanat Yalcin
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Mark W Youngblood
- 7Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Danielle F Miyagishima
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Ketu Mishra-Gorur
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Amy Y Zhao
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Joseph Antonios
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Anita Huttner
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
- 8Pathology
| | - Declan McGuone
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
- 8Pathology
| | - Nicholas A Blondin
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
- 9Clinical Neurology
| | - Joseph N Contessa
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
- 10Therapeutic Radiology and Pharmacology
| | - Yawei Zhang
- 5Surgery
- 6Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut; and
| | - Robert K Fulbright
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
- 11Radiology and Biomedical Imaging, and
| | - Murat Gunel
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
- 12Genetics, Yale School of Medicine, New Haven
| | - Zeynep Erson-Omay
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Jennifer Moliterno
- Departments of1Neurosurgery
- 2Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
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Predicting postoperative seizure development in meningiomas - Analyses of clinical, histological and radiological risk factors. Clin Neurol Neurosurg 2020; 200:106315. [PMID: 33092928 DOI: 10.1016/j.clineuro.2020.106315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Delgado-López PD, Ortega-Cubero S, González Bernal JJ, Cubo-Delgado E. Seizure prophylaxis in meningiomas: A systematic review and meta-analysis. Neurologia 2020; 38:S0213-4853(20)30225-5. [PMID: 32896461 DOI: 10.1016/j.nrl.2020.06.014] [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: 04/17/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION No formal indication currently exists for seizure prophylaxis in neurosurgical oncology patients. Neither have specific recommendations been made on the use of antiepileptic drugs (AED) in seizure-free patients with meningiomas scheduled for surgery. AEDs are generally prescribed on a discretionary basis, taking into consideration a range of clinical and radiological risk factors. We present a systematic review and meta-analysis exploring the effectiveness of antiepileptic prophylaxis in patients with meningioma and no history of seizures. METHODS We performed a systematic review of the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and clinicaltrials.gov databases. Of a total of 4368 studies initially identified, 12 were selected for extraction of data and qualitative analysis. Based on the clinical data presented, we were only able to include 6 studies in the meta-analysis. We performed heterogeneity studies, calculated a combined odds ratio, evaluated publication bias, and conducted a sensitivity analysis. RESULTS AED prophylaxis in patients with meningioma and no history of seizures did not significantly reduce the incidence of post-operative seizures in comparison to controls (Mantel-Haenszel combined odds ratio, random effects model: 1.26 [95% confidence interval, 0.60-2.78]; 2041 patients). However, we are unable to establish a robust recommendation against this treatment due to the lack of prospective studies, the presence of selection bias in the studies reviewed, the likelihood of underestimation of seizure frequency during follow-up, and the strong influence of one study on the overall effect. CONCLUSIONS Despite the limitations of this review, the results of the meta-analysis do not support the routine use of seizure prophylaxis in patients with meningioma and no history of seizures.
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Affiliation(s)
- P D Delgado-López
- Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
| | - S Ortega-Cubero
- Servicio de Neurología, Hospital Universitario de Burgos, Burgos, España
| | - J J González Bernal
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - E Cubo-Delgado
- Servicio de Neurología, Hospital Universitario de Burgos, Burgos, España
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Early postoperative seizures (EPS) in patients undergoing brain tumour surgery. Sci Rep 2020; 10:13674. [PMID: 32792594 PMCID: PMC7426810 DOI: 10.1038/s41598-020-70754-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 07/31/2020] [Indexed: 12/16/2022] Open
Abstract
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.
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Venkatapura RJ, Dubey SK, Panda N, Chakrabarti D, Venkataramaiah S, Rath GP, Kaloria N, Sharma D, Ganne URS. Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2020. [DOI: 10.1055/s-0040-1715355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Cranial surgery is associated with multiple postoperative complications varying from simple nausea and vomiting to devastating complications such as stroke and death. This multicentre collaborative effort was envisioned to collect observational data regarding postoperative complications in cranial surgeries among the Indian population. The aim of this study was to describe the postoperative neurological complications occurring within the first 24 hours after surgery and to identify the predictive factors.
