University of Liverpool



The Role of Prophylactic Antiepileptic Drugs for Seizure Prophylaxis in Meningioma Surgery: A Systematic ReviewRunning head: Seizure Prophylaxis in Meningioma SurgerySubmission category: Review article Authors and Affiliations: Abdurrahman I Islima; a.islim@liv.ac.uk Stephen McKeevera; hlsmckee@student.liv.ac.ukTer-Er?Kusu-Orkara; hltkusuo@student.liv.ac.ukMichael D Jenkinsonb,c, PhD, F.R.C.S (Neuro.Surg); michael.jenkinson@liv.ac.ukaSchool of Medicine, University of Liverpool, Liverpool, UK?bInstitute of Translational Medicine, University of Liverpool, Liverpool, UK?cDepartment of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK ?Corresponding author Michael D JenkinsonDepartment of Neurosurgery?The Walton Centre and University of Liverpool?Lower Lane?Liverpool?L9 7LJ?Tel: 0044 151 5295683 (sec)?Fax: 0044 151 5295509?Email:?michael.jenkinson@liv.ac.uk Funding The authors did not receive any funding for the completion of this review. Conflict of InterestThe authors have no relationships that might lead to a perceived conflict of interest.AbstractMeningiomas are the commonest type of primary brain tumours. Whilst most patients are seizure-free prior to surgery, antiepileptic drugs are frequently administered to reduce the risk of developing post-operative seizures. However, evidence to support their efficacy in providing this outcome is sparse. To this end, we performed a systematic review to assess the impact of prophylactic antiepileptic drugs on post-operative epilepsy rates in seizure-na?ve patients undergoing craniotomy for resection of meningiomas. The literature search was performed using PubMed for studies published between January 1990 and November 2016. The total number of patients in each study was extracted and divided into cohorts according to administration of prophylactic antiepileptic drugs. Clinical characteristics, study type and post-operative epilepsy rates were recorded. A total of 11 studies involving 1,143 patients met the selection criteria. There was no statistically significant difference in the number of patients who developed post-operative epilepsy in the cohort that received prophylactic antiepileptic drugs (20 of 766; 2.6%) and the cohort that did not (10 of 377; 2.7%) (Chi-square test; P = 0.96). A detailed meta-analysis could not be performed due to the insufficiency in data reported. Based on the results of this systematic review, the routine use of antiepileptic drugs for seizure prophylaxis in seizure-na?ve patients undergoing meningioma resection could not be substantiated. However, limitations of a systematic review should be considered on interpretation. High quality prospective randomised controlled trials are required to definitively answer this important clinical question.KeywordsAntiepileptic drugs; craniotomy; meningioma; post-operative seizure; prophylaxis.IntroductionMeningiomas?are the most common primary brain tumours, accounting for approximately a third of all intracranial neoplasms and with an estimated incidence rate of 5 per 100,000 person-years in the UK. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"tnddSgpe","properties":{"formattedCitation":"(1,2)","plainCitation":"(1,2)"},"citationItems":[{"id":10,"uris":[""],"uri":[""],"itemData":{"id":10,"type":"article-journal","title":"Epidemiology of meningioma in the United Kingdom","container-title":"Neuroepidemiology","page":"27-34","volume":"39","issue":"1","source":"PubMed","abstract":"BACKGROUND: Data on the epidemiology and aetiology of meningioma are limited.\nMETHODS: The Health Improvement Network UK primary care database was used to ascertain incident cases of meningioma between January 1996 and June 2008. Ten thousand controls analysis were frequency-matched by age, sex and year. A nested case control analysis was performed to determine risk factors for meningioma.\nRESULTS: The incidence of meningioma was 5.30 per 100,000 person-years over the study period. The incidence was higher in women than in men (7.19 vs. 3.05 per 100,000 person-years). Cerebrovascular disease (OR 1.86; 95% CI 1.46-2.36) and a history of cancer, thyroid disease, epilepsy, migraine and headache and exposure to antiepileptics were significantly associated with an increased risk of meningioma. Ischemic heart disease and exposure to antiepileptics were associated with a decreased risk of meningioma.\nCONCLUSIONS: The incidence of meningioma in the UK remained stable over the 12-year study period and was twofold higher in women than men. Although the prevalence and incidence of meningioma remained stable during the study, further research into risk factors and predisposing conditions for the onset of meningioma and early symptoms of tumor development is warranted to improve prevention and early diagnosis of this disease.","DOI":"10.1159/000338081","ISSN":"1423-0208","journalAbbreviation":"Neuroepidemiology","language":"eng","author":[{"family":"Cea-Soriano","given":"Lucía"},{"family":"Wallander","given":"Mari-Ann"},{"family":"García Rodríguez","given":"Luis A."}],"issued":{"date-parts":[["2012"]]}}},{"id":1557,"uris":[""],"uri":[""],"itemData":{"id":1557,"type":"article-journal","title":"Epidemiology and etiology of meningioma","container-title":"Journal of Neuro-Oncology","page":"307-314","volume":"99","issue":"3","source":"PubMed","abstract":"Although most meningiomas are encapsulated and benign tumors with limited numbers of genetic aberrations, their intracranial location often leads to serious and potentially lethal consequences. They are the most frequently diagnosed primary brain tumor accounting for 33.8% of all primary brain and central nervous system tumors reported in the United States between 2002 and 2006. Inherited susceptibility to meningioma is suggested both by family history and candidate gene studies in DNA repair genes. People with certain mutations in the neurofibromatosis gene (NF2) have a very substantial increased risk for meningioma. High dose ionizing radiation exposure is an established risk factor for meningioma, and lower doses may also increase risk, but which types and doses are controversial or understudied. Because women are twice as likely as men to develop meningiomas and these tumors harbor hormone receptors, an etiologic role for hormones (both endogenous and exogenous) has been hypothesized. The extent to which immunologic factors influence meningioma etiology has been largely unexplored. Growing emphasis on brain tumor research coupled with the advent of new genetic and molecular epidemiologic tools in genetic and molecular epidemiology promise hope for advancing knowledge about the causes of intra-cranial meningioma. In this review, we highlight current knowledge about meningioma epidemiology and etiology and suggest future research directions.","DOI":"10.1007/s11060-010-0386-3","ISSN":"1573-7373","note":"PMID: 20821343\nPMCID: PMC2945461","journalAbbreviation":"J. Neurooncol.","language":"eng","author":[{"family":"Wiemels","given":"Joseph"},{"family":"Wrensch","given":"Margaret"},{"family":"Claus","given":"Elizabeth B."}],"issued":{"date-parts":[["2010",9]]},"PMID":"20821343","PMCID":"PMC2945461"}}],"schema":""} 1,2 The World Health Organisation (WHO) classifies these tumours into three groups: benign meningioma (grade I), atypical meningioma (grade II) and anaplastic meningioma (grade III). ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"5hSiVZRq","properties":{"formattedCitation":"(3)","plainCitation":"(3)"},"citationItems":[{"id":325,"uris":[""],"uri":[""],"itemData":{"id":325,"type":"article-journal","title":"The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary","container-title":"Acta Neuropathologica","page":"803-820","volume":"131","issue":"6","source":"link.","abstract":"The 2016 World Health Organization Classification of Tumors of the Central Nervous System is both a conceptual and practical advance over its 2007 predecessor. For the first time, the WHO classification of CNS tumors uses molecular parameters in addition to histology to define many tumor entities, thus formulating a concept for how CNS tumor diagnoses should be structured in the molecular era. As such, the 2016 CNS WHO presents major restructuring of the diffuse gliomas, medulloblastomas and other embryonal tumors, and incorporates new entities that are defined by both histology and molecular features, including glioblastoma, IDH-wildtype and glioblastoma, IDH-mutant; diffuse midline glioma, H3 K27M–mutant; RELA fusion–positive ependymoma; medulloblastoma, WNT-activated and medulloblastoma, SHH-activated; and embryonal tumour with multilayered rosettes, C19MC-altered. The 2016 edition has added newly recognized neoplasms, and has deleted some entities, variants and patterns that no longer have diagnostic and/or biological relevance. Other notable changes include the addition of brain invasion as a criterion for atypical meningioma and the introduction of a soft tissue-type grading system for the now combined entity of solitary fibrous tumor / hemangiopericytoma—a departure from the manner by which other CNS tumors are graded. Overall, it is hoped that the 2016 CNS WHO will facilitate clinical, experimental and epidemiological studies that will lead to improvements in the lives of patients with brain tumors.","DOI":"10.1007/s00401-016-1545-1","ISSN":"0001-6322, 1432-0533","shortTitle":"The 2016 World Health Organization Classification of Tumors of the Central Nervous System","journalAbbreviation":"Acta Neuropathol","language":"en","author":[{"family":"Louis","given":"David N."},{"family":"Perry","given":"Arie"},{"family":"Reifenberger","given":"Guido"},{"family":"Deimling","given":"Andreas","dropping-particle":"von"},{"family":"Figarella-Branger","given":"Dominique"},{"family":"Cavenee","given":"Webster K."},{"family":"Ohgaki","given":"Hiroko"},{"family":"Wiestler","given":"Otmar D."},{"family":"Kleihues","given":"Paul"},{"family":"Ellison","given":"David W."}],"issued":{"date-parts":[["2016",6,1]]}}}],"schema":""} 3 Approximately 90% of meningiomas discovered are benign and asymptomatic; the remainder go unnoticed until they clinically manifest in the form of headaches, seizures or other neurological problems. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vo2iicd29","properties":{"formattedCitation":"(4)","plainCitation":"(4)"},"citationItems":[{"id":331,"uris":[""],"uri":[""],"itemData":{"id":331,"type":"article-journal","title":"Meningiomas","container-title":"The Lancet","page":"1535-1543","volume":"363","issue":"9420","source":"ScienceDirect","abstract":"Summary\nMeningiomas are by far the most common tumours arising from the meninges. Progressive enlargement of the tumour leads to focal or generalised seizure disorders or neurological deficits caused by compression of adjacent neural tissue. Surgery remains the primary treatment of choice, although the use of fractionated radiotherapy or stereotactic single-dose radiosurgery is increasing for meningiomas that are incompletely excised, surgically inaccessible, or recurrent and either atypical or anaplastic. Although most meningiomas have good long-term prognosis after treatment, there are still controversies over management in a proportion of cases. We review various features of meningioma biology, diagnosis, and treatment and provide an overview of the current rationale and evidence base for the various therapeutic approaches.","DOI":"10.1016/S0140-6736(04)16153-9","ISSN":"0140-6736","journalAbbreviation":"The Lancet","author":[{"family":"Whittle","given":"Ian R"},{"family":"Smith","given":"Colin"},{"family":"Navoo","given":"Parthiban"},{"family":"Collie","given":"Donald"}],"issued":{"date-parts":[["2004",5,8]]}}}],"schema":""} 4 This indicates that the?majority of patients?are?free of seizures at the time of diagnosis and remain so up until the time of surgery. