Hinrichs Fynn L, Brokinkel Caroline, Adeli Alborz, Sporns Peter B, Hess Katharina, Paulus Werner, Stummer Walter, Grauer Oliver, Spille Dorothee C, Brokinkel Benjamin
Department of Neurosurgery, University Hospital Münster, Münster, Germany.
Department of Clinical Radiology, University of Münster, Münster, Germany.
J Neurosurg Sci. 2023 Feb;67(1):66-72. doi: 10.23736/S0390-5616.20.05068-7. Epub 2020 Oct 15.
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.
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.
Preoperative seizures were found in 189 patients (20%). In univariate analyses, male gender (OR=1.91, 95% CI: 1.37-2.68; P<0.001), grade II/III histology (OR=2.24, 95% CI: 1.46-3.46; P<0.001), 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<0.001), heterogeneous contrast-enhancement (OR=1.60, 95% CI: 1.04-2.46; P=0.031), intratumoral calcifications (OR=1.91, 95% CI: 1.17-3.10; P=0.009), an irregular shape (OR=2.07, 95% CI: 1.32-3.26; P=0.002) as well as tumor (OR=1.01 per ccm, 95% CI: 1.00-1.02; P=0.001) and edema volumes (OR=1.01 per ccm, 95% CI: 1.00-1.01; P<0.001) were correlated with seizures. Semiology was not related to any of the analyzed variables (P>0.05, each). No associations were found between seizures and histological subtype of 832 grade I meningiomas (P=0.391). In multivariate analyses, only non-skull base tumor location (OR=3.12, 95% CI: 1.74-5.59; P<0.001) and a rising peritumoral edema volume (OR=1.01 per ccm, 95% CI: 1.00-1.01; P<0.001) were identified as independent predictors for preoperative seizures.
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.
约25%的颅内脑膜瘤患者在初次就诊时出现癫痫发作。因此，在脑膜瘤患者围手术期护理中，识别术前癫痫发作的危险因素至关重要。
对945例（689例女性，占73%；256例男性，占27%；中位年龄：58岁）经手术治疗的原发性颅内脑膜瘤患者，分析术前癫痫发作与临床、影像学和组织学变量之间的关联。
189例（20%）患者存在术前癫痫发作。单因素分析显示，男性（比值比[OR]=1.91，95%置信区间[CI]：1.37 - 2.68；P<0.001）、II/III级组织学（OR=2.24，95% CI：1.46 - 3.46；P<0.001）、脑侵犯（OR=2.59，95% CI：1.45 - 4.63；P = 0.001）、非颅底肿瘤位置（OR=3.07，95% CI：2.13 - 4.41；P<0.001）、不均匀强化（OR=1.60，95% CI：1.04 - 2.46；P = 0.031）、瘤内钙化（OR=1.91，95% CI：1.17 - 3.10；P = 0.009）、不规则形状（OR=2.07，95% CI：1.32 - 3.26；P = 0.002）以及肿瘤（每立方厘米OR=1.01，95% CI：1.00 - 1.02；P = 0.001）和水肿体积（每立方厘米OR=1.01，95% CI：1.00 - 1.01；P<0.001）与癫痫发作相关。癫痫发作的症状学与任何分析变量均无关联（各P>0.05）。在832例I级脑膜瘤中，癫痫发作与组织学亚型之间未发现关联（P = 0.391）。多因素分析显示，仅非颅底肿瘤位置（OR=3.12，95% CI：1.74 - 5.59；P<0.001）和瘤周水肿体积增加（每立方厘米OR=1.01，95% CI：1.00 - 1.01；P<0.001）被确定为术前癫痫发作的独立预测因素。
多个主要为影像学的变量被确定为癫痫的危险因素。然而，多因素分析仅证实瘤周水肿和非颅底肿瘤位置是术前癫痫发作的独立预测因素。没有变量能预测癫痫发作的症状学。
