Marco Skardelly1, Christian Rother2, Susan Noell2, Felix Behling2, Thomas V Wuttke3, Jens Schittenhelm4, Sotirios Bisdas5, Christoph Meisner6, Sabine Rona7, Ghazaleh Tabatabai8, Florian Roser7, Marcos Soares Tatagiba2. 1. Department of Neurosurgery, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany. Electronic address: marco.skardelly@med.uni-tuebingen.de. 2. Department of Neurosurgery, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany. 3. Department of Neurosurgery, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany. 4. Institute of Pathology and Neuropathology, Division of Neuropathology, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany. 5. Department of Neuroradiology, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany. 6. Institute of Clinical Epidemiology and Applied Biometry, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany. 7. Department of Neurosurgery, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany. 8. Department of Neurosurgery, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; Interdisciplinary Division of Neuro-Oncology, Departments of Vascular Neurology and Neurosurgery, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Tübingen, Germany; Center for Personalized Medicine, Eberhard Karls University of Tübingen, University Hospital Tübingen, Tübingen, Germany.
Abstract
OBJECTIVE: Well-defined risk factors for the identification of patients with meningioma who might benefit from preoperative or early postoperative seizure prophylaxis are unknown. We investigated and quantified risk factors to determine individual risks of seizure occurrence in patients with meningioma. METHODS: A total of 634 adult patients with meningioma were included in this retrospective cohort study. Patient gender and age, tumor location, grade and volume, usage of antiepileptic drugs (AEDs) and extent of resection were determined. RESULTS: Preoperative and early postoperative seizures occurred in 15% (n = 97) and 5% (n = 21) of the patients, respectively. Overall, 502 and 418 patients were eligible for multivariate logistic regression analyses of preoperative and early postoperative seizures, respectively. Male gender (odds ratio [OR], 2.06; P = 0.009), a non-skull base location (OR, 4.43; P < 0.001), and a tumor volume of >8 cm3 (OR, 3.05; P = 0.002) were associated with a higher risk of preoperative seizures and were used to stratify the patients into 3 prognostic groups. The high-risk subgroup of patients with meningioma showed a seizure rate of >40% (OR, 9.8; P < 0.001). Only a non-skull base tumor location (OR, 2.61; P = 0.046) was identified as a significant risk factor for early postoperative seizures. AEDs did not reduce early postoperative seizure occurrence. CONCLUSIONS: Seizure prophylaxis might be considered for patients at high risk of developing seizures who are for other reasons being considered for watchful waiting instead of resection. In contrast, our data do not provide any evidence of the efficacy of perioperative AEDs in patients with meningioma.
OBJECTIVE: Well-defined risk factors for the identification of patients with meningioma who might benefit from preoperative or early postoperative seizure prophylaxis are unknown. We investigated and quantified risk factors to determine individual risks of seizure occurrence in patients with meningioma. METHODS: A total of 634 adult patients with meningioma were included in this retrospective cohort study. Patient gender and age, tumor location, grade and volume, usage of antiepileptic drugs (AEDs) and extent of resection were determined. RESULTS: Preoperative and early postoperative seizures occurred in 15% (n = 97) and 5% (n = 21) of the patients, respectively. Overall, 502 and 418 patients were eligible for multivariate logistic regression analyses of preoperative and early postoperative seizures, respectively. Male gender (odds ratio [OR], 2.06; P = 0.009), a non-skull base location (OR, 4.43; P < 0.001), and a tumor volume of >8 cm3 (OR, 3.05; P = 0.002) were associated with a higher risk of preoperative seizures and were used to stratify the patients into 3 prognostic groups. The high-risk subgroup of patients with meningioma showed a seizure rate of >40% (OR, 9.8; P < 0.001). Only a non-skull base tumor location (OR, 2.61; P = 0.046) was identified as a significant risk factor for early postoperative seizures. AEDs did not reduce early postoperative seizure occurrence. CONCLUSIONS:Seizure prophylaxis might be considered for patients at high risk of developing seizures who are for other reasons being considered for watchful waiting instead of resection. In contrast, our data do not provide any evidence of the efficacy of perioperative AEDs in patients with meningioma.
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