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1tf4ajju1l","properties":{"formattedCitation":"(5)","plainCitation":"(5)"},"citationItems":[{"id":1512,"uris":[""],"uri":[""],"itemData":{"id":1512,"type":"article-journal","title":"Epilepsy and brain tumors","container-title":"Handbook of Clinical Neurology","page":"267-285","volume":"134","source":"PubMed","abstract":"Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70-80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60-75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20-50% of patients with meningioma and 20-35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60-90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life.","DOI":"10.1016/B978-0-12-802997-8.00016-5","ISSN":"0072-9752","note":"PMID: 26948360\nPMCID: PMC4803433","journalAbbreviation":"Handb Clin Neurol","language":"eng","author":[{"family":"Englot","given":"Dario J."},{"family":"Chang","given":"Edward F."},{"family":"Vecht","given":"Charles J."}],"issued":{"date-parts":[["2016"]]},"PMID":"26948360","PMCID":"PMC4803433"}}],"schema":""} 5 Despite this, antiepileptic drugs (AEDs) are frequently?prescribed peri-operatively in?an attempt?to reduce the risk of?seizures post-craniotomy albeit being rather evidently unfounded. Furthermore, a recent Cochrane review on the routine administration of AEDs post-operatively?for brain tumours, including?meningiomas, concluded there was little?evidence to recommend routine use. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"X0cHI3b2","properties":{"formattedCitation":"(6)","plainCitation":"(6)"},"citationItems":[{"id":1561,"uris":[""],"uri":[""],"itemData":{"id":1561,"type":"chapter","title":"Antiepileptic drugs as prophylaxis for post-craniotomy seizures","container-title":"Cochrane Database of Systematic Reviews","publisher":"John Wiley & Sons, Ltd","source":"Wiley Online Library","abstract":"Background\nBackground\n\nThe incidence of seizures following supratentorial craniotomy for non-traumatic pathology has been estimated to be between 15% to 20%; however, the risk of experiencing a seizure may vary from 3% to 92% over a five-year period. Postoperative seizures can precipitate the development of epilepsy; seizures are most likely to occur within the first month of cranial surgery. The use of antiepileptic drugs (AEDs) administered pre- or postoperatively to prevent seizures following cranial surgery has been investigated in a number of randomised controlled trials (RCTs).\n\nObjectives\nObjectives\n\nTo determine the efficacy and safety of AEDs when used prophylactically in people undergoing craniotomy and to examine which AEDs are most effective.\n\nSearch methods\nSearch methods\n\nSearches were run for the original review in January 2012. We performed subsequent searches in September 2012 and up to 04 August 2014. We searched the Cochrane Epilepsy Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE. We did not apply any language restrictions.\n\nSelection criteria\nSelection criteria\n\nWe included RCTs of people with no history of epilepsy who were undergoing craniotomy for either therapeutic or diagnostic reasons. Trials with adequate randomisation methods and concealment were included; these could either be blinded or unblinded parallel trials. We did not stipulate a minimum treatment period, and we included trials using active drugs or placebo as a control group.\n\nData collection and analysis\nData collection and analysis\n\nTwo review authors (JP and JG) independently selected trials for inclusion and performed data extraction and risk of bias assessments. We resolved any disagreements through discussion. Outcomes investigated included the number of patients experiencing seizures (early - occurring within first week following craniotomy, and late - occurring after first week following craniotomy), the number of deaths and the number of people experiencing disability and adverse effects. Due to the heterogeneous nature of the trials, we did not combine data from the included trials in a meta-analysis; we presented the findings of the review in narrative format.\n\nMain results\nMain results\n\nWe included eight RCTs (N = 1602), which were published between 1983 and 2013. Three trials compared a single AED (phenytoin) with a placebo or no treatment. One three-arm trial compared two AEDs (carbamazepine, phenytoin) with no treatment. A second three-arm trial compared phenytoin, phenobarbital and no treatment. Three other trials were head-to-head trials of AEDs (phenytoin vs. valproate; zonisamide vs. phenobarbital and levetiracetam vs. phenytoin). Of the five trials comparing AEDs with controls, only one trial reported a significant difference between AED treatment and controls for early seizure occurrence. All other comparisons were non-significant.\nOf the head to head trials, one reported statistically significant more early seizures in the phenytoin group as compared with the levetiracetam group. No other trial reported statistically significant differences between treatments for either early or late seizures.\nIncidences of adverse effects of treatment were poorly reported, and most trials reported no significant differences between treatment groups. However data on adverse events were limited.\n\nAuthors' conclusions\nAuthors' conclusions\n\nThere is little evidence to suggest that AED treatment administered prophylactically is effective or not effective in preventing post-craniotomy seizures. The current evidence base is limited due to the differing methodologies employed in the trials and inconsistencies in reporting of outcomes. Further evidence from good-quality, contemporary trials is required in order to assess the effectiveness of prophylactic AED treatment compared to control groups or other AEDs in preventing post-craniotomy seizures properly.","URL":"","language":"en","author":[{"family":"Weston","given":"Jennifer"},{"family":"Greenhalgh","given":"Janette"},{"family":"Marson","given":"Anthony G"}],"issued":{"date-parts":[["2015",3,4]]},"accessed":{"date-parts":[["2016",6,3]]}}}],"schema":""} 6 In addition to the risk of acute adverse drug reactions, recent studies have suggested that AEDs may also limit neurological recovery due to their effects on cognitive function. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1bhF7IOo","properties":{"formattedCitation":"(7)","plainCitation":"(7)"},"citationItems":[{"id":1564,"uris":[""],"uri":[""],"itemData":{"id":1564,"type":"article-journal","title":"Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs","container-title":"Journal of Neurosurgery","page":"253-260","volume":"107","issue":"2","source":"PubMed","abstract":"OBJECT: Prophylactic use of antiepileptic drugs (AEDs) in patients admitted with aneurysmal subarachnoid hemorrhage (SAH) is common practice; however, the impact of this treatment strategy on in-hospital complications and outcome has not been systematically studied. The goal in this study was twofold: first, to describe the prescribing pattern for AEDs in an international study population; and second, to delineate the impact of AEDs on in-hospital complications and outcome in patients with SAH.\nMETHODS: The authors examined data collected in 3552 patients with SAH who were entered into four prospective, randomized, double-blind, placebo-controlled trials conducted in 162 neurosurgical centers and 21 countries between 1991 and 1997. The prevalence of AED use was assessed by study country and center. The impact of AEDs on in-hospital complications and outcome was evaluated using conditional logistic regressions comparing treated and untreated patients within the same study center.\nRESULTS: Antiepileptic drugs were used in 65.1% of patients and the prescribing pattern was mainly dependent on the treating physicians: the prevalence of AED use varied dramatically across study country and center (intraclass correlation coefficients 0.22 and 0.66, respectively [p < 0.001]). Other predictors included younger age, worse neurological grade, and lower systolic blood pressure on admission. After adjustment, patients treated with AEDs had odds ratios of 1.56 (95% confidence interval [CI] 1.16-2.10; p = 0.003) for worse outcome based on the Glasgow Outcome Scale; 1.87 (95% CI 1.43-2.44; p < 0.001) for cerebral vasospasm; 1.61 (95% CI 1.25-2.06; p < 0.001) for neurological deterioration; 1.33 (95% CI 1.01-1.74; p = 0.04) for cerebral infarction; and 1.36 (95% CI 1.03-1.80; p = 0.03) for elevated temperature during hospitalization.\nCONCLUSIONS: Prophylactic AED treatment in patients with aneurysmal SAH is common, follows an arbitrary prescribing pattern, and is associated with increased in-hospital complications and worse outcome.","DOI":"10.3171/JNS-07/08/0253","ISSN":"0022-3085","note":"PMID: 17695377","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Rosengart","given":"Axel J."},{"family":"Huo","given":"J. Dezheng"},{"family":"Tolentino","given":"Jocelyn"},{"family":"Novakovic","given":"Roberta L."},{"family":"Frank","given":"Jeffrey I."},{"family":"Goldenberg","given":"Fernando D."},{"family":"Macdonald","given":"R. Loch"}],"issued":{"date-parts":[["2007",8]]},"PMID":"17695377"}}],"schema":""} 7 Nonetheless, the consequences of post-operative seizures include major morbidity from cerebral oedema, reduced quality of life, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"15n5qqbjve","properties":{"formattedCitation":"(8)","plainCitation":"(8)"},"citationItems":[{"id":1505,"uris":[""],"uri":[""],"itemData":{"id":1505,"type":"article-journal","title":"The impact of epilepsy on the quality of life of patients with meningioma: A systematic review","container-title":"British Journal of Neurosurgery","page":"23-28","volume":"30","issue":"1","source":"PubMed","abstract":"Quality of life (QoL) is regarded as an important outcome measure in meningioma, and studies have investigated the role of various clinical and demographic factors. Epilepsy is known to impair quality of life but the impact of epilepsy on quality of life in a meningioma population is not well defined. The aim of this systematic review is to identify and summarise the current literature on meningioma, epilepsy and quality of life. A PubMed search was performed that identified 162 articles. Only 4 articles relevant to meningioma, epilepsy and QoL were found and each were analysed in terms of design, data, findings and conclusions. Each article was different in terms of study population, aims and outcome measure, but all suggest that epilepsy has an impact on quality of life. Anti-epileptic drugs, uncontrolled seizures and cognitive dysfunction may be particularly significant. The identified articles were weakened by small sample size, short follow-up, a lack of recorded epilepsy variables and the use of quality of life measures that are either too specific or not validated. Future studies are warranted to improve understanding in this topic, aid clinical decisions and improve QoL in these patients.","DOI":"10.3109/02688697.2015.1080215","ISSN":"1360-046X","note":"PMID: 26982950","shortTitle":"The impact of epilepsy on the quality of life of patients with meningioma","journalAbbreviation":"Br J Neurosurg","language":"eng","author":[{"family":"Tanti","given":"Matthew J."},{"family":"Marson","given":"Anthony G."},{"family":"Chavredakis","given":"Emmanuel"},{"family":"Jenkinson","given":"Michael D."}],"issued":{"date-parts":[["2016",2]]},"PMID":"26982950"}}],"schema":""} 8 cognitive issues and loss of driving licence, but the rate at which new seizures develop in patients undergoing meningioma surgery has been inconsistently and variably reported over the last four decades and ranges from 0.5-22%. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6b1cdsfg4","properties":{"formattedCitation":"{\\rtf (9\\uc0\\u8211{}11)}","plainCitation":"(9–11)"},"citationItems":[{"id":1610,"uris":[""],"uri":[""],"itemData":{"id":1610,"type":"article-journal","title":"The incidence of postoperative seizures","container-title":"Acta Neurochirurgica","page":"253-264","volume":"55","issue":"3-4","source":"link..liverpool.idm.","abstract":"Summary Overall, supratentorial neurosurgical procedures are associated with a 17% risk of developing postoperative seizures. The incidence varies, but treatment of an arteriovenous malformation, an intracerebral haematoma, a middle cerebral artery aneurysm, an abscess, and meningiomas carry the highest risk. The role of prophylactic anticonvulsant therapy is discussed.","DOI":"10.1007/BF01808441","ISSN":"0001-6268, 0942-0940","journalAbbreviation":"Acta neurochir","language":"en","author":[{"family":"Foy","given":"P. M."