Methods Data was collected from three participating tertiary care academic institutions. The study was prospective, observational, multicentre design with data collected over a period of two months or 100 cases, whichever is earlier, from each participating institute. A predesigned Microsoft excel sheet was distributed among all three centers to maintain uniformity. All patients aged 18 years and above of both sexes undergoing elective or emergency craniotomies were included in the study. The postoperative neurological complications (within 24 hours) assessed were: (1) Neurological deficit (ND) defined as new focal neurological motor deficit relative to preoperative status. (2) Sensorium deterioration (SD) defined as reduction in Glasgow coma score (GCS) by 2 or more points compared with preoperative GCS. (4) Postoperative seizures (SZs) defined as any seizure activity. All possible variables associated with the above neurological complications were tested using Chi-square/Fisher exact test or Mann–Whitney U test. The predictors, which were statistically significant at p < 0.2, were entered into a multiple logistic regression model. Alpha error of 5% was taken as significant.
Results Data from three institutions was collected with a total of 279 cases. In total, there were 53 (19%) neurological complications. There were 28 patients with new postoperative NDs (10.04%), 24 patients had SD (8.6%), and 17 patients had seizures (6.1%). Neurological deficits were significantly less in institution 2. Diagnosis of traumatic brain injury (TBI) was associated with very low risk of ND, and vascular pathology was associated with higher chance of a ND. The duration of anesthesia was found to be significantly predictive of SD (OR/CI = 1.01 / 1–1.02). None of the factors were predictive of PS.
Conclusion The incidences of postoperative ND, SD and postoperative seizures were 10%, 8.6%, and 6.1%, respectively. Studies with a much larger sample size are required for a better and detailed analysis of these complications.
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Affiliation(s)
- Ramesh J. Venkatapura
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Surya K. Dubey
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Panda
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sudhir Venkataramaiah
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Girija P. Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Narender Kaloria
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Sharma
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, United States
| | - Umamaheswara Rao S. Ganne
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Four Independent Predictors of Postoperative Seizures After Meningioma Surgery: A Meta-Analysis. World Neurosurg 2019; 130:537-545.e3. [DOI: 10.1016/j.wneu.2019.06.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 12/29/2022]
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Cômes PC, Huberfeld G, Metellus P, Pallud J, Vercueil L, Peyre M. [Management of tumoral epilepsy in meningioma surgery: Review of the literature and survey of French national practices]. Neurochirurgie 2019; 65:178-186. [PMID: 31100348 DOI: 10.1016/j.neuchi.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 11/18/2022]
Abstract
Prophylaxis or treatment of tumor-associated seizures is adaily concern in neurosurgical practice but is often guided by the surgeon's habits rather than evidence from clinical trials, which is lacking. The present study reviews the literature on the incidence, clinical aspects and treatment of epilepsy and epileptic seizures in patients undergoing surgery for meningioma. Based on the published data, we then performed a French nationwide survey of neurosurgeons' practices regarding perioperative management of meningioma-related epilepsy and epileptic seizures.
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Affiliation(s)
- P-C Cômes
- Service de neurochirurgie, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Huberfeld
- Service d'exploration fonctionnelle de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; CNR UMR 7241, Inserm U 1050, Labex Memolife, Neuroglial interactions in cerebral physiopathology, Center for interdisciplinary research in biology, Collège de France, PSL Research university, 75005 Paris, France
| | - P Metellus
- Service de neurochirurgie, hôpital Privé Clairval, 13009 Marseille, France
| | - J Pallud
- Service de neurochirurgie, centre hospitalier Sainte-Anne, 75014 Paris, France
| | - L Vercueil
- Service de neurologie, CHU de Grenoble, 38100 Grenoble, France
| | - M Peyre
- Service de neurochirurgie, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Mirian C, Møller Pedersen M, Sabers A, Mathiesen T. Antiepileptic drugs as prophylaxis for de novo brain tumour-related epilepsy after craniotomy: a systematic review and meta-analysis of harm and benefits. J Neurol Neurosurg Psychiatry 2019; 90:599-607. [PMID: 30674543 DOI: 10.1136/jnnp-2018-319609] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate potential harm and benefits of antiepileptic drugs (AED) given prophylactically to prevent de novo brain tumour-related epilepsy after craniotomy. METHODS Randomised controlled trials (RCT) and retrospective studies published before 27 November 2018 were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied. Eligible patients were diagnosed with a brain tumour, were seizure naïve and underwent craniotomy. The random effects model was used for quantitative synthesis. The analysis was adjusted for the confounding effect of including patients with a history of seizure prior to study inclusion. RESULTS A total of 454 patients received prophylactic AED whereas 333 were allocated to placebo or no treatment. Two RCTs and four retrospective studies were identified. The OR was 1.09 (95% CI 0.7 to 1.8, p=0.7, I2=5.6%, χ2 p=0.5), indicating study consistency and no significant differences. An additional two RCTs and one retrospective study combined craniotomy and diagnostic biopsy, and were subgroup analysed-which supported no difference in odds for epilepsy. CONCLUSIONS A prophylactic effect of AED could not be demonstrated (nor rejected statistically). Levetiracetam was associated with less adverse effects than phenytoin. The potential harm of AED was not balanced by the potential prophylactic benefit. This study suggests that prophylactic AED should not be administered to prevent brain tumour-related epilepsy after craniotomy.
