The risk of developing seizures before and after surgery for brain metastases.

OBJECTIVE: Several risk factors have been shown to be associated with pre- and postoperative seizures in patients undergoing neurosurgical intervention for meningiomas and other primary brain tumors. This study aimed to identify risk factors associated with pre- and postoperative seizures in patients undergoing surgery for brain metastases (BM). PATIENTS AND METHODS: 286 patients who had undergone neurosurgical resection for brain metastases between 2007 and 2015 were included in this single-center retrospective cohort. Seizure incidence and patient characteristics were recorded. Univariate and multivariate logistic regression was performed for both pre- and postoperative seizures. RESULTS: 16.8 % of patients presented with seizures before surgical intervention, and a further 7.7 % of patients developed seizures within 3 months of surgical resection of BM. Patient age, cerebellar location, large tumor size, and headache were negatively correlated with pre-operative seizures, whereas parietal location was positively correlated. Surgery for recurrent tumor was positively correlated with newly developed seizures after surgery. CONCLUSION: Age, cerebellar location, large tumor size, and headache were negatively correlated with development of seizures while parietal location was found to be a risk factor. Lower age and resection of recurrent tumors was correlated with an increased risk of developing postoperative seizures. There was no correlation between type of primary tumor and development of seizures.

The risk of developing seizures before and after primary brain surgery of low- and high-grade gliomas.

OBJECTIVE: To identify risk factors for developing seizures pre- and postoperatively in low- and high-grade gliomas. PATIENTS AND METHODS: 282 patients undergoing neurosurgical tumor resection between 2013-2015 were included in the present single-center retrospective cohort study. Seizure incidences according to various variables were described. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for both pre- and postoperative seizures. RESULTS: 37.6% of patients presented with seizures before surgery, 18.4% developed seizures in the postoperative course, and 55.0% had no record of seizures pre- or postoperatively. Focal, cognitive, and other symptoms, tumors located in a non-eloquent area, and tumors ≥ 40 mm in diameter were found to be associated with a reduced risk of preoperative seizures, whereas hypertension or no comorbidity posed an increased risk. The presence of seizures pre- or perioperatively (≤ 24 h before and after surgery), and tumors located in the thalamus were associated with an increased risk of seizures in the postoperative course. CONCLUSION: Predictors for pre- and postoperative seizures identified in this study should be taken into account and integrated into the present knowledge, when determining patients at increased risk of developing seizures. Future prospective studies investigating the efficacy of prophylactic antiepileptic therapy in subgroups of glioma patients are needed before applied into clinical practice.

Risk of seizures before and after neurosurgical treatment of intracranial meningiomas.

OBJECTIVE: To identify variables associated with the development of pre- and postoperative seizures in patients who underwent surgical resection of intracranial meningiomas, in a patient cohort not routinely treated prophylactically with antiepileptic drugs (AED). PATIENTS AND METHODS: Retrospective cohort study of 295 patients that underwent resection of a supratentorial meningioma at Odense University Hospital in between 2007-2015. Multivariate logistic regression was used to identify variables significantly correlating with pre- and postoperative seizures. Retrospective chart review was used to identify the rates of seizure incidence in patients, and the effect of AED on them. RESULTS: The presence of peritumoral edema (OR:18.00, 7.44-43.58) was identified as predictor of preoperative seizure, while headache (OR:0.43, 0.22-0.84) and neurological deficit (OR:0.18, 0.09-0.39) were associated with a reduced incidence of preoperative seizures. The rates of postoperative seizure were increased in meningiomas in the left side (OR:1.91, 1.11-3.29), and reduced for tumor location in the convexity/parasagittal/falx (OR:0.72, 0.59-0.88) as well as in the absence of postoperative complications (OR:0.19, 0.10-0.36). 24.4% of the patients experienced seizures preoperatively, and a complete seizure freedom was achieved in 63.9% of them. 75.6% of the patients did not experience seizures preoperatively, but 15.2% of them then developed seizures postoperatively. A total of 20.3% of the patients experienced seizures after surgery. Time to first seizure in patients that did not experience seizures preoperatively but developed seizures after surgery, was one week (47%). However, first time postoperative seizures were also observed within one month postoperative (21%) and three months after surgery (32%). AED had a treatment success rate of 98.2% in preoperative seizures, and 98.0% in postoperative seizures. CONCLUSION: Seizures after supratentorial meningioma surgery is common also in patients with no seizures preoperatively and mainly occurs within the first three postoperative months. AED are effective in controlling seizures.