Journal of Neurosurgical Sciences 2020 Oct 15

DOI: 10.23736/S0390-5616.20.05068-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Risk factors for preoperative seizures in intracranial meningiomas

Fynn L. HINRICHS ¹, Caroline BROKINKEL ², Alborz ADELI ², Peter B. SPORNS ^{2, 3, 4}, Katharina HESS ⁵, Werner PAULUS ⁵ , Walter STUMMER ¹, Oliver GRAUER ⁶, Dorothee C. SPILLE ¹, Benjamin BROKINKEL ¹ ✉

¹ Department of Neurosurgery, University Hospital Münster, Münster, Germany; ² Department of Clinical Radiology, University of Münster, Münster, Germany; ³ Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland; ⁴ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; ⁵ Institute of Neuropathology, University Hospital Münster, Münster, Germany; ⁶ Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany

BACKGROUND: About 25% of patients with intracranial meningioma display seizures at the time of initial presentation. Hence, identification of risk factors for preoperative seizures is crucial during perioperative care of meningioma patients.
METHODS: Associations of preoperative seizures with clinical, radiological and histological variables were analyzed in 945 patients (689 females, 73% and 256 males, 27%; median age: 58 years) who underwent surgery for primary diagnosed intracranial meningioma.
RESULTS: Preoperative seizures were found in 189 patients (20%). In univariate analyses, male gender (OR: 1.91, 95%CI 1.37-2.68; p<.001), grade II/III histology (OR: 2.24, 95%CI 1.46-3.46; p<.001), brain invasion (OR: 2.59, 95%CI 1.45-4.63; p=001), non-skull base tumor location (OR: 3.07, 95%CI 2.13-4.41; p<.001), heterogeneous contrast-enhancement (OR: 1.60, 95%CI 1.04-2.46; p=.031), intratumoral calcifications (OR: 1.91, 95%CI 1.17-3.10; p=.009), an irregular shape (OR: 2.07, 95%CI 1.32-3.26; p=.002) as well as tumor (OR: 1.01 per ccm, 95%CI 1.00-1.02; p=.001) and edema volumes (OR: 1.01 per ccm, 95%CI 1.00-1.01; p<.001) were correlated with seizures. Semiology was not related to any of the analyzed variables (p>.05, each). No associations were found between seizures and histological subtype of 832 grade I meningiomas (p=.391). In multivariate analyses, only non-skull base tumor location (OR: 3.12, 95%CI 1.74-5.59; p<.001) and a rising peritumoral edema volume (OR: 1.01 per ccm, 95%CI 1.00-1.01; p<.001) were identified as independent predictors for preoperative seizures.
CONCLUSIONS: Several mostly radiological variables were identified as risk factors for epilepsy. However, multivariate analyses confirmed only peritumoral edema and non-skull base tumor location as independent predictors for preoperative seizures. None of the variables predicts semiology.

KEY WORDS: Epilepsy; Meningioma; Seizure; Surgery