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Affiliation(s)
- Christian Mirian
- Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Maria Møller Pedersen
- Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sabers
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tiit Mathiesen
- Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Hwang K, Joo JD, Kim YH, Han JH, Oh CW, Yun CH, Park SH, Kim CY. Risk factors for preoperative and late postoperative seizures in primary supratentorial meningiomas. Clin Neurol Neurosurg 2019; 180:34-39. [PMID: 30889470 DOI: 10.1016/j.clineuro.2019.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We performed a retrospective study to identify factors associated with preoperative and late postoperative seizures in primary supratentorial meningiomas. PATIENTS AND METHODS Between July 2003 and December 2014, we extracted 303 consecutive patients who underwent primary resection for supratentorial meningiomas at a single institution. Univariate analysis and multivariate logistic regression analysis were performed to determine the associations of seizure occurrence and outcome. RESULTS Forty-nine (16.2%) of the total 303 patients presented with preoperative seizures. The risk factors independently associated with preoperative seizures were vasogenic edema (OR 4.44, p = 0.001), parasagittal or parafalcine location (OR 2.20, p = 0.020), and absence of neurologic deficit (OR 0.30, p = 0.003). Among these patients, 33 (67.3%) were seizure free postoperatively (Engel Class I). Of the 303 patients, we observed late postoperative seizures in 35 (11.6%) patients. The associated risk factors included history of preoperative seizure (OR 3.96, p = 0.002), bigger tumor size (OR 1.04, p = 0.002), and continuation of anti-epileptic drugs (OR 4.74, p = 0.001). We analyzed that meningiomas with a largest diameter of greater than 45.5 mm were 4.2 times more likely to have late postoperative seizures than those with less diameter (HR 4.20, p < 0.001). Ten (28.6%) of the 35 patients with late postoperative seizures experienced poor seizure control. The independently associated predictive factors were high grade meningiomas (WHO Grade II or III) (OR 10.66, p = 0.030) and history of postoperative adjuvant therapy (OR 12.58, p = 0.040). CONCLUSIONS Identifying factors associated with preoperative or late postoperative seizures may help guide treatment strategies, eventually improving the quality of life for patients with meningiomas.
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Affiliation(s)
- Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea
| | - Jin-Deok Joo
- Department of Neurosurgery, Jeju National University Hospital, Republic of Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, Republic of Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea
| | - Seong-Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea.
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Li X, Wang C, Lin Z, Zhao M, Ren X, Zhang X, Jiang Z. Risk factors and control of seizures in 778 Chinese patients undergoing initial resection of supratentorial meningiomas. Neurosurg Rev 2019; 43:597-608. [PMID: 30771118 DOI: 10.1007/s10143-019-01085-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/16/2018] [Accepted: 02/07/2019] [Indexed: 12/20/2022]
Abstract
This retrospective study explored the risk factors for the occurrence of seizures in the pre- and postoperative period in patients undergoing supratentorial meningiomas surgery to investigate those who are likely to benefit from prophylactic antiepileptic drugs (AEDs). We reviewed the medical records of 778 supratentorial meningiomas patients who were operated at our institution between 2011 and 2012. A total of 100 (12.9%) patients experienced preoperative seizures; 41 patients (5.3%) experienced postoperative in-hospital seizures, and 91 (13.5%, n = 673) patients experienced postoperative seizures after discharge. Multivariate analysis revealed that motor cortex involvement (odds ratio [OR] 3.243, P < 0.001) and peritumoral edema ≥ 1 cm (OR 3.936, P < 0.001) were significant risk factors of preoperative seizures. Whereas presenting with headache (OR 0.259, P < 0.001) and age ≥ 55 years at surgery (OR 0.514, P = 0.009) showed decreased incidence of preoperative seizures. The involvement of motor cortex (OR 3.290, P = 0.003), postoperative Karnofsky Performance Scale (KPS) ≤ 70 (OR 5.389, P < 0.001), preoperative seizure (OR 4.003, P < 0.001), and occurrence of any medical/surgical complication (OR 3.925, P = 0.001) were significant risk factors for postoperative in-hospital seizures. Postoperative seizures after discharge were associated with tumor maximal diameter ≥ 3.5 cm (OR 1.903, P = 0.022), preoperative seizures (OR 4.350, P < 0.001), postoperative in-hospital seizures (OR 6.385, P < 0.001), and tumor recurrence/progression (OR 7.642, P < 0.001). The probability of seizure freedom in the 5-year follow-up was roughly 59% among patients with preoperative seizures, and 87% among patients without preoperative seizures. Cox regression analysis showed that tumor recurrence/progression (relative risk 2.987, 95% CI 1.517, 5.879, P = 0.002) was the only predictor of postoperative seizures in patients without a history of preoperative epilepsy. The use of postoperative prophylactic antiepileptic drug (AED) did not reduce the incidence of seizures in our analysis. Understanding the risk factors for seizures might help clinicians to predict their occurrence and develop effective anti-epileptic treatment strategies. Further prospective randomized controlled trials are needed to determine the risk factors for seizures and the efficacy of AED prophylaxis.