},{"family":"Copeland","given":"G. P."},{"family":"Shaw","given":"M. D. M."}]}},{"id":1568,"uris":[""],"uri":[""],"itemData":{"id":1568,"type":"article-journal","title":"Prospective Study of Postoperative Seizure in Intracranial Meningioma","container-title":"Psychiatry and Clinical Neurosciences","page":"331-334","volume":"47","issue":"2","source":"Wiley Online Library","DOI":"10.1111/j.1440-1819.1993.tb02094.x","ISSN":"1440-1819","language":"en","author":[{"family":"Tsuji","given":"Masahiro"},{"family":"Shinomiya","given":"Shigeko"},{"family":"Inoue","given":"Reiichi"},{"family":"Sato","given":"Kiyoshi"}],"issued":{"date-parts":[["1993",6,1]]}}},{"id":23,"uris":[""],"uri":[""],"itemData":{"id":23,"type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"date-parts":[["2011",3]]}}}],"schema":""} 9–11 When all of the aforementioned factors are taken into consideration, they present a challenge to the clinician whose responsibility is to measure the potential benefits of AED prophylaxis against the adverse effects. Several reviews have previously addressed this issue, however, these include older studies that pre-date more modern micro-neurosurgical practice. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"146s0rbftu","properties":{"formattedCitation":"{\\rtf (12\\uc0\\u8211{}14)}","plainCitation":"(12–14)"},"citationItems":[{"id":1566,"uris":[""],"uri":[""],"itemData":{"id":1566,"type":"article-journal","title":"Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection: a systematic analysis of efficacy","container-title":"Journal of Neurosurgery","page":"483-490","volume":"115","issue":"3","source":"PubMed","abstract":"OBJECT: Meningiomas are one of the more common intracranial neoplasms. The risk of seizures and secondary aspiration, brain edema, and brain injury often leads practitioners to administer prophylactic antiepileptic drugs (AEDs) perioperatively. The efficacy of this practice remains controversial, however, with prior investigations reaching conflicting results and recent studies focusing on AED side effects. The authors performed a systematic analysis of outcomes following supratentorial meningioma resection with and without prophylactic AED administration in the hope of clarifying the role of AEDs in the perioperative care of patients with these lesions.\nMETHODS: A MEDLINE search of the literature (1979-2010) was performed. Comparisons were made for patient and tumor characteristics as well as success of repair, morbidity, and seizure outcome. Statistical analyses of categorical variables were undertaken using chi-square and Fisher exact tests.\nRESULTS: Nineteen studies, involving 698 patients, were included. There were no significant differences in the extent of resection, perioperative mortality, or recurrence between the AED and no-AED cohorts. Likewise, there were no significant differences in the incidence of early or late seizures between the cohorts.\nCONCLUSIONS: The results of this systematic analysis supports the conclusion that the prophylactic administration of anticonvulsants during resection of supratentorial meningiomas provides no benefit in the prevention of either early or late postoperative seizures. Despite their traditional role in this patient population, the routine use of AEDs should be carefully reconsidered.","DOI":"10.3171/2011.4.JNS101585","ISSN":"1933-0693","note":"PMID: 21639698","shortTitle":"Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Komotar","given":"Ricardo J."},{"family":"Raper","given":"Daniel M. S."},{"family":"Starke","given":"Robert M."},{"family":"Iorgulescu","given":"J. Bryan"},{"family":"Gutin","given":"Philip H."}],"issued":{"date-parts":[["2011",9]]},"PMID":"21639698"}},{"id":1615,"uris":[""],"uri":[""],"itemData":{"id":1615,"type":"article-journal","title":"Seizures in supratentorial meningioma: a systematic review and meta-analysis","container-title":"Journal of Neurosurgery","page":"1552-1561","volume":"124","issue":"6","source":"PubMed","abstract":"OBJECT Meningioma is the most common benign intracranial tumor, and patients with supratentorial meningioma frequently suffer from seizures. The rates and predictors of seizures in patients with meningioma have been significantly under-studied, even in comparison with other brain tumor types. Improved strategies for the prediction, treatment, and prevention of seizures in patients with meningioma is an important goal, because tumor-related epilepsy significantly impacts patient quality of life. METHODS The authors performed a systematic review of PubMed for manuscripts published between January 1980 and September 2014, examining rates of pre- and postoperative seizures in supratentorial meningioma, and evaluating potential predictors of seizures with separate meta-analyses. RESULTS The authors identified 39 observational case series for inclusion in the study, but no controlled trials. Preoperative seizures were observed in 29.2% of 4709 patients with supratentorial meningioma, and were significantly predicted by male sex (OR 1.74, 95% CI 1.30-2.34); an absence of headache (OR 1.77, 95% CI 1.04-3.25); peritumoral edema (OR 7.48, 95% CI 6.13-9.47); and non-skull base location (OR 1.77, 95% CI 1.04-3.25). After surgery, seizure freedom was achieved in 69.3% of 703 patients with preoperative epilepsy, and was more than twice as likely in those without peritumoral edema, although an insufficient number of studies were available for formal meta-analysis of this association. Of 1085 individuals without preoperative epilepsy who underwent resection, new postoperative seizures were seen in 12.3% of patients. No difference in the rate of new postoperative seizures was observed with or without perioperative prophylactic anticonvulsants. CONCLUSIONS Seizures are common in supratentorial meningioma, particularly in tumors associated with brain edema, and seizure freedom is a critical treatment goal. Favorable seizure control can be achieved with resection, but evidence does not support routine use of prophylactic anticonvulsants in patients without seizures. Limitations associated with systematic review and meta-analysis should be considered when interpreting these results.","DOI":"10.3171/2015.4.JNS142742","ISSN":"1933-0693","note":"PMID: 26636386\nPMCID: PMC4889504","shortTitle":"Seizures in supratentorial meningioma","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Englot","given":"Dario J."},{"family":"Magill","given":"Stephen T."},{"family":"Han","given":"Seunggu J."},{"family":"Chang","given":"Edward F."},{"family":"Berger","given":"Mitchel S."},{"family":"McDermott","given":"Michael W."}],"issued":{"date-parts":[["2016",6]]},"PMID":"26636386","PMCID":"PMC4889504"}},{"id":1507,"uris":[""],"uri":[""],"itemData":{"id":1507,"type":"article-journal","title":"Intracranial meningiomas and seizures: a review of the literature","container-title":"Acta Neurochirurgica","page":"1541-1548","volume":"157","issue":"9","source":"link.","abstract":"Background Seizures are a common manifestation of brain tumors, but literature on the incidence of seizures before and after surgery for meningiomas is limited, and principles for use of antiepileptic drugs (AEDs) are controversial. Methods This review is based on a MEDLINE search for articles from 1994 to 2014 describing intracranial meningioma and seizures or epilepsy, and AEDs treatment during and after surgery. Results Up to 40 % of patients with symptomatic meningiomas present with seizures before operation. Tumor removal usually results in seizure control, but around 20 % of patients continue to have or develop new-onset seizures after surgery. Risk factors for seizures after surgery include preoperative seizures, tumor location, and extent of tumor removal. There are no solid data to support routine pre- or postoperative AED prophylaxis in seizure-free patients, and the decision to treat and the selection of AEDs should follow the general principles of treatment of focal epilepsies. Conclusions Seizures are a common manifestation of meningiomas, but about 80 % patients with preoperative seizures can be seizure free after tumor removal. Prospective controlled AED trials specifically on meningioma patients are much needed.","DOI":"10.1007/s00701-015-2495-4","ISSN":"0001-6268, 0942-0940","shortTitle":"Intracranial meningiomas and seizures","journalAbbreviation":"Acta Neurochir","language":"en","author":[{"family":"Xue","given":"Hai"},{"family":"Sveinsson","given":"Olafur"},{"family":"Tomson","given":"Torbj?rn"},{"family":"Mathiesen","given":"Tiit"}],"issued":{"date-parts":[["2015",7,11]]}}}],"schema":""} 12–14 The role of prophylactic AEDs in meningioma surgery has also been the topic of regular editorials and opinion pieces that highlight the unresolved clinical dilemma. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2o23c0j275","properties":{"formattedCitation":"(15,16)","plainCitation":"(15,16)"},"citationItems":[{"id":1634,"uris":[""],"uri":[""],"itemData":{"id":1634,"type":"article-journal","title":"Do Meningioma Patients Benefit from Antiepileptic Drug Treatment?","container-title":"World Neurosurgery","page":"433-434","volume":"79","issue":"3–4","source":"ScienceDirect","DOI":"10.1016/j.wneu.2012.05.013","ISSN":"1878-8750","journalAbbreviation":"World Neurosurgery","author":[{"family":"Ngwenya","given":"Laura B."},{"family":"Chiocca","given":"E. Antonio"}],"issued":{"date-parts":[["2013",3]]}}},{"id":1631,"uris":[""],"uri":[""],"itemData":{"id":1631,"type":"article-journal","title":"Meningiomas and Postoperative Epilepsy: It is Time for a Randomized Controlled Clinical Trial","container-title":"World Neurosurgery","page":"431-432","volume":"79","issue":"3–4","source":"ScienceDirect","DOI":"10.1016/j.wneu.2012.06.004","ISSN":"1878-8750","shortTitle":"Meningiomas and Postoperative Epilepsy","journalAbbreviation":"World Neurosurgery","author":[{"family":"Tomasello","given":"Francesco"}],"issued":{"date-parts":[["2013",3]]}}}],"schema":""} 15,16 The aim of this study was to perform a systematic literature review to determine the association between prophylactic AEDs and the risk of post-operative epilepsy in seizure-na?ve patients undergoing meningioma resection.MethodsStudy selectionA?filtered literature search was performed using the US National Library of Medicine PubMed database. Filters applied were Language, which had been set as English, and a date range from 01/01/1990 to 30/11/2016. The search term utilised was ("Meningioma"[Mesh] AND ("Postoperative Period"[Mesh] OR "Postoperative Complications"[Mesh] OR "Treatment Outcome"[Mesh] OR "Epilepsy"[Mesh] OR "Seizures"[Mesh] OR "Risk Assessment"[Mesh])) OR ("Meningioma" AND ("Treatment Outcome" OR "Epilepsy" OR "Seizures")). This term incorporated Medical Subject Headings (MeSH) in conjunction with their counterpart keywords to ensure that relevant MeSH-unindexed records were included. The titles of all results were screened. Abstracts were reviewed with titles that mentioned intracranial meningiomas or brain tumours in combination with seizure, epilepsy, antiepileptic drugs, surgical outcome or anything of similar construct. Full-text articles were inspected if from the abstracts the number of seizure-na?ve meningioma patients could be discerned to be more than 15 and if reported outcomes could have possibly incorporated seizures or epilepsy. For inclusion, full-text articles were subjected to the following selection criteria: The number of seizure-na?ve meningioma patients ≥ 15.The duration of follow-up ≥?1 month.The neurosurgical approach was craniotomy based.Post-operative seizure data was available for seizure-na?ve patients.A clear statement on whether prophylactic AEDs had been used or not was present. Data for patients < 16 years of age was omitted. A?reference list search on all relevant papers?was also undertaken to identify any further relevant studies. The search was carried out by A.I.I, S.M and T-E.K-O. Articles identified were