Dincer Alper, Jalal Muhammad I, Gupte Trisha P, Vetsa Shaurey, Vasandani Sagar, Yalcin Kanat, Marianayagam Neelan, Blondin Nicholas, Corbin Zachary, McGuone Declan, Fulbright Robert K, Erson-Omay Zeynep, Günel Murat, Moliterno Jennifer
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
Neurooncol Adv. 2023 Jun 3;5(Suppl 1):i49-i57. doi: 10.1093/noajnl/vdac110. eCollection 2023 May.
Meningiomas are the most common central nervous system tumors. Although these tumors are extra-axial, a relatively high proportion (10%-50%) of meningioma patients have seizures that can substantially impact the quality of life. Meningiomas are believed to cause seizures by inducing cortical hyperexcitability that results from mass effect and cortical irritation, brain invasion, or peritumoral brain edema. In general, meningiomas that are associated with seizures have aggressive features, with risk factors including atypical histology, brain invasion, and higher tumor grade. Somatic mutated meningiomas are associated with preoperative seizures, but the effect of the driver mutation is mediated through atypical features. While surgical resection is effective in controlling seizures in most patients with meningioma-related epilepsy, a history of seizures and uncontrolled seizures prior to surgery is the most significant predisposing factor for persistent postoperative seizures. Subtotal resection (STR) and relatively larger residual tumor volume are positive predictors of postoperative seizures. Other factors, including higher WHO grade, peritumoral brain edema, and brain invasion, are inconsistently associated with postoperative seizures, suggesting they might be crucial in the development of an epileptogenic focus, but do not appear to play a substantial role after seizure activity has been established. Herein, we review and summarize the current literature surrounding meningioma-related epilepsy and underscore the interaction of multiple factors that relate to seizures in patients with meningioma.
脑膜瘤是最常见的中枢神经系统肿瘤。尽管这些肿瘤位于轴外，但相当一部分（10%-50%）脑膜瘤患者会出现癫痫发作，这会对生活质量产生重大影响。据信，脑膜瘤通过诱导由占位效应、皮质刺激、脑侵袭或瘤周脑水肿导致的皮质过度兴奋而引起癫痫发作。一般来说，与癫痫发作相关的脑膜瘤具有侵袭性特征，危险因素包括非典型组织学、脑侵袭和更高的肿瘤分级。体细胞突变的脑膜瘤与术前癫痫发作有关，但驱动突变的作用是通过非典型特征介导的。虽然手术切除对大多数脑膜瘤相关癫痫患者控制癫痫发作有效，但癫痫发作史和术前未控制的癫痫发作是术后持续性癫痫发作的最重要诱发因素。次全切除（STR）和相对较大的残余肿瘤体积是术后癫痫发作的阳性预测指标。其他因素，包括世界卫生组织（WHO）分级较高、瘤周脑水肿和脑侵袭，与术后癫痫发作的相关性不一致，这表明它们可能在致痫灶的形成中起关键作用，但在癫痫发作活动确立后似乎不起重要作用。在此，我们回顾并总结了目前围绕脑膜瘤相关癫痫的文献，并强调了与脑膜瘤患者癫痫发作相关的多种因素之间的相互作用。