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Affiliation(s)
- Xiangrong Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Chengjun Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhiqin Lin
- Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Longyan, Fujian, China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xiaohui Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhongli Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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Corell A, Thurin E, Skoglund T, Farahmand D, Henriksson R, Rydenhag B, Gulati S, Bartek J, Jakola AS. Neurosurgical treatment and outcome patterns of meningioma in Sweden: a nationwide registry-based study. Acta Neurochir (Wien) 2019; 161:333-341. [PMID: 30675656 PMCID: PMC6373228 DOI: 10.1007/s00701-019-03799-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/04/2019] [Indexed: 11/07/2022]
Abstract
Background Surgery is the main treatment modality for intracranial meningiomas, but data on short-term surgical outcome are limited. The aim of this Swedish nationwide registry-based study was to benchmark the 30-day complication rate in a cohort of meningioma patients using data from the Swedish brain tumor registry (SBTR). Furthermore, we investigated outcomes for asymptomatic patients. Methods Data were collected from the SBTR for all adults with histopathologically verified intracranial meningioma between 2009 and 2015. Patient symptoms, tumor characteristics, and complications within 30 days postoperatively were analyzed. Results In total, 2324 patients, with a mean age of 58.7 years (SD 13.5), underwent surgery for intracranial meningioma and 14.1% of the patients were asymptomatic before the intervention. The most common symptom prior to treatment was focal deficit, which occurred in 1450 patients (62.4%). Moreover, within 30 days after surgery, 344 patients (14.8%) developed new neurological deficits and new-onset seizures occurred in 105 patients (4.5%), while 8.3% of asymptomatic patients developed neurological deficit and 3.7% new-onset seizures. Due to complications, reoperations were performed in 120 patients (5.2%). The postoperative 30-day mortality in the whole cohort was 1.5%. Conclusion This study benchmarks the 30-day complication rate after meningioma surgery and provides outcome data in the highly relevant group of asymptomatic patients using data from the Swedish brain tumor registry. Since surgical decision-making is a careful consideration of short-term risk versus long-term benefit, this information may be useful for both caregivers and patients.
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Focused review on seizures caused by meningiomas. Epilepsy Behav 2018; 88:146-151. [PMID: 30269033 DOI: 10.1016/j.yebeh.2018.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/31/2018] [Accepted: 09/01/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Meningiomas belong to the most common intracranial neoplasms in adults. One of the most common symptoms patients with meningioma experience is seizures. However, it remains unclear whether prophylactic preoperative anticonvulsant treatment is worthwhile. Furthermore, it is not clear which patients are likely to experience seizures in the course of the disease. In recent years, many studies and meta-analyses addressed this question with particular contradictory results. Therefore, we aimed to identify the most important risk factors for seizures in patients with meningiomas. METHODS For the search terms "meningioma and seizure", "meningioma and epilepsy", and "Simpson and seizure" Medline query identified 865 articles. After applying inclusion and exclusion criteria, 20 papers were chosen for further study. The papers were analyzed for all risk factors for pre- and postoperative risk factors for seizures. RESULTS Preoperative seizures were mostly associated with extensive brain edema, localization, and bigger tumor size. Even though data were sometimes very contradictory, higher postoperative seizure rate in patients with meningioma was associated with distinct localizations, preoperative seizures, tumor size, brain edema, extent of resection, tumor recurrence, and new neurological deficits. There were no randomized trials showing a prophylactic effect of anticonvulsant drugs. CONCLUSIONS There are relevant risk factors for seizures in patients with meningioma. There is the need for a double blind randomized trial for the prophylactic use of antiepileptic drugs (AEDs).