only included upon mutual agreement. Corresponding authors of articles that created a dispute amongst the authors due to their ambiguity were contacted via e-mail by A.I.I to ascertain additional data that could help resolve such disputes. Articles for whom authors did not provide a response were dismissed. Records supplemented by further communications were reviewed again and included upon mutual agreement. M.D.J verified and approved the final set of papers. Data extractionPatient characteristics, study type (retrospective, prospective, randomised controlled trial), AED use and post-operative outcomes were recorded. The outcomes of interest were extent of resection (as defined by each study), occurrence of post-operative seizures, and AED-associated adverse reactions. For each study, patients were divided into two cohorts: patients that received prophylactic AEDs and those who did not. Seizures?occurring?within one week of surgery were classed as "early”, and "late" if they occurred after one week. Data for all seizure-na?ve patients were recorded when available including: age, gender,?features of meningioma, and AED used.Statistical analysisDue to limitations in the available data and variation in outcome reporting it was not possible to perform a detailed meta-analysis. Descriptive statistics were used. For comparisons between the cohorts receiving AED prophylaxis and those not, Chi-square test was employed. Differences were considered to be statistically significant at P < 0.05. Statistical analyses were conducted using IBM SPSS Version 24.0 (SPSS Inc.).ResultsLiterature SearchFigure 1 describes the study selection process. The filtered PubMed search identified 2,321 records. The number of abstracts screened was 254, and the full-text articles of 114 of those abstracts were reviewed. The initial number of articles excluded and included was 99 and 8 respectively. The corresponding authors of 7 articles were contacted and only 3 of those articles were included in the final analysis. No additional articles were identified on review of references. The final number of articles included was 11, with an overall population of 1,473 patients.Study characteristicsThe characteristics of the 11 studies are summarised in table 1. Eight papers investigated meningioma resection in patients that received prophylactic AEDs: 3 prospective ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"AKtpIsdU","properties":{"formattedCitation":"(10,17,18)","plainCitation":"(10,17,18)"},"citationItems":[{"id":1568,"uris":[""],"uri":[""],"itemData":{"id":1568,"type":"article-journal","title":"Prospective Study of Postoperative Seizure in Intracranial Meningioma","container-title":"Psychiatry and Clinical Neurosciences","page":"331-334","volume":"47","issue":"2","source":"Wiley Online Library","DOI":"10.1111/j.1440-1819.1993.tb02094.x","ISSN":"1440-1819","language":"en","author":[{"family":"Tsuji","given":"Masahiro"},{"family":"Shinomiya","given":"Shigeko"},{"family":"Inoue","given":"Reiichi"},{"family":"Sato","given":"Kiyoshi"}],"issued":{"date-parts":[["1993",6,1]]}}},{"id":107,"uris":[""],"uri":[""],"itemData":{"id":107,"type":"article-journal","title":"The value of routine electroencephalographic recordings in predicting postoperative seizures associated with meningioma surgery","container-title":"Neurosurgical Review","page":"108-112","volume":"26","issue":"2","source":"link.","abstract":". We analyzed the incidence of postoperative seizures in patients undergoing craniotomy for meningioma removal in order to determine whether EEG recordings are able to predict the incidence of postoperative seizures. We included 102 patients who had undergone surgery on intracranial meningiomas. Pre- and postoperative EEG images were divided into groups showing epileptiform activity including spikes or sharp waves, focal slowing, and normal activity. Follow-up was carried out using a standardized telephone questionnaire by an independent investigator after a mean of 889 days. Seizure outcome was determined by patient reports to the interviewer. Preoperatively obtained, abnormal EEGs correlated significantly to preoperative seizures (P<0.0005), but neither preoperative nor postoperative EEGs correlated to the incidence of postoperative seizures. It would seem that, while evaluation of some clinical parameters revealed a statistically significant correlation, pre- and early postoperative EEGs after meningioma surgery are not useful in determining the risk of postoperative seizures.","DOI":"10.1007/s10143-002-0240-y","ISSN":"0344-5607, 1437-2320","journalAbbreviation":"Neurosurg Rev","language":"en","author":[{"family":"Rothoerl","given":"Ralf D."},{"family":"Bernreuther","given":"D."},{"family":"Woertgen","given":"C."},{"family":"Brawanski","given":"A."}],"issued":{"date-parts":[["2002",10,10]]}}},{"id":112,"uris":[""],"uri":[""],"itemData":{"id":112,"type":"article-journal","title":"Tuberculum and diaphragma sella meningioma – surgical technique and visual outcome in a series of 20 cases operated over a 2.5-year period","container-title":"Acta Neurochirurgica","page":"1199-1204","volume":"149","issue":"12","source":"link.","abstract":"Summary Background. A retrospective analysis of 20 cases of tuberculum sella meningioma with emphasis on the surgical technique and visual outcome. Methods. Between 2003 and 2006 twenty patients with tuberculum and diaphragma sella meningioma were treated at the Tel Aviv medical center. There were 17 females and 3 males. The age range was 28–83. Most patients presented with visual deterioration. Surgery was performed using the subfrontal approach. The visual function before and after surgery was evaluated as the main outcome parameter of the surgical treatment of these tumours. Findings. In 16 patients complete tumour resection was achieved and in 4 subtotal removal was performed. Visual acuity improved in 32% of the eyes and deterioration was observed in two eyes (5%). Visual field improved in 28% of the eyes and deteriorated in 14%. There was no complete vision loss as a result of surgery. There was no mortality in our series. Conclusions. Tuberculum and diaphragma sella meningioma can be safely resected using the subfrontal approach with preservation and even improvement of visual function after surgery. Early surgery with better pre-operation visual function and smaller tumour size were associated with a better outcome.","DOI":"10.1007/s00701-007-1280-4","ISSN":"0001-6268, 0942-0940","journalAbbreviation":"Acta Neurochir (Wien)","language":"en","author":[{"family":"Margalit","given":"N."},{"family":"Kesler","given":"A."},{"family":"Ezer","given":"H."},{"family":"Freedman","given":"S."},{"family":"Ram","given":"Z."}],"issued":{"date-parts":[["2007",10,29]]}}}],"schema":""} 10,17,18 and 5 retrospective. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"4YfSp6x6","properties":{"formattedCitation":"{\\rtf (19\\uc0\\u8211{}23)}","plainCitation":"(19–23)"},"citationItems":[{"id":118,"uris":[""],"uri":[""],"itemData":{"id":118,"type":"article-journal","title":"Tuberculum sellae meningiomas: Microsurgical anatomy and surgical technique","container-title":"NEUROSURGERY","page":"1432-1439","volume":"51","issue":"6","source":"EBSCOHost","abstract":"OBJECTIVE: Despite Cushing's accurate description of the anatomic origin of tuber-culum sellae meningiomas, many subsequent authors have included tumors originating from the neighboring Sella region in this classification. This has led to difficulty in evaluating the surgical results and consensus for an optimal surgical technique. W e think this confusion has arisen from Cushing's description of these tumors under,the heading \"suprasellar meningiomas,\" which referred-to their distinctive clinical symptoms toms and not their anatomic origin. We describe the microsurgical anatomy and tumor, growth patterns to reemphasize the original classification of Cushing's tuberculum sellae meningiomas. Additionally, we describe our surgical approach, which creases the risk of injury to anterior visual pathways and anterior cerebral circulation arteries.","ISSN":"0148396X","shortTitle":"Tuberculum sellae meningiomas","journalAbbreviation":"NEUROSURGERY","author":[{"family":"Jallo","given":"Gi"},{"family":"Benjamin","given":"V"}],"issued":{"date-parts":[["2002",12]]}}},{"id":126,"uris":[""],"uri":[""],"itemData":{"id":126,"type":"article-journal","title":"Surgical management of tuberculum sellae meningioma: Role of selective extradural anterior clinoidectomy","container-title":"British Journal of Neurosurgery","page":"129-138","volume":"20","issue":"3","source":"EBSCOhost","abstract":"A retrospective analysis of 32 patients with tuberculum sellae meningiomas who underwent surgery via a unilateral pterional approach was performed. A selective extradural anterior clinoidectomy (SEAC) technique was added in 20 patients. All patients had visual dysfunction preoperatively. Macroscopically complete removal with Simpson grade II was performed in 28 patients (87.5%). The postoperative visual function improved in 25 (78.1%), did not change in 3 (9.4%), and worsened in 4 patients (12.5%). The SEAC technique was effective, especially for removal of the tumour extending into the sellae/pituitary stalk (9 patients), the optic canal (4 patients) and hypothalamus (4 patients) with preservation of the visual and endocrinological function. These results were superior to those of surgery without SEAC technique. This technique is therefore recommended for complete resection of the tuberculum sellae meningiomas extending to the surrounding anatomical structures as the SEAC procedure reduces the risk of intraoperative optic nerve injury considerably.","DOI":"10.1080/02688690600776747","ISSN":"02688697","shortTitle":"Surgical management of tuberculum sellae meningioma","journalAbbreviation":"British Journal of Neurosurgery","author":[{"family":"Otani","given":"Naoki"},{"family":"Muroi","given":"Carl"},{"family":"Yano","given":"Hirohito"},{"family":"Khan","given":"Nadia"},{"family":"Pangalu","given":"Athina"},{"family":"Yonekawa","given":"Yasuhiro"}],"issued":{"date-parts":[["2006",6]]}}},{"id":121,"uris":[""],"uri":[""],"itemData":{"id":121,"type":"article-journal","title":"Giant olfactory groove meningioma: ophthalmological and cognitive outcome after bifrontal microsurgical approach","container-title":"ACTA NEUROCHIRURGICA","page":"1117-1126","volume":"150","issue":"11","source":"EBSCOHost","abstract":"Olfactory groove meningiomas arise in the midline along the dura of the cribriform plate and may reach a large size before producing symptoms. We conducted a retrospective study of patients with these lesions focused on pre- and post-operative investigations for ophthalmological, personality and cognitive disturbances.","ISSN":"00016268","shortTitle":"Giant olfactory groove meningioma","journalAbbreviation":"ACTA NEUROCHIRURGICA","author":[{"family":"Gazzeri","given":"R"},{"family":"Galarza","given":"M"},{"family":"Gazzeri","given":"G"}],"issued":{"date-parts":[["2008",11]]}}},{"id":129,"uris":[""],"uri":[""],"itemData":{"id":129,"type":"article-journal","title":"Outcome comparison between younger and older patients undergoing intracranial meningioma resections","container-title":"Journal of Neuro-Oncology","page":"219-227","volume":"114","issue":"2","source":"link.","abstract":"Studies directly comparing the outcomes of intracranial meningioma resection between elderly and younger patients are currently limited. This study aimed to assess the perioperative complications, mortalities and functional outcomes in these two groups. Consecutive elderly patients (aged ≥65) and tumor-location-matched younger patients who underwent intracranial meningioma resections were retrospectively reviewed. Outcomes were assessed at 30-day, 90-day, 6-month and 1-year. We used a standardized classification of operative complications, and conducted subgroup analyses based on tumor location [convexity, parasagittal and falcine (CPF) as one group; skull base (SB) as another]. There were 92 patients in each group. The mean age was 74.6 ± 6.4 years in the elderly and 49.3 ± 10.1 years