Introduction: Meningiomas often present with seizures, however, predictors of pre- and post-operative seizures in patients with meningioma are under-studied.
Methods: A retrospective review of 1033 subjects undergoing resection of supratentorial meningioma from 1991-2014 was conducted. Logistic regression was performed to identify variables associated with pre- and post-operative seizures.
Results: Pre-operative seizure occurred in 225 (22.6%) subjects. At 5 year follow-up, 62.2% of subjects with a pre-operative seizure, and 89.9% without a pre-operative seizure, were seizure-free. Male gender (OR: 1.48), WHO grade II/III (OR: 1.77), non-skull-base location (OR: 2.73), and = 1 cm peritumoral edema (OR: 4.35) were significant predictors of pre-operative seizures. Tumors presenting with headache (OR: 0.48) or cranial nerve deficit (OR: 0.36) had a lower risk of pre-operative seizures. Non-skull-base location (OR: 2.16) and weakness on presentation (OR: 3.04) were significant predictors of early post-operative seizures. Pre-operative seizure was the single significant predictor of post-operative seizure (RR: 2.89).
Conclusions: In this large series of meningioma patients, male gender, WHO Grade II/III tumors, non-skull base location and peri-tumoral edema were associated with increased risk of pre-operative seizures, and non-skull base location and weakness on presentation were associated with increased risk of post-operative seizures.
Patient Care: This work will inform neurosurgeons about the risk of pre-operative seizures and help them decide about the use of prophylactic AEDs. It also helps raise the controversy, and provides support for the importance of doing a prospective trial of AED prophylaxis for patient's undergoing surgery for meningioma.
Learning Objectives: By the conclusion of this session, participants should be able to discuss: 1) risk factors for pre-operative seizure with menignioma, 2) risk factors for post-operative seizure after surgery for meningioma, 3) controversies remaining in the field about anti-epileptic prophylaxis.