Introduction: Meningiomas are the most common benign intracranial tumor, and patients often suffer from seizures. Seizure rates and predictors in meningioma have been significantly under-studied, even in comparison with other brain tumor types. Better strategies for prediction, treatment, and prevention of seizures in meningioma patients is an important goal, as tumor-related epilepsy significantly impacts patient quality of life.
Methods: We performed a systematic review of the literature between 1980 and September 2014, examining rates of pre-operative and post-operative seizures in supratentorial meningioma, and evaluating potential predictors of seizures with separate meta-analyses.
Results: We identified 39 observational case series for inclusion in our study. Pre-operative seizures were observed in 29.2% of 4709 patients with supratentorial meningioma, and were significantly predicted by male gender (OR =1.74; 1.30-2.34, 95% CI), absence of headache (OR = 1.77; 1.04-3.25, 95% CI), peritumoral edema (OR = 7.48; 6.13-9.47, 95% CI), and non-skull base location (OR = 1.77; 1.04-3.25, 95% CI). After surgery, seizure freedom was achieved in 69.3% of 703 patients with pre-operative epilepsy, being twice as likely in those without peritumoral edema. Out of 1085 individuals without pre-operative epilepsy who underwent resection, new post-operative seizures were seen in 12.3% of patients. No difference in post-operative seizure rates were observed with or without prophylactic anticonvulsants.
Conclusions: Seizures are common in supratentorial meningioma, particularly with tumors associated with brain edema, and seizure freedom is a critical treatment goal. Favorable seizure control can be achieved with resection, but evidence does not support routine prophylactic anticonvulsants in patients without seizures.
Patient Care: Our results will guide practioners in predicting which patients with meningioma are at risk for seizures, optimize seizure outcomes in meningioma resection, and make informed decisions about peri-operative prophylactic anticonvulsants in patients without a history of seizures.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe rates and predictors of pre-operative seizures in supratentorial meningioma, 2) Describe post-operative seizure outcomes in meningioma resection, and 3) Discuss the utility of peri-operative prophylactic anticonvulsants during meningioma surgery in patients without a history of seizures.