Skardelly Marco, Rother Christian, Noell Susan, Behling Felix, Wuttke Thomas V, Schittenhelm Jens, Bisdas Sotirios, Meisner Christoph, Rona Sabine, Tabatabai Ghazaleh, Roser Florian, Tatagiba Marcos Soares
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.
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.
World Neurosurg. 2017 Jan;97:538-546. doi: 10.1016/j.wneu.2016.10.062. Epub 2016 Oct 21.
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.
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.
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 cm (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.
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.
目前尚不清楚用于识别可能从术前或术后早期癫痫预防中获益的脑膜瘤患者的明确危险因素。我们对危险因素进行了调查和量化，以确定脑膜瘤患者癫痫发作的个体风险。
本回顾性队列研究共纳入634例成年脑膜瘤患者。确定了患者的性别和年龄、肿瘤位置、分级和体积、抗癫痫药物（AEDs）的使用情况以及切除范围。
术前和术后早期癫痫发作的患者分别占15%（n = 97）和5%（n = 21）。总体而言，分别有502例和418例患者符合术前和术后早期癫痫发作的多因素逻辑回归分析条件。男性（比值比[OR]，2.06；P = 0.009）、非颅底位置（OR，4.43；P < 0.001）和肿瘤体积>8 cm（OR，3.05；P = 0.002）与术前癫痫发作风险较高相关，并用于将患者分为3个预后组。脑膜瘤高危亚组患者的癫痫发作率>40%（OR，9.8；P < 0.001）。仅非颅底肿瘤位置（OR，2.61；P = 0.046）被确定为术后早期癫痫发作的显著危险因素。AEDs并未降低术后早期癫痫发作率。
对于因其他原因考虑进行观察等待而非切除的、癫痫发作风险高的患者，可考虑进行癫痫预防。相比之下，我们的数据没有提供任何证据表明围手术期AEDs对脑膜瘤患者有效。
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