Risk factors for preoperative and late postoperative seizures in primary supratentorial meningiomas.

ABSTRACT

OBJECTIVE: We performed a retrospective study to identify factors associated with preoperative and late postoperative seizures in primary supratentorial meningiomas. PATIENTS AND METHODS: Between July 2003 and December 2014, we extracted 303 consecutive patients who underwent primary resection for supratentorial meningiomas at a single institution. Univariate analysis and multivariate logistic regression analysis were performed to determine the associations of seizure occurrence and outcome. RESULTS: Forty-nine (16.2%) of the total 303 patients presented with preoperative seizures. The risk factors independently associated with preoperative seizures were vasogenic edema (OR 4.44, p = 0.001), parasagittal or parafalcine location (OR 2.20, p = 0.020), and absence of neurologic deficit (OR 0.30, p = 0.003). Among these patients, 33 (67.3%) were seizure free postoperatively (Engel Class I). Of the 303 patients, we observed late postoperative seizures in 35 (11.6%) patients. The associated risk factors included history of preoperative seizure (OR 3.96, p = 0.002), bigger tumor size (OR 1.04, p = 0.002), and continuation of anti-epileptic drugs (OR 4.74, p = 0.001). We analyzed that meningiomas with a largest diameter of greater than 45.5 mm were 4.2 times more likely to have late postoperative seizures than those with less diameter (HR 4.20, p < 0.001). Ten (28.6%) of the 35 patients with late postoperative seizures experienced poor seizure control. The independently associated predictive factors were high grade meningiomas (WHO Grade II or III) (OR 10.66, p = 0.030) and history of postoperative adjuvant therapy (OR 12.58, p = 0.040). CONCLUSIONS: Identifying factors associated with preoperative or late postoperative seizures may help guide treatment strategies, eventually improving the quality of life for patients with meningiomas.