Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection.
BACKGROUND
Risk factors for pre- and postoperative seizures in supratentorial meningiomas are understudied compared to other brain tumors.


OBJECTIVE
To report seizure frequency and identify factors associated with pre- and postoperative seizures in a large single-center population study of patients undergoing resection of supratentorial meningioma.


METHODS
Retrospective chart review of 1033 subjects undergoing resection of supratentorial meningioma at the author's institution (1991-2014). Multivariate regression was used to identify variables significantly associated with pre- and postoperative seizures.


RESULTS
Preoperative seizures occurred in 234 (22.7%) subjects. At 5 years postoperative, probability of seizure freedom was 89.9% among subjects without preoperative seizures and 62.2% with preoperative seizures. Multivariate analysis identified the following predictors of preoperative seizures: presence of  ≥1 cm peritumoral edema (odds ratio [OR]: 4.45, 2.55-8.50), nonskull base tumor location (OR: 2.13, 1.26-3.67), greater age (OR per unit increase: 1.03, 1.01-1.05), while presenting symptom of headache (OR: 0.50, 0.29-0.84) or cranial nerve deficit (OR: 0.36, 0.17-0.71) decreased odds of preoperative seizures. Postoperative seizures after discharge were associated with preoperative seizures (OR: 5.70, 2.57-13.13), in-hospital seizure (OR: 4.31, 1.28-13.67), and among patients without preoperative seizure, occurrence of medical or surgical complications (OR 3.39, 1.09-9.48). Perioperative anti-epileptic drug use was not associated with decreased incidence of postoperative seizures.


CONCLUSIONS
Nonskull base supratentorial meningiomas with surrounding edema have the highest risk for preoperative seizure. Long-term follow-up showing persistent seizures in meningioma patients with preoperative seizures raises the possibility that these patients may benefit from electrocorticographic mapping of adjacent cortex and resection of noneloquent, epileptically active cortex.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
William C
WC
Chen
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Stephen T
ST
Magill
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Dario J
DJ
Englot
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Joe D
JD
Baal
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Sagar
S
Wagle
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Jonathan W
JW
Rick
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Michael W
MW
McDermott
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000453:epidemiology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology*; D015173:Supratentorial Neoplasms / Q000453:epidemiology*
Complications; Epilepsy; Meningioma; Predictor; Seizure; Supratentorial; Surgery