gms | German Medical Science

Objective: Meningioma is the most common primary intracranial brain tumor. Both pre- and postoperative seizures comprise common side effects that negatively impact quality of life. Therefore, seizure freedom represents an important outcome measure following meningioma resection in patients suffering from preoperative symptomatic seizures. In the present study, we analyzed our institutional database in order to identify factors associated with postoperative seizure freedom after surgical meningioma treatment in patients suffering from preoperative symptomatic epilepsy.

Methods: Between February 2009 and April 2017, 187 patients with preoperative seizures underwent resection of supratentorial meningioma at the authors’ institution. Seizure outcome was assessed 6 months after tumor resection according to the Engel classification and stratified into favorable (Engel class I; seizure free) versus unfavorable (Engel class II, III, IV; rare to no improvement and deterioration of seizure frequency and/or seizure disabling quality). Univariate analysis was performed to identify factors influencing seizure outcome.

Results: Overall 169 of 187 patients with preoperative seizures achieved favorable outcome (90%) in terms of seizure freedom after meningioma resection. Factors influencing postoperative seizure freedom were identified as absent peritumoral edema (p= 0.007), low WHO grading (I; p=0.02) as well as a high extent of tumor resection according to Simpson grade 1 and 2 (p=0.004).

Conclusion: Absent peritumoral edema as well as a histological benign feature of preoperative epileptic meningiomas are associated with postoperative seizure freedom. Furthermore, a higher extent of tumor resection in terms of Simpson grade 1 and 2 facilitates favorable seizure-free outcome.