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Islim AI, Ali A, Bagchi A, Ahmad MU, Mills SJ, Chavredakis E, Brodbelt AR, Jenkinson MD. Postoperative seizures in meningioma patients: improving patient selection for antiepileptic drug therapy. J Neurooncol 2018; 140:123-134. [PMID: 29959695 PMCID: PMC6182382 DOI: 10.1007/s11060-018-2941-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
Background Epilepsy is a major cause of morbidity and mortality in meningioma patients. The aims of this study were to determine which factors predispose meningioma patients to developing perioperative seizures and to understand the impact of antiepileptic drugs. Methods Patients treated for a histologically-confirmed intracranial meningioma at the authors’ institution between 2010 and 2015 were retrospectively examined. Clinical and imaging data were assessed. Multivariate analysis was performed using binary logistic regression. The effect of antiepileptic treatment was assessed using survival analysis. Results Two hundred and eighty-three patients met the selection criteria; seizures were present in 68 preoperatively (24%) and in 48 patients (17%) following surgery. Of the 68 with preoperative seizures, 19 continued to have them, whereas de-novo seizures arose postoperatively in 29 seizure-naïve patients. Risk factors of postoperative seizures were convexity location (OR 2.05 [95% CI 1.07–3.98], p = 0.030), fronto-parietal location (OR 4.42 [95% CI 1.49–13.16], p = 0.007) and preoperative seizures (OR 2.65 [95% CI 1.37–5.24], p = 0.005). The two locations, in addition to the presence of midline shift on preoperative imaging (OR 4.15 [95% CI 1.54–11.24], p = 0.005), were significantly correlated with postoperative seizures in seizure-naïve patients. Antiepileptic treatment in patients with those risk factors reduced the possibility of seizures at any time point within the 1st year postoperatively by approximately 40%, although this did not meet statistical significance. Conclusion Prophylactic antiepileptic treatment might be warranted in seizure-naïve meningioma patients with ≥ 1 risk factor. High-quality randomised controlled trials are required to verify those factors and to define the role of antiepileptics in meningioma practice.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK. .,School of Medicine, University of Liverpool, Liverpool, UK. .,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - Arousa Ali
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Ananyo Bagchi
- School of Medicine, University of Liverpool, Liverpool, UK.,Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emmanuel Chavredakis
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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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.
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Wang YC, Chuang CC, Tu PH, Wei KC, Wu CT, Lee CC, Liu ZH, Chen PY. Seizures in surgically resected atypical and malignant meningiomas: Long-term outcome analysis. Epilepsy Res 2018; 140:82-89. [DOI: 10.1016/j.eplepsyres.2017.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022]
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The role of prophylactic antiepileptic drugs for seizure prophylaxis in meningioma surgery: A systematic review. J Clin Neurosci 2017. [PMID: 28625584 DOI: 10.1016/j.jocn.2017.05.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Meningiomas are the commonest type of primary brain tumours. Whilst most patients are seizure-free prior to surgery, antiepileptic drugs are frequently administered to reduce the risk of developing post-operative seizures. However, evidence to support their efficacy in providing this outcome is sparse. To this end, we performed a systematic review to assess the impact of prophylactic antiepileptic drugs on post-operative epilepsy rates in seizure-naïve patients undergoing craniotomy for resection of meningiomas. The literature search was performed using PubMed for studies published between January 1990 and November 2016. The total number of patients in each study was extracted and divided into cohorts according to administration of prophylactic antiepileptic drugs. Clinical characteristics, study type and post-operative epilepsy rates were recorded. A total of 11 studies involving 1143 patients met the selection criteria. There was no statistically significant difference in the number of patients who developed post-operative epilepsy in the cohort that received prophylactic antiepileptic drugs (20 of 766; 2.6%) and the cohort that did not (10 of 377; 2.7%) (Chi-square test; P=0.96). A detailed meta-analysis could not be performed due to the insufficiency in data reported. Based on the results of this systematic review, the routine use of antiepileptic drugs for seizure prophylaxis in seizure-naïve patients undergoing meningioma resection could not be substantiated. However, limitations of a systematic review should be considered on interpretation. High quality prospective randomised controlled trials are required to definitively answer this important clinical question.
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