Artikel
Early postoperative seisures after meningioma surgery
Früh-postoperative Anfälle nach Meningeom-Operationen
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Autoren
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Tunc Faik Ersoy
- Evangelisches Klinikum Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Roland Coras
- Universtitätsklinikum Erlangen, Institut für Neuropathologie, Erlangen, Deutschland
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Hans-Joachim Hoff
- Evangelisches Klinikum Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Matthias Simon
- Evangelisches Klinikum Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Early postsurgical seizures may pose specific challenges. The objective of this study was to study the relevance and causes of early postoperative seizures after meningioma surgery.
Methods: This retrospective study was based on a cohort of 220 consecutive meningioma surgeries performed at the authors’ institution between January 2015 and August 2017. Pertinent clinical data was collected from the respective patients’ charts. All seizures occuring during the initial hospital stay for meningioma surgery were considered early postoperative seizures.
Results: 171 (77.7%) patients were female. Median age was 62.0 (range: 17–89). Median pre- and postsurgical KPI was 90%. 168 tumors (76.4%) were assigned to WHO grade I, 47 (21.4%) meningiomas to WHO grade II and 5 (2.3%) to WHO grade III. There were 31 (14.1%) posterior fossa meningiomas. Early postsurgical seizures were observed in 22 cases (10.0%). 12 suffered multiple seizures. Causes included hemorrhage (7), edema (5), and ischemia (1). Two cases required a surgical revision. There was no significant association with age or gender. Postsurgical seizures were associated with a worse postsurgical KPI (10/52 [19.2%] KPI 0–70% vs. 12/168 [7.1%] KPI 80–100%; p=0.017) and KPI worsening (7/32 [21.9%] KPI decrease 20% vs. 15/188 [8.0%]; p=0.025). Early postoperative seizures were not observed in infratentorial tumors (0/31; p=0.05). Postsurgical seizures were observed in 14/168 (8.3%) WHO grade I vs. 8/52 (15.4%) WHO grade II/III meningiomas. Similarly presurgical seizures occured more frequently in cases with WHO grade II/III meningiomas (19/52 [36.5%] vs. 37/168 [22.0%]; p=0.045). Presurgical seizures increased the risk of postoperative seizures (13/167 [7.9%] vs. 9/56 [16.1%]). 19 patients with early postsurgical seizures were followed for 1 year. Six (31.6%) reported at least one additional seizure during follow-up.
Conclusion: Early postsurgical seizures after meningioma surgery should be taken seriously. They are associated with a worse KPI and KPI worsening, and often reflect a relevant underlying structural pathology. Hence, an imaging work-up is mandatory. Multiple and recurrent seizures during follow-up are frequent, i.e. an early postoperative seizure is an indication for antiepileptic pharamcotherapy.
