Article
Postoperative seizures in neurosurgical oncology: an underestimated problem?
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Authors
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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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Matthias Simon
- Evangelisches Klinikum Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Postoperative seizures are a daily problem in neurosurgical oncology. Literature on this subject remains, nevertheless, scarce. The aim of this study is to identify frequency, clinical relevance, and risk factors for occurrence of postsurgical seizures.
Methods: Medical records of 789 patients, who underwent surgical resection (epilepsy surgery excluded) between January 2015 and August 2017, were investigated retrospectively for occurrence of postoperative seizures during in-patient care. Histological and radiological reports as well as physicians’ letters were available for all patients.
Results: Postoperative seizures were observed in 3.9% (31/789) of the patients, of which 41.9% (13/31) exhibited a grand-mal seizure. In patients who suffered seizures before surgery, postsurgical occurrence was observed in 8.9% (15/169) of the cases, whereas in patients without a presurgical seizure anamnesis, the rate was 2.6% (16/620). Seizures occurred in 8.0% (12/224) of the patients with meningioma. While only 3.0% (6/197) of the patients with glioblastoma suffered seizures, this rate was found to be 5.5% in patients with lower-grade glioma. Among various other causes, 3 after-bleeding cases (with 2 of them requiring a surgical revision) were recorded in patients with a presurgical seizure anamnesis. In patients without a presurgical seizure anamnesis, 7 after-bleeding (with 1 requiring a surgical revision) and 1 meningitis case were recorded. 41.9% of the patients suffered more than one seizure, 12.9% continued to manifest seizure-associated neurological deficits at hospital discharge.
Conclusion: Postoperative seizures are not uncommon – and not in the least benign. Presurgical seizure history increases the risk by 3.4-fold. After-bleeding is the most frequent cause. Meningioma appear to be a risk factor. Lower-grade glioma patients manifest seizures more frequently than glioblastoma patients. Multiple seizures are very common; thus, we recommend an anticonvulsive therapy – at least temporarily – already at the first occurrence.
