Risk factors for developing post-operative seizures following meningioma resection

Abstract

BACKGROUND

Meningiomas are benign primary tumours treated by surgical resection. Following surgery patients may develop postoperative seizures. The aim of this study was to investigate the risk factors associated with developing postoperative seizures and determine whether prophylactic antiepileptic drugs (AED) should be prescribed.

METHODS

Retrospective analysis of patients undergoing surgical resection of meningioma between 2010–2015. The following clinical factors were assessed: tumour location, grade, Simpson resection, post-operative haemorrhage/infection and use of AED prophylaxis. MRI parameters were assessed including: tumour volume, adjacent parenchymal T2 signal change, midline shift. Logistical regression was performed.

RESULTS

285 patients were identified with a median age of 60 years (range: 16–83 years). 68 (24%) had pre-operative seizures of which 62 were on AEDs and post-operatively 48 (17%) had seizures. 217 (76%) were seizure naïve, 19 were given prophylactic AEDs and post-operatively 5 had seizures. Of the 198 patients who did not receive prophylactic AED, 43 had post-operative seizures (22%). Prophylactic AED did not reduce the risk of seizures compared to no use (OR = 1.85, p= 0.260). Clinical risk factors for developing post-operative seizures were non-skull base location (n= 207, OR = 0.35, p= 0.010) and presence of post-operative haemorrhage/infection (n= 25, OR = 1.69, p= 0.002). MRI factors associated with developing post-operative seizures were presence of T2 signal intensity change greater than 66% of tumour volume (n= 81, OR = 4.71, p= 0.000).

CONCLUSION

Risk factors associated with postoperative seizure development were the non-skull base tumour location and post-operative haemorrhage/infection. The role of prophylactic AED could not be determined in this study due to insufficient sample size. Randomized control trials are required.