INCIDENCE OF SEIZURES AFTER SURGERY FOR SUPRATENTORIAL MENINGIOMAS - A MODERN ANALYSIS

The authors have assessed the incidence of postoperative seizures in 1 58 patients with supratentorial meningiomas diagnosed by computerized tomography (CT) and/or magnetic resonance (MR) imaging, which theoreti cally should lead to early diagnosis and treatment and the potential f or improved seizure outcome. Univariate chi-square and logistic regres sion analyses were performed on 24 independent variables against the o utcome variable of occurrence of a postoperative seizure. The median d uration of preoperative seizures was 1 month, considerably shorter tha n that found in studies conducted prior to the advent of CT and MR ima ging. Of 63 patients with a history of preoperative seizures, 40 (63.5 %) had complete cessation of seizures after surgery. Twelve (92.3%) of 13 patients with one to three postoperative seizures eventually achie ved complete seizure control. whereas only four (40%) of 10 patients w ith more than three postoperative seizures achieved this result. Overa ll, 88.9% of patients with preoperative seizures achieved complete sei zure control postoperatively. Multivariate analysis was used to identi fy six variables that were predictive of the occurrence of postoperati ve seizures: preoperative seizure history, preoperative language distu rbance, extent of tumor removal, parietal location of tumor, postopera tive anticonvulsant medication status, and postoperative hydrocephalus . These variables were incorporated into a diagnostic model designed t o predict the risk of a postoperative seizure following meningioma sur gery. On the basis of their findings, the authors conclude that earlie r detection and treatment of supratentorial meningiomas improve seizur e outcome in patients with preoperative epilepsy. Furthermore, an asse ssment of the risk of postoperative seizures may help guide decisions concerning weaning patients from anticonvulsant medications postoperat ively.