Prophylactic AEDs Treatment for Patients With Supratentorial Meningioma Does Not Reduce the Rate of Perioperative Seizures: A Retrospective Single-Center Cohort Study

Oedema as a prognostic factor for seizures in meningioma - a systematic review and meta-analysis

Meningiomas are benign intracranial tumours that commonly lead to seizures and oedema. An understanding of seizure risk factors is essential for the meningioma community. Many studies have differing conclusions on whether oedema is associated with seizure. Existing meta-analyses are limited by lack of focus on oedema. Our objective was to summarise all literature on oedema as a prognostic factor for seizures in meningioma patients. We searched OVID, Scopus, Pubmed, Web of Science, ClinicalTrials.gov and Google scholar up to April 2024 for reports with more than 10 human meningioma participants. Statistics were performed on R-Studio. Cochrane and Campbell guides for systematic reviews and meta-analysis were followed. Risk of bias was assessed with ROBINS-E. Our protocol was uploaded to INPLASY. We included 51 studies for meta-analysis and 21 for narrative review. Most studies were of surgically treated adults. Heterogeneity was low once outliers were removed. Preoperative oedema was associated with preoperative seizure (k = 28, n = 7,725, OR 3.5, 95% CI = 3.1-4.0, I2 = 0%, p < .001), early postoperative seizure (k = 9, n = 2,929, OR 1.5, CI = 1.1-1.9, I2 = 0%, p = .011) and late postoperative seizure (k = 9, n = 2,150, OR 1.9, CI = 1.5-2.2, I2 = 0%, p < .001). We performed an additional adjusted analysis for preoperative seizures which was also significant (k = 3, n = 2,241, OR 3.9, CI = 2.4-6.3, I2 = 0%, p = .007). There were few studies of post-radiosurgery oedema and seizure, and of postoperative oedema and seizure, with insignificant but positive associations. Preoperative oedema is a key factor for preoperative seizures. Oedema also increases risk of postoperative seizures. Further study in conservative, radiosurgery and paediatric populations, as well as study of oedema and seizure severity or subtype is warranted.

Postoperative Seizure Prophylaxis in Meningioma Resection: A Systematic Review and Meta-Analysis

BACKGROUND

Seizures in the early postoperative period may impair patient recovery and increase the risk of complications. The aim of this study is to determine whether there is any advantage in postoperative seizure prophylaxis following meningioma resection.

METHODS

This systematic review was conducted in accordance with PRISMA guidelines. PUBMED, Web of Science, Embase, Science Direct, and Cochrane were searched for papers until April 2023.

RESULTS

Among nine studies, a total of 3249 patients were evaluated, of which 984 patients received antiepileptic drugs (AEDs). No significant difference was observed in the frequency of seizure events between patients who were treated with antiepileptic drugs (AEDs) and those who were not. (RR 1.22, 95% CI 0.66 to 2.40; I2 = 57%). Postoperative seizures occurred in 5% (95% CI: 1% to 9%) within the early time period (<7 days), and 9% (95% CI: 1% to 17%) in the late time period (>7 days), with significant heterogeneity between the studies (I2 = 91% and 97%, respectively). In seizure-naive patients, the rate of postoperative seizures was 2% (95% CI: 0% to 6%) in the early period and increased to 6% (95% CI: 0% to 15%) in the late period. High heterogeneity led to the use of random-effects models in all analyses.

CONCLUSIONS

The current evidence does not provide sufficient support for the effectiveness of prophylactic AED medications in preventing postoperative seizures in patients undergoing meningioma resection. This underscores the importance of considering diagnostic criteria and conducting individual patient analysis to guide clinical decision-making in this context.

Factors predicting seizure outcome after surgical excision of meningioma: SOLID-C guideline for prophylactic AED

BACKGROUND

Seizures are commonly seen among meningioma patients and may cause impaired quality of life. These patients can be effectively treated with surgery. Still, many patients have persistent seizure episodes after surgery. The factors which are associated with worsening of seizure episodes remain critical in improving the quality of life for such patients. In this study, we aim to analyze the clinical and histopathological factors to predict the post excision seizure-outcome in meningioma and need of antiepileptic prophylaxis for these patients.

METHODS

Adult patients who underwent primary resection of meningioma at our institute between 2007 and 2020 were included in the study. Eligibility criteria were as follows: (i) Surgery for newly-diagnosed biopsy proven meningioma, (ii) Presence of pre-operative seizure (iii) A follow-up period ≥ 12 months.

RESULTS

Of the 1145 patients in this series, 333 patients were recruited in study. The major determinants of prophylactic anti-epileptic were tumour size (S), Oedema (O), location (L), inclusion body (I), antiepileptic drugs (D) and surgical complication (C). The factors independently associated with poor seizure control after surgical resection were presence of brain parenchyma invasion (p < 0.001), pre-operative use of > 2 antiepileptics (p = 0.016) and presence of intranuclear inclusion bodies (p = 0.001).

CONCLUSIONS

The identification and consideration of factors associated with prolonged seizure control after surgery may help us to guide treatment strategies aimed at improving the quality of life for patients with meningiomas. Authors have proposed a SOLID-C guideline to avoid the blanket approach of prophylactic AED in patients undergoing for meningioma resection.

Early and Late Postoperative Seizures in Meningioma Patients and Prediction by a Recent Scoring System

Simple Summary

Seizures are among the most common symptoms of meningioma patients even after surgery. This study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified version of a score to predict postoperative seizures on an independent cohort. The data underline that there are distinct factors identifying patients with a high risk of postoperative seizures following meningioma surgery which has been already shown before. We could further show that the high proportion of 43% of postoperative seizures occur as late seizures which are more dangerous because they may happen out of hospital. The modified STAMPE2 score could predict postoperative seizures when reaching very high scores but was not generally transferable to our independent cohort.

Abstract

Seizures are among the most common symptoms of meningioma. This retrospective study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified STAMPE2 score. In 556 patients who underwent meningioma surgery, we correlated different risk factors with the occurrence of postoperative seizures. A modified STAMPE2 score was applied. Risk factors for preoperative seizures were edema (p = 0.039) and temporal location (p = 0.038). For postoperative seizures preoperative tumor size (p < 0.001), sensomotory deficit (p = 0.004) and sphenoid wing location (p = 0.032) were independent risk factors. In terms of postoperative status epilepticus; sphenoid wing location (p = 0.022), tumor volume (p = 0.045) and preoperative seizures (p < 0.001) were independent risk factors. Postoperative seizures lead to a KPS deterioration and thus an impaired quality of life (p < 0.001). Late seizures occurred in 43% of patients with postoperative seizures. The small sub-cohort of patients (2.7%) with a STAMPE2 score of more than six points had a significantly increased risk for seizures (p < 0.001, total risk 70%). We concluded that besides distinct risk factors, high scores of the modified STAMPE2 score could estimate the risk of postoperative seizures. However, it seems not transferable to our cohort