in the younger groups. The cumulative 30-day, 90-day and 1-year mortality rates were 0, 2.2 and 4.3 % for the elderly, respectively, and 1.1 % for all time points in the young. These differences were not statistically significant. Overall, the elderly suffered from more perioperative complications (P = 0.010), and these were mostly minor complications according to the classification of operative complications. However, these differences were observed only in the SB but not in the CPF subgroup. More elderly patients had impaired functional outcome 1-year after surgery. Significantly more elderly patients had new neurological deficits 1-year after surgery (26.1 vs. 6.6 %; P = 0.001). Comparable mortality rates were observed in elderly and younger patients. However, the elderly had more minor complications and poorer functional outcomes. Patient selection remains key to good clinical outcome.","DOI":"10.1007/s11060-013-1173-8","ISSN":"0167-594X, 1573-7373","journalAbbreviation":"J Neurooncol","language":"en","author":[{"family":"Poon","given":"Michael Tin-Chung"},{"family":"Fung","given":"Linus Hing-Kai"},{"family":"Pu","given":"Jenny Kan-Suen"},{"family":"Leung","given":"Gilberto Ka-Kit"}],"issued":{"date-parts":[["2013",6,5]]}}},{"id":85,"uris":[""],"uri":[""],"itemData":{"id":85,"type":"article-journal","title":"Open Transcranial Resection of Small (<35 mm) Meningiomas of the Anterior Midline Skull Base in Current Microsurgical Practice","container-title":"World Neurosurgery","page":"741-750","volume":"84","issue":"3","source":"ScienceDirect","abstract":"Objective\nDespite technical surgical advance, the ultimate management of midline anterior skull base meningiomas remains to be defined. Open transcranial surgery is usually the first treatment option for large meningiomas, while less invasive techniques such as endoscopic surgery or radiosurgery might represent an alternative to open microsurgery for smaller lesions. The aim of our study is to investigate the outcome of open transcranial microsurgery in the resection of small (&lt;35 mm) meningiomas of the midline anterior cranial base.\nMethods\nClinical and surgical data from 43 patients affected by small midline anterior skull base meningiomas operated via an open transcranial approach were retrospectively reviewed.\nResults\nThe tumor diameter on its major axis ranged from 12 to 35 mm, with a mean diameter of 28 mm. Gross total resection (Simpson grades I–II) was achieved in 100% of cases through a pterional approach. Postoperative overall morbidity was 9%. It was 3% among patients &lt;70 years. No mortality was reported. Postoperative visual outcome was significantly associated with preoperative visual performance (P?= 0.02), but not with preoperative optic nerve compression as detected by magnetic resonance imaging (P?= 0.116). Age &gt;70 years was associated with postoperative visual impairment, although not significantly (P?= 0.06). Visual function was preserved or improved in 95% of cases, in 100% of patients &lt;70 years, and in 71% of patients with preoperative visual impairment.\nConclusions\nIn our experience, open transcranial surgery proved safe and effective for midline anterior skull base meningiomas smaller than 35 mm in all patients &lt;70 years and in patients &gt;70 years without preoperative visual deficit. Our data are consistent with the literature. Conversely, the standard of treatment for the subgroup of patients &gt;70 years with preoperative visual deficit has not yet been defined. This specific subgroup of patients offers a topic for further investigation.","DOI":"10.1016/j.wneu.2015.04.055","ISSN":"1878-8750","journalAbbreviation":"World Neurosurgery","author":[{"family":"Della Puppa","given":"Alessandro"},{"family":"Avella","given":"Elena","non-dropping-particle":"d’"},{"family":"Rossetto","given":"Marta"},{"family":"Volpin","given":"Francesco"},{"family":"Rustemi","given":"Oriela"},{"family":"Gioffrè","given":"Giorgio"},{"family":"Lombardi","given":"Giuseppe"},{"family":"Rolma","given":"Giuseppe"},{"family":"Scienza","given":"Renato"}],"issued":{"date-parts":[["2015",9]]}}}],"schema":""} 19–23 One prospective study investigated meningioma resection in patients that were not administered AEDs. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gTXonCCa","properties":{"formattedCitation":"(24)","plainCitation":"(24)"},"citationItems":[{"id":133,"uris":[""],"uri":[""],"itemData":{"id":133,"type":"article-journal","title":"Outcome following surgery for intracranial meningiomas in the aging","container-title":"Acta Neurologica Scandinavica","page":"161-169","volume":"127","issue":"3","source":"Wiley Online Library","abstract":"Objective\n\nTo prospectively assess mortality, morbidity and the functional and symptomatic outcome following intracranial surgery for meningiomas in elderly patients at two neurosurgical institutions in Norway.\n\n\nMethods\n\nPatients ≥60?years who underwent craniotomies for intracranial meningiomas at Oslo University Hospital and Haukeland University Hospital in 2008 and 2009 were included (n?=?54). Outcome was assessed at 6?months.\n\n\nResults\n\nThirty-five females and 19 males of median age 70 (60–84)?years were assessed pre- and post-operatively, 87% attended follow-up at 6?months. The surgical mortality rate was 5.6% at 30?days and 7.4% at 3 and 6?months. The rates of complications were: post-operative hematomas 5.6%, deep venous thrombosis 1.9%, osteitis 1.9%, cerebrospinal fluid disturbances 13.0% and neurological sequelae 13.0%. Surgery resulted in a significant improvement in the MMSE score, with a further 14.9% obtaining scores of ≥25 without a significant change in the level of independence according to the Karnofsky performance scale. QoL assessments showed good functioning post-operatively compared to other cancer patient groups, yet slightly reduced when compared to data from the general population.\n\n\nConclusion\n\nIn our series, we found that meningioma surgery in the aging patient carries a higher risk of mortality and morbidity compared to intracranial tumor surgery in general. Our findings indicate, however, that the survivors have improved cognitive function and acceptable QoL, and we did not see any significant decrease in the proportion of independent patients according to the KPS.","DOI":"10.1111/j.1600-0404.2012.01692.x","ISSN":"1600-0404","journalAbbreviation":"Acta Neurol Scand","language":"en","author":[{"family":"Konglund","given":"A."},{"family":"Rogne","given":"S. G."},{"family":"Lund-Johansen","given":"M."},{"family":"Scheie","given":"D."},{"family":"Helseth","given":"E."},{"family":"Meling","given":"T. R."}],"issued":{"date-parts":[["2013",3,1]]}}}],"schema":""} 24 The remaining 2 papers were retrospective and had mixed cohorts. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Sryk6m6o","properties":{"formattedCitation":"(11,25)","plainCitation":"(11,25)"},"citationItems":[{"id":23,"uris":[""],"uri":[""],"itemData":{"id":23,"type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"date-parts":[["2011",3]]}}},{"id":12,"uris":[""],"uri":[""],"itemData":{"id":12,"type":"article-journal","title":"Predicting outcome of epilepsy after meningioma resection","container-title":"Neuro-Oncology","page":"nov303","source":"neuro-oncology.","abstract":"Background Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.\nMethods Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.\nResults Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32–5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53–22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35–7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25–6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17–5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36–4.67]), younger age (OR: 1.74 [(95% CI: 1.18–2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16–3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25–0.85], P = .013).\nConclusion We suggest prospective validation of a score (“STAMPE2”) based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.","DOI":"10.1093/neuonc/nov303","ISSN":"1522-8517, 1523-5866","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Wirsching","given":"Hans-Georg"},{"family":"Morel","given":"Corinne"},{"family":"Gmür","given":"Corinne"},{"family":"Neidert","given":"Marian Christoph"},{"family":"Baumann","given":"Christian Richard"},{"family":"Valavanis","given":"Antonios"},{"family":"Rushing","given":"Elisabeth Jane"},{"family":"Krayenbühl","given":"Niklaus"},{"family":"Weller","given":"Michael"}],"issued":{"date-parts":[["2015",12,18]]}}}],"schema":""} 11,25 The occurrence of post-operative seizures was the primary investigated outcome in only 4 studies. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"WwQK18JZ","properties":{"formattedCitation":"(10,11,17,25)","plainCitation":"(10,11,17,25)"},"citationItems":[{"id":"xyJOXs15/bpvpzwwf","uris":[""],"uri":[""],"itemData":{"id":"xyJOXs15/bpvpzwwf","type":"article-journal","title":"Predicting outcome of epilepsy after meningioma resection","container-title":"Neuro-Oncology","page":"nov303","source":"neuro-oncology.","abstract":"Background Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.\nMethods Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.\nResults Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32–5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53–22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35–7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25–6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17–5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36–4.67]), younger age (OR: 1.74 [(95% CI: 1.18–2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16–3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25–0.85], P = .013).\nConclusion We suggest prospective validation of a score (“STAMPE2”) based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.","DOI":"10.1093/neuonc/nov303","ISSN":"1522-8517, 1523-5866","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Wirsching","given":"Hans-Georg"},{"family":"Morel","given":"Corinne"},{"family":"Gmür","given":"Corinne"},{"family":"Neidert","given":"Marian Christoph"},{"family":"Baumann","given":"Christian Richard"},{"family":"Valavanis","given":"Antonios"},{"family":"Rushing","given":"Elisabeth Jane"},{"family":"Krayenbühl","given":"Niklaus"},{"family":"Weller","given":"Michael"}],"issued":{"year":2015,"month":12,"day":18},"page-first":"nov303","container-title-short":"Neuro-Oncol."}},{"id":"xyJOXs15/xhEtz3ZM","uris":[""],"uri":[""],"itemData":{"id":"xyJOXs15/xhEtz3ZM","type":"article-journal","title":"Prospective Study of Postoperative Seizure in Intracranial Meningioma","container-title":"Psychiatry and Clinical Neurosciences","page":"331-334","volume":"47","issue":"2","source":"Wiley Online Library","DOI":"10.1111/j.1440-1819.1993.tb02094.x","ISSN":"1440-1819","language":"en","author":[{"family":"Tsuji","given":"Masahiro"},{"family":"Shinomiya","given":"Shigeko"},{"family":"Inoue","given":"Reiichi"},{"family":"Sato","given":"Kiyoshi"}],"issued":{"year":1993,"month":6,"day":1},"page-first":"331","container-title-short":"Psychiatry Clin. Neurosci."}},{"id":"xyJOXs15/3XuXGiAh","uris":[""],"uri":[""],"itemData":{"id":"xyJOXs15/3XuXGiAh","type":"article-journal","title":"The value of routine electroencephalographic recordings in predicting postoperative seizures associated with meningioma surgery","container-title":"Neurosurgical Review","page":"108-112","volume":"26","issue":"2","source":"link.","abstract":". We analyzed the incidence of postoperative seizures in patients undergoing craniotomy for meningioma removal in order to determine whether EEG recordings are able to predict the incidence of postoperative seizures. We included 102 patients who had undergone surgery on intracranial meningiomas. Pre- and postoperative EEG images were divided into groups showing epileptiform activity including spikes or sharp waves, focal slowing, and normal activity. Follow-up was carried out using a standardized telephone questionnaire by an independent investigator after a mean of 889 days. Seizure outcome was determined by patient reports to the interviewer. Preoperatively obtained, abnormal EEGs correlated significantly to preoperative seizures (P<0.0005), but neither preoperative nor postoperative EEGs correlated to the incidence of postoperative seizures. It would seem that, while evaluation of some clinical parameters revealed a statistically significant correlation, pre- and early postoperative EEGs after meningioma surgery are not useful in determining the risk of postoperative seizures.","DOI":"10.1007/s10143-002-0240-y","ISSN":"0344-5607, 1437-2320","journalAbbreviation":"Neurosurg Rev","language":"en","author":[{"family":"Rothoerl","given":"Ralf D."},{"family":"Bernreuther","given":"D."},{"family":"Woertgen","given":"C."},{"family":"Brawanski","given":"A."}],"issued":{"year":2002,"month":10,"day":10},"page-first":"108","container-title-short":"Neurosurg. Rev."}},{"id":"xyJOXs15/mEdflEXo","uris":[""],"uri":[""],"itemData":{"id":"xyJOXs15/mEdflEXo","type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"year":2011,"month":3},"page-first":"705","title-short":"Postoperative seizures following the resection of convexity meningiomas","container-title-short":"J. Neurosurg."}}],"schema":""} 10,11,17,25 One study was multi-centred ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vcJl6SiQ","properties":{"formattedCitation":"(24)","plainCitation":"(24)"},"citationItems":[{"id":"3MuUnfCE/Jz7ceP91","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/Jz7ceP91","type":"article-journal","title":"Outcome following surgery for intracranial meningiomas in the aging","container-title":"Acta Neurologica Scandinavica","page":"161-169","volume":"127","issue":"3","source":"Wiley Online Library","abstract":"Objective\n\nTo prospectively assess mortality, morbidity and the functional and symptomatic outcome following intracranial surgery for meningiomas in elderly patients at two neurosurgical institutions in Norway.\n\n\nMethods\n\nPatients ≥60?years who underwent craniotomies for intracranial meningiomas at Oslo University Hospital and Haukeland University Hospital in 2008 and 2009 were included (n?=?54). Outcome was assessed at 6?months.\n\n\nResults\n\nThirty-five females and 19 males of median age 70 (60–84)?years were assessed pre- and post-operatively, 87% attended follow-up at 6?months. The surgical mortality rate was 5.6% at 30?days and 7.4% at 3 and 6?months. The rates of complications were: post-operative hematomas 5.6%, deep venous thrombosis 1.9%, osteitis 1.9%, cerebrospinal fluid disturbances 13.0% and neurological sequelae 13.0%. Surgery resulted in a significant improvement in the MMSE score, with a further 14.9% obtaining scores of ≥25 without a significant change in the level of independence according to the Karnofsky performance scale. QoL assessments showed good functioning post-operatively compared to other cancer patient groups, yet slightly reduced when compared to data from the general population.\n\n\nConclusion\n\nIn our series, we found that meningioma surgery in the aging patient carries a higher risk of mortality and morbidity compared to intracranial tumor surgery in general. Our findings indicate, however, that the survivors have improved cognitive function and acceptable QoL, and we did not see any significant decrease in the proportion of independent patients according to the KPS.","DOI":"10.1111/j.1600-0404.2012.01692.x","ISSN":"1600-0404","journalAbbreviation":"Acta Neurol Scand","language":"en","author":[{"family":"Konglund","given":"A."},{"family":"Rogne","given":"S. G."},{"family":"Lund-Johansen","given":"M."},{"family":"Scheie","given":"D."},{"family":"Helseth","given":"E."},{"family":"Meling","given":"T. R."}],"issued":{"year":2013,"month":3,"day":1},"page-first":"161","container-title-short":"Acta Neurol. Scand."}}],"schema":""} 24 whilst the rest were single-institution studies. There were no prospective randomised controlled trials. Patient characteristicsThe total number of patients was 1,473, with a mean age of 56.8 years (range 18-95 years). The follow-up period ranged from 1 to 222 months. For the purpose of this systematic review, only seizure-na?ve patients were included (n = 1,143). A total of 766 patients who received prophylaxis constituted the AED cohort. The remaining 377 patients formed the No-AED cohort. The differences in proportions of non-skull base (% of valid cases = 29.5; 100% vs 46.9%; P < 0.05) and WHO grade I (% of valid cases = 64.8; 85.7% vs 75.2%; P < 0.05) meningiomas amongst the two cohorts were statistically significant. The remaining characteristics, detailed in table 2, were either balanced or incomparable. Antiepileptic drug characteristicsThe AEDs that were utilised in seizure-na?ve patients are detailed in table 3. Selected doses for AEDs were not reported. Duration of AED administration was only described in 1 study, where patients received a one week treatment course post-operatively. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"F5GxyvjN","properties":{"formattedCitation":"(11)","plainCitation":"(11)"},"citationItems":[{"id":23,"uris":[""],"uri":[""],"itemData":{"id":23,"type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"date-parts":[["2011",3]]}}}],"schema":""} 11 No studies reported whether pre-operative AEDs were switched post-operatively in peri-operative prophylaxis. The discontinuation or withdrawal process was not outlined in any of the studies. Post-operative outcomesExtent of resectionExtent of resection was reported for seizure-na?ve patients in 6 of the 11 studies. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"U39gombK","properties":{"formattedCitation":"(10,11,18,19,23,25)","plainCitation":"(10,11,18,19,23,25)"},"citationItems":[{"id":"3MuUnfCE/1vSHCm81","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/1vSHCm81","type":"article-journal","title":"Prospective Study of Postoperative Seizure in Intracranial Meningioma","container-title":"Psychiatry and Clinical Neurosciences","page":"331-334","volume":"47","issue":"2","source":"Wiley Online Library","DOI":"10.1111/j.1440-1819.1993.tb02094.x","ISSN":"1440-1819","language":"en","author":[{"family":"Tsuji","given":"Masahiro"},{"family":"Shinomiya","given":"Shigeko"},{"family":"Inoue","given":"Reiichi"},{"family":"Sato","given":"Kiyoshi"}],"issued":{"year":1993,"month":6,"day":1},"page-first":"331","container-title-short":"Psychiatry Clin. Neurosci."}},{"id":"3MuUnfCE/LxCaVS2N","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/LxCaVS2N","type":"article-journal","title":"Tuberculum sellae meningiomas: Microsurgical anatomy and surgical technique","container-title":"NEUROSURGERY","page":"1432-1439","volume":"51","issue":"6","source":"EBSCOHost","abstract":"OBJECTIVE: Despite Cushing's accurate description of the anatomic origin of tuber-culum sellae meningiomas, many subsequent authors have included tumors originating from the neighboring Sella region in this classification. This has led to difficulty in evaluating the surgical results and consensus for an optimal surgical technique. W e think this confusion has arisen from Cushing's description of these tumors under,the heading \"suprasellar meningiomas,\" which referred-to their distinctive clinical symptoms toms and not their anatomic origin. We describe the microsurgical anatomy and tumor, growth patterns to reemphasize the original classification of Cushing's tuberculum sellae meningiomas. Additionally, we describe our surgical approach, which creases the risk of injury to anterior visual pathways and anterior cerebral circulation arteries.","ISSN":"0148396X","shortTitle":"Tuberculum sellae meningiomas","journalAbbreviation":"NEUROSURGERY","author":[{"family":"Jallo","given":"Gi"},{"family":"Benjamin","given":"V"}],"issued":{"year":2002,"month":12},"page-first":"1432","title-short":"Tuberculum sellae meningiomas","container-title-short":"NEUROSURGERY"}},{"id":"3MuUnfCE/7YKh32Yf","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/7YKh32Yf","type":"article-journal","title":"Tuberculum and diaphragma sella meningioma – surgical technique and visual outcome in a series of 20 cases operated over a 2.5-year period","container-title":"Acta Neurochirurgica","page":"1199-1204","volume":"149","issue":"12","source":"link.","abstract":"Summary Background. A retrospective analysis of 20 cases of tuberculum sella meningioma with emphasis on the surgical technique and visual outcome. Methods. Between 2003 and 2006 twenty patients with tuberculum and diaphragma sella meningioma were treated at the Tel Aviv medical center. There were 17 females and 3 males. The age range was 28–83. Most patients presented with visual deterioration. Surgery was performed using the subfrontal approach. The visual function before and after surgery was evaluated as the main outcome parameter of the surgical treatment of these tumours. Findings. In 16 patients complete tumour resection was achieved and in 4 subtotal removal was performed. Visual acuity improved in 32% of the eyes and deterioration was observed in two eyes (5%). Visual field improved in 28% of the eyes and deteriorated in 14%. There was no complete vision loss as a result of surgery. There was no mortality in our series. Conclusions. Tuberculum and diaphragma sella meningioma can be safely resected using the subfrontal approach with preservation and even improvement of visual function after surgery. Early surgery with better pre-operation visual function and smaller tumour size were associated with a better outcome.","DOI":"10.1007/s00701-007-1280-4","ISSN":"0001-6268, 0942-0940","journalAbbreviation":"Acta Neurochir (Wien)","language":"en","author":[{"family":"Margalit","given":"N."},{"family":"Kesler","given":"A."},{"family":"Ezer","given":"H."},{"family":"Freedman","given":"S."},{"family":"Ram","given":"Z."}],"issued":{"year":2007,"month":10,"day":29},"page-first":"1199","container-title-short":"Acta Neurochir. (Wien)"}},{"id":"3MuUnfCE/fxzlm1qr","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/fxzlm1qr","type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"year":2011,"month":3},"page-first":"705","title-short":"Postoperative seizures following the resection of convexity meningiomas","container-title-short":"J. Neurosurg."}},{"id":"3MuUnfCE/fFdXWGGF","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/fFdXWGGF","type":"article-journal","title":"Open Transcranial Resection of Small (<35 mm) Meningiomas of the Anterior Midline Skull Base in Current Microsurgical Practice","container-title":"World Neurosurgery","page":"741-750","volume":"84","issue":"3","source":"ScienceDirect","abstract":"Objective\nDespite technical surgical advance, the ultimate management of midline anterior skull base meningiomas remains to be defined. Open transcranial surgery is usually the first treatment option for large meningiomas, while less invasive techniques such as endoscopic surgery or radiosurgery might represent an alternative to open microsurgery for smaller lesions. The aim of our study is to investigate the outcome of open transcranial microsurgery in the resection of small (&lt;35 mm) meningiomas of the midline anterior cranial base.\nMethods\nClinical and surgical data from 43 patients affected by small midline anterior skull base meningiomas operated via an open transcranial approach were retrospectively reviewed.\nResults\nThe tumor diameter on its major axis ranged from 12 to 35 mm, with a mean diameter of 28 mm. Gross total resection (Simpson grades I–II) was achieved in 100% of cases through a pterional approach. Postoperative overall morbidity was 9%. It was 3% among patients &lt;70 years. No mortality was reported. Postoperative visual outcome was significantly associated with preoperative visual performance (P?= 0.02), but not with preoperative optic nerve compression as detected by magnetic resonance imaging (P?= 0.116). Age &gt;70 years was associated with postoperative visual impairment, although not significantly (P?= 0.06). Visual function was preserved or improved in 95% of cases, in 100% of patients &lt;70 years, and in 71% of patients with preoperative visual impairment.