gms | German Medical Science

Objective: Meningiomas belong to the most common intracranial neoplasms in adults. One of the most common clinical symptoms of meningiomas are seizures. However, it still remains unclear whether prophylactic preoperative anticonvulsive treatment is worthwhile. Furthermore it is not clear which patients are likely to experience seizures in the course of the disease. In recent years, many studies and meta-analyses addressed this question with particular contradictory results. Therefore, we aimed to identify the most important risk factors for seizures in patients with meningiomas with focus of anti-epileptic drugs.

Methods: We investigated a total of 556 patients (female 375 / male 181) that underwent meningioma resection in our hospital. The WHO grade at primary resection in 331 patients was grade I, in 197 patients grade II and in 9 patients grade III meningiomas. Recurrent tumors were also included in the study. The presence of pre- or intra-operative seizures, pre-operative edema, tumor localization, brain invasion and the administration of pre- or post-operative anti-epileptic drugs was correlated with the occurrence of post-operative seizures.

Results: In our cohort 58 patients showed tumor recurrence after a mean of 36 months (range 3 – 277 months) and 82 developed postoperative seizures. There was a significant correlation of postoperative seizures with edema (p=0.004), pre-operative seizures (p=0.0006), localization (p<0.0001) and supratentorial tumor localization (p<0.0001) as 81 of 82 patients with postoperative seizures suffered from supratentorial tumors. Patients with pre-operative speech disorders showed a higher seizure rate (p=0.004) whereas patients with sensory and / or motor deficits did not (p=0.55). Furthermore, patients that experienced postoperative seizures had a significantly poorer clinical outcome (p<0.0001). However, there was no correlation between postoperative seizures and anti-epileptic medication.

Conclusion: Our data suggest that there are distinct factors to identify patients with a higher risk of postoperative seizures after meningioma surgery. These patients face a significantly poorer clinical outcome. Therefore further studies evaluating the impact of prophylactic anti-epileptic drugs in patients with high risk for postoperative seizures are needed in order to improve the clinical outcome in meningioma patients.