title: Predicting outcome of epilepsy after meningioma resection.
abstract: Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.
  
  
  
  Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.
  
  
  
  Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32-5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53-22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35-7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25-6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17-5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36-4.67]), younger age (OR: 1.74 [(95% CI: 1.18-2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16-3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25-0.85], P = .013).
  
  
  
  We suggest prospective validation of a score ("STAMPE2") based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Wirsching
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Corinne
authors.initials: C
authors.lastname: Morel
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Corinne
authors.initials: C
authors.lastname: Gmür
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Marian Christoph
authors.initials: MC
authors.lastname: Neidert
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Christian Richard
authors.initials: CR
authors.lastname: Baumann
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Antonios
authors.initials: A
authors.lastname: Valavanis
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Elisabeth Jane
authors.initials: EJ
authors.lastname: Rushing
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Niklaus
authors.initials: N
authors.lastname: Krayenbühl
authors.affiliation: Department of Neurology, University Hospital Zurich, Switzerland (H.-G.W., C.M., C.G., C.R.B., M.W.); Department of Neurosurgery, University Hospital Zurich, Switzerland (M.C.N., N.K.); Department of Neuroradiology, University Hospital Zurich, Switzerland (A.V.); Department of Neuropathology, University Hospital Zurich, Switzerland (E.J.R.).
authors.forename: Michael
authors.initials: M
authors.lastname: Weller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: EEG; STAMPE2; meningioma; postoperative epilepsy