\nConclusions\nIn our experience, open transcranial surgery proved safe and effective for midline anterior skull base meningiomas smaller than 35 mm in all patients &lt;70 years and in patients &gt;70 years without preoperative visual deficit. Our data are consistent with the literature. Conversely, the standard of treatment for the subgroup of patients &gt;70 years with preoperative visual deficit has not yet been defined. This specific subgroup of patients offers a topic for further investigation.","DOI":"10.1016/j.wneu.2015.04.055","ISSN":"1878-8750","journalAbbreviation":"World Neurosurgery","author":[{"family":"Della Puppa","given":"Alessandro"},{"family":"Avella","given":"Elena","non-dropping-particle":"d’"},{"family":"Rossetto","given":"Marta"},{"family":"Volpin","given":"Francesco"},{"family":"Rustemi","given":"Oriela"},{"family":"Gioffrè","given":"Giorgio"},{"family":"Lombardi","given":"Giuseppe"},{"family":"Rolma","given":"Giuseppe"},{"family":"Scienza","given":"Renato"}],"issued":{"year":2015,"month":9},"page-first":"741","container-title-short":"World Neurosurg."}},{"id":"3MuUnfCE/gAh8ueKG","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/gAh8ueKG","type":"article-journal","title":"Predicting outcome of epilepsy after meningioma resection","container-title":"Neuro-Oncology","page":"nov303","source":"neuro-oncology.","abstract":"Background Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.\nMethods Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.\nResults Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32–5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53–22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35–7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25–6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17–5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36–4.67]), younger age (OR: 1.74 [(95% CI: 1.18–2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16–3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25–0.85], P = .013).\nConclusion We suggest prospective validation of a score (“STAMPE2”) based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.","DOI":"10.1093/neuonc/nov303","ISSN":"1522-8517, 1523-5866","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Wirsching","given":"Hans-Georg"},{"family":"Morel","given":"Corinne"},{"family":"Gmür","given":"Corinne"},{"family":"Neidert","given":"Marian Christoph"},{"family":"Baumann","given":"Christian Richard"},{"family":"Valavanis","given":"Antonios"},{"family":"Rushing","given":"Elisabeth Jane"},{"family":"Krayenbühl","given":"Niklaus"},{"family":"Weller","given":"Michael"}],"issued":{"year":2015,"month":12,"day":18},"page-first":"nov303","container-title-short":"Neuro-Oncol."}}],"schema":""} 10,11,18,19,23,25 In the AED cohort, gross total resection (GTR) was achieved in 86.5% (410 of 474) patients. In the no-AED cohort, GTR was achieved in 76.3% (261 of 342) patients. The difference in the proportions of GTR between the two cohorts was statistically significant (table 4; P < 0.05).Antiepileptic drug use and post-operative?seizuresOut of 1,143 seizure-na?ve patients, 766 received prophylactic AEDs peri or post-operatively. Early post-operative seizures occurred in 2.6% of patients (20 of 766). In the no-AED cohort of 377 patients, early post-operative seizures occurred in 2.7% of patients (10 of 377). The occurrence of late post-operative seizures was similarly low in the prophylactic AED group; 52 of 766 patients (6.8%) and the no-AED group; 29 of 377 patients (7.7%). There was no statistically significant difference in early seizure rates (P = 0.96), late seizure rates (P = 0.58) and the overall seizure rates (P = 0.62) (table 4). Antiepileptic drug-related adverse effects The adverse effects of AEDs or possible consequential changes or discontinuations to the AED regimens were not noted in any of the included studies.DiscussionSeizures, as a clinical manifestation of meningiomas, arise in an estimated 14-50% of cases. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"62l5k5q8e","properties":{"formattedCitation":"{\\rtf (26\\uc0\\u8211{}30)}","plainCitation":"(26–30)"},"citationItems":[{"id":1577,"uris":[""],"uri":[""],"itemData":{"id":1577,"type":"article-journal","title":"Clinicopathologic analysis of 615 cases of meningioma with special reference to recurrence","container-title":"Journal of the Formosan Medical Association = Taiwan Yi Zhi","page":"145-152","volume":"93","issue":"2","source":"PubMed","abstract":"A total of 615 cases of meningioma operated on from 1959 to 1992 at National Taiwan University Hospital were reviewed. Factors influencing tumor recurrence were also evaluated. Of the 566 patients with intracranial meningioma, 350 were females and 216 were males (F:M = 1.6:1). The mean age was 47.5 years. The distribution of histologic type was: 232 meningothelial (41%), 141 transitional (24.9%), 106 fibroblastic (18.7%), 42 atypical (7.4%), 16 anaplastic (2.8%), and 29 angioblastic [5.2%, including five hemangioblastic (0.9%) and 24 hemangiopericytic (4.3%)]. Anatomical locations were parasagittal/falx area (35%), cerebral convexity (19.3%), sphenoid wing (10.2%), posterior fossa (7.4%), tuberculum sellae (6.7%), olfactory groove (5.7%), tentorium (4.8%), middle fossa (3.7%), and others (7.4%). Recurrence occurred in 83 patients, with a total 19.4% recurrence rate at five years. Sex, histologic grade, and tumor location were associated with recurrence. The recurrence rate was 19% for males and 12% for females (p < 0.05); while it was 42.9%, 64.3%, and 69.6%, respectively for atypical, anaplastic and hemangiopericytic meningiomas, which was much higher than 12.2% for benign ones (p < 0.005). Tumors in less accessible surgical sites also had a higher recurrence rate (p < 0.005). There was no correlation between the age of patients, the tumor size, and the histological subtypes and variants. Of the 49 spinal meningiomas, the majority occurred in adult females (80%), were benign in nature (98%) and thoracic in location (71.4%).","ISSN":"0929-6646","note":"PMID: 7912586","journalAbbreviation":"J. Formos. Med. Assoc.","language":"eng","author":[{"family":"Yao","given":"Y. T."}],"issued":{"date-parts":[["1994",2]]},"PMID":"7912586"}},{"id":1581,"uris":[""],"uri":[""],"itemData":{"id":1581,"type":"article-journal","title":"Epilepsy and intracranial meningiomas","container-title":"Zhonghua Yi Xue Za Zhi = Chinese Medical Journal; Free China Ed","page":"151-155","volume":"55","issue":"2","source":"PubMed","abstract":"BACKGROUND: Only a few studies have reflected the incidence and causes of preoperative and postoperative seizures in meningiomas. This study concerned the incidence and types of preoperative epilepsy, and the predisposing factors for postoperative epilepsy in meningiomas.\nMETHODS: Epilepsy occurred in 323 surgically treated intracranial meningiomas. The focus here is different types of seizures, tumor locations, onset of seizures and the histopathological features of the meningiomas.\nRESULTS: From analysis of 323 patients with intracranial meningiomas, aged 10 to 79, 98 (30.3%) were found to have different types of preoperative epilepsy; in 32 (32.7%) of them, the seizures persisted postoperatively. Among 225 patients without preoperative seizures, 39 (17.3%) developed postoperative seizures. Thus, a history of preoperative seizures is a significant index (p < 0.005) for predicting the occurrence of postoperative seizures. In a total of 71 patients with postoperative seizures, the precipitating factors in the first week were cerebral edema and hemorrhage at the surgical sites. In late postoperative seizures (onset beyond one week post-surgery), the main cause was tumor recurrence. Patients with sagittal and convexity meningiomas had a higher incidence of seizures. There is no relationship between the histopathological features of the tumor and the occurrence of epilepsy in meningiomas.\nCONCLUSIONS: There is a significant incidence of postoperative seizures in meningioma patients with a history of preoperative seizures. Surgical excision of tumor, absence of postoperative hemorrhage or edema and anticonvulsant therapy reduced the occurrence of postoperative seizures.","ISSN":"0578-1337","note":"PMID: 7750055","journalAbbreviation":"Zhonghua Yi Xue Za Zhi (Taipei)","language":"eng","author":[{"family":"Chow","given":"S. Y."},{"family":"Hsi","given":"M. S."},{"family":"Tang","given":"L. M."},{"family":"Fong","given":"V. H."}],"issued":{"date-parts":[["1995",2]]},"PMID":"7750055"}},{"id":56,"uris":[""],"uri":[""],"itemData":{"id":56,"type":"article-journal","title":"Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors","container-title":"Epilepsy Research","page":"45-52","volume":"38","issue":"1","source":"PubMed","abstract":"In a retrospective study of a consecutive series of 222 surgically treated meningiomas, it was found that 26.6% of the patients presented epilepsy as their initial symptom. In this group, surgical excision of the intracranial meningiomas stopped the epilepsy in about 62.7% of the patients. But approximately one-fifth of the patients with intracranial meningiomas and no history of preoperative epilepsy developed new onset postoperative seizures. Of the patients with early onset of postoperative epilepsy, epilepsy appeared in 66.7% within first 48 h after surgery. Of the patients with postoperative epilepsy, 71.2% were seizure-free following 1 year of anticonvulsant therapy. Regarding preoperative existing factors, intracranial meningiomas located at supratentorium, convexity, and with evidence of or severe peritumoral edema significantly contributed to preoperative epilepsy. And in patients with preoperative epilepsy, those tumors with evidence of or severe perifocal edema and cerebral edema at the operative site were significantly more likely to suffer from postoperative epilepsy.","ISSN":"0920-1211","shortTitle":"Intracranial meningiomas and epilepsy","journalAbbreviation":"Epilepsy Res.","language":"eng","author":[{"family":"Lieu","given":"A. S."},{"family":"Howng","given":"S. L."}],"issued":{"date-parts":[["2000",1]]}}},{"id":1583,"uris":[""],"uri":[""],"itemData":{"id":1583,"type":"article-journal","title":"[The frequency of seizures in patients with primary brain tumors or cerebral metastases. An evaluation from the Ludwig Boltzmann Institute of Neuro-Oncology and the Department of Neurology, Kaiser Franz Josef Hospital, Vienna]","container-title":"Wiener Klinische Wochenschrift","page":"911-916","volume":"114","issue":"21-22","source":"PubMed","abstract":"Epileptic seizures are common in patients with cerebral metastases as well as in patients with primary brain tumors. In cancer patients without primary brain tumors or brain metastasis, epileptic seizures may occur due to metabolic or toxic causes, or due to infections. We performed a retrospective analysis from our neurooncological database concerning the occurrence of seizures in patients with primary brain tumors, patients with cerebral metastases and in cancer patients without brain tumors. Patients with low grade gliomas, such as astrocytoma WHO I + II (69%), oligodendroglioma WHO II (50%), and mixed glioma WHO II-III (56%) were more likely to have seizures than patients with anaplastic glioma WHO III (44%), glioblastoma WHO IV (48%) or meningeoma (45%). In patients with brain metastasis, melanoma (67%), cancer of the lung (29%), and gastrointestinal tumors (21%) were the primaries with the highest frequency of seizures. In cancer patients without brain metastases or primary brain tumors, seizures occurred in 4%. In conclusion, the occurrence of epileptic seizures in patients suffering from primary brain tumors, as well as in patients with cerebral metastases, varied within the tumor entity. Therefore, especially in brain tumors where a higher probability of epileptic seizures is expected, they should be taken into account in the care of cancer patients.","ISSN":"0043-5325","note":"PMID: 12528323","journalAbbreviation":"Wien. Klin. Wochenschr.","language":"ger","author":[{"family":"Oberndorfer","given":"Stefan"},{"family":"Schmal","given":"Thomas"},{"family":"Lahrmann","given":"Heinz"},{"family":"Urbanits","given":"Sabine"},{"family":"Lindner","given":"Klaus"},{"family":"Grisold","given":"Wolfgang"}],"issued":{"date-parts":[["2002",11,30]]},"PMID":"12528323"}},{"id":1585,"uris":[""],"uri":[""],"itemData":{"id":1585,"type":"article-journal","title":"Seizures as a presenting symptom in neurosurgical patients: a retrospective single-institution analysis","container-title":"Clinical Neurology and Neurosurgery","page":"2336-2340","volume":"115","issue":"11","source":"PubMed","abstract":"BACKGROUND: In patients with brain lesions, the appropriate management of epileptic seizures is important because recurrent seizures have a negative effect on the clinical course and quality of life. Acute symptomatic seizures are known to be one of the risk factors to develop epilepsy that cause recurrent unprovoked seizures in the later stage. To obtain background information, we performed a retrospective study in which we investigated the incidence of seizures as one of the presenting symptoms in neurosurgical patients admitted to our department during the past 43 years.\nMETHODS: We extracted 4537 consecutive patients from 11,675 records in our inpatient database to calculate the seizure incidence in patients with 19 most common diagnoses. We also studied whether the location of cortical lesions have relation to the seizure incidence.\nRESULTS: Among 2342 patients with brain tumors, 9 of 18 (50%) ganglioglioma-, 40 of 87 (46%) oligodendroglioma-, 69 of 207 (33%) low-grade astrocytoma-, 172 of 804 (21%) high-grade astrocytoma- or anaplastic oligodendroglioma-, 84 of 598 (14%) meningioma-, 38 of 313 (12%) metastatic brain tumor-, 7 of 67 (10%) malignant meningioma-, 7 of 79 (9%) ependymoma-, and 11 of 169 (7%) malignant lymphoma patients suffered seizures. There were 1626 patients with vascular lesions, 20 of 80 (25%) with cavernous malformation, 61 of 281 (22%) with arteriovenous malformation, 50 of 666 (8%) with subarachnoid hemorrhage, 26 of 457 (6%) with brain infarcts, and 5 of 142 (4%) with hypertensive brain hemorrhage had seizures. Of the 569 patients with traumatic brain injury, 33 of 168 (20%) with traumatic intracranial hemorrhage, 6 of 31 (19%) with brain concussion, 18 of 96 (19%) with brain contusion, 15 of 244 (6%) with chronic subdural hematoma, and 1 of 30 (3%) with minor head injury suffered seizures. We found that these seizure incidences were significantly higher when the cortical lesion was located in the frontal lobe (p<0.01, chi square test) but not in parietal, occipital, nor temporal lobes.\nCONCLUSION: We investigated the prevalence rate of seizures at the time of admission in a large number of patients who had been treated in our institution. Our results suggest that seizures are a common feature in patients with slow-growing and frontal intra-parenchymal lesions.","DOI":"10.1016/j.clineuro.2013.08.016","ISSN":"1872-6968","note":"PMID: 24011499","shortTitle":"Seizures as a presenting symptom in neurosurgical patients","journalAbbreviation":"Clin Neurol Neurosurg","language":"eng","author":[{"family":"Hamasaki","given":"Tadashi"},{"family":"Yamada","given":"Kazumichi"},{"family":"Kuratsu","given":"Jun-ichi"}],"issued":{"date-parts":[["2013",11]]},"PMID":"24011499"}}],"schema":""} 26–30 In brain tumour patients, potential neurological sequelae of craniotomy include seizures, which are associated with secondary morbidities such as cerebral oedema, hypoxia and brain injury, which in turn could have an impact on the long term quality of life and survival rates. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"lepoeg8po","properties":{"formattedCitation":"{\\rtf (31\\uc0\\u8211{}33)}","plainCitation":"(31–33)"},"citationItems":[{"id":1592,"uris":[""],"uri":[""],"itemData":{"id":1592,"type":"article-journal","title":"Postoperative seizures: epidemiology, pathology, and prophylaxis","container-title":"Neurologia Medico-Chirurgica","page":"589-600; discussion 600","volume":"43","issue":"12","source":"PubMed","abstract":"The risk of epileptic seizures after craniotomy is extremely important but the incidence of postoperative epilepsy varies greatly, depending on the patient's conditions such as primary diseases, severity of surgical insult, and pre-existing epilepsy. Animal studies suggest that neurosurgical insults lead to seizures by two different mechanisms: One mechanism is mediated by free radical generation and the other by impaired ion balance across the cell membrane caused by ischemia or hypoxia. Conventional antiepileptic agents such as phenytoin, phenobarbital, carbamazepine, and valproic acid are promising for the prevention of early seizures, but the effect in preventing postoperative epilepsy is still controversial. Studies on the prophylactic effect of newer antiepileptic agents in craniotomized patients were very limited. Zonisamide, an antiepileptic agent with antiepileptogenic, free radical scavenging and neuroprotective actions in experimental animals, showed promising effects against postoperative epilepsy in a randomized double blind controlled trial. Prophylactic treatment for craniotomized patients significantly prevented the development of partial seizures during the follow-up period. Most recent studies have not supported the prophylactic use of antiepileptic agents in craniotomized patients, but further studies are required.","ISSN":"0470-8105","note":"PMID: 14723265","shortTitle":"Postoperative seizures","journalAbbreviation":"Neurol. Med. Chir. (Tokyo)","language":"eng","author":[{"family":"Manaka","given":"Shinya"},{"family":"Ishijima","given":"Buichi"},{"family":"Mayanagi","given":"Yoshiaki"}],"issued":{"date-parts":[["2003",12]]},"PMID":"14723265"}},{"id":1594,"uris":[""],"uri":[""],"itemData":{"id":1594,"type":"article-journal","title":"Antiepileptic drug therapy in the perioperative course of neurosurgical patients","container-title":"Current Opinion in Anaesthesiology","page":"564-567","volume":"23","issue":"5","source":"PubMed","abstract":"PURPOSE OF REVIEW: Antiepileptic agents are widely used in the perioperative course of neurosurgical patients - for prophylactic and therapeutic reasons. However, the evidence supporting their use is extremely small and adverse events are common. This review highlights the current controversies.\nRECENT FINDINGS: Prophylactic use of antiepileptic agents is unfavorable for patients with subarachnoid hemorrhage. In patients with brain tumors, prophylactic use is not recommended. If the drugs are used nevertheless, stopping after the first postoperative week must be strongly recommended. After traumatic brain injury, early prophylactic use might prevent late post-traumatic seizures. The new antiepileptic drug levetiracetam seems to have a better safety profile, which makes it more suitable for prophylactic use. However, in all groups, evidence concerning the choice of drugs and duration of prophylaxis is lacking. Current research is focusing on prevention of epileptogenesis. Therapeutic use of antiepileptic drugs is supported by evidence. These drugs should be continued perioperatively. However, they might induce severe adverse events during adjuvant treatments like radiotherapy or chemotherapy in patients with brain tumors.\nSUMMARY: Despite lacking evidence, prophylactic antiepileptic drug use is common in the perioperative course of neurosurgical patients. More research is needed to deal better with epileptogenesis and to define the right drug for the right patient at the right time.","DOI":"10.1097/ACO.0b013e32833e14f2","ISSN":"1473-6500","note":"PMID: 20689411","journalAbbreviation":"Curr Opin Anaesthesiol","language":"eng","author":[{"family":"Klimek","given":"Markus"},{"family":"Dammers","given":"Ruben"}],"issued":{"date-parts":[["2010",10]]},"PMID":"20689411"}},{"id":1590,"uris":[""],"uri":[""],"itemData":{"id":1590,"type":"article-journal","title":"Treatment of epileptic seizures in brain tumors: a critical review","container-title":"Neurosurgical Review","page":"381-388; discussion 388","volume":"37","issue":"3","source":"PubMed","abstract":"Epileptic seizures represent a common signal of intracranial tumors, frequently the presenting symptom and the main factor influencing quality of life. Treatment of tumors concentrates on survival; antiepileptic drug (AED) treatment frequently is prescribed in a stereotyped way. A differentiated approach according to epileptic syndromes can improve seizure control and minimize unwarranted AED effects. Prophylactic use of AEDs is to be discouraged in patients without seizures. Acutely provoked seizures do not need long-term medication except for patients with high recurrence risk indicated by distinct EEG patterns, auras, and several other parameters. With chronically repeated seizures (epilepsies), long-term AED treatment is indicated. Non-enzyme-inducing AEDs might be preferred. Valproic acid exerts effects against progression of gliomatous tumors. In low-grade astrocytomas with epilepsy, a comprehensive presurgical epilepsy work-up including EEG-video monitoring is advisable; in static non-progressive tumors, it is mandatory. In these cases, the neurosurgical approach has to include the removal of the seizure-onset zone frequently located outside the lesion.","DOI":"10.1007/s10143-014-0538-6","ISSN":"1437-2320","note":"PMID: 24760366","shortTitle":"Treatment of epileptic seizures in brain tumors","journalAbbreviation":"Neurosurg Rev","language":"eng","author":[{"family":"Bauer","given":"R."},{"family":"Ortler","given":"M."},{"family":"Seiz-Rosenhagen","given":"M."},{"family":"Maier","given":"R."},{"family":"Anton","given":"J. V."},{"family":"Unterberger","given":"I."}],"issued":{"date-parts":[["2014",7]]},"PMID":"24760366"}}],"schema":""} 31–33 Whilst older studies suggested a role for AEDs in preventing seizures post-operatively, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vOV9lSLW","properties":{"formattedCitation":"{\\rtf (34\\uc0\\u8211{}36)}","plainCitation":"(34–36)"},"citationItems":[{"id":1600,"uris":[""],"uri":[""],"itemData":{"id":1600,"type":"article-journal","title":"Phenytoin and postoperative epilepsy. A double-blind study","container-title":"Journal of Neurosurgery","page":"672-677","volume":"58","issue":"5","source":"PubMed","abstract":"A double-blind trial of phenytoin therapy following craniotomy was performed to test the hypothesis that phenytoin is effective in reducing postoperative epilepsy. A significant reduction in the frequency of epilepsy was observed in the group receiving the active drug up to the 10th postoperative week. Half of the seizures occurred in the first 2 weeks and two-thirds within 1 month of cranial surgery. High rates of epilepsy were observed after surgery in patients with meningioma, metastasis, aneurysm, and head injury. Routine prophylaxis with phenytoin (in a dosage of 5 to 6 mg/kg/day) would seem to be indicated, particularly in high-risk patients and, where possible, this treatment should be started 1 week preoperatively. Seizure control is best when therapeutic levels of phenytoin are maintained.","DOI":"10.3171/jns.1983.58.5.0672","ISSN":"0022-3085","note":"PMID: 6339686","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"North","given":"J. B."},{"family":"Penhall","given":"R. K."},{"family":"Hanieh","given":"A."},{"family":"Frewin","given":"D. B."},{"family":"Taylor","given":"W. B."}],"issued":{"date-parts":[["1983",5]]},"PMID":"6339686"}},{"id":51,"uris":[""],"uri":[""],"itemData":{"id":51,"type":"article-journal","title":"Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumours","container-title":"Acta Neurochirurgica","page":"47-51","volume":"103","issue":"1-2","source":"link.","abstract":"Summary One hundred and twenty-eight adult patients presenting with and operated on for supratentorial neoplasms were studied. Sixty-five had preoperative seizures and were treated with anti-epileptic drugs (AEDs). Among the 63 patients without preoperative epileptic fits, 41 were given AEDs (either phenobarbital or phenytoin) as prophylactic treatment and 22 were not treated. The preoperative epilepsy course was considered with respect to tumