Seizure control for patients undergoing meningioma surgery

Objective: Seizures are common among patients with meningiomas and are a significant cause of morbidity and poor quality of life. The factors associated with the onset of seizures as well as factors associated with seizure control remains poorly understood. Methods: Adult patients who underwent primary resection of a supratentorial World Health Organization grade I meningioma at a single institution between 1996 and 2006 were retrospectively reviewed. Multivariate logistical regression analyses were used to identify associations with preoperative seizures, and multivariate proportional hazards regression analyses were used to identify associations with prolonged seizure control after surgical resection. Results: Of the 626 patients in this series, 84 (13%) presented with seizures. The factors independently associated with preoperative seizures were Karnofsky performance score ≤80 (P< 0.0001), absence of headaches (P = 0.0006), and vasogenic edema (P = 0.007). At 48 months postoperatively, 90% were Engel class I, 3% were class II, 0 were class III, and 7% were class IV. The factors independently associated with decreased seizure control after surgical resection were uncontrolled preoperative seizures (P = 0.04), parasagittal tumors (P = 0.03), and tumors along the sphenoid wing (P = 0.05). The association between seizure recurrence and tumor recurrence trended toward but did not achieve statistical significance (P = 0.11). Conclusions: With the widespread availability of various neuroimaging modalities, there will be increased detection of intracranial meningiomas. The identification and consideration of factors associated with seizure onset and prolonged seizure control may help guide treatment strategies aimed at improving the quality of life for patients with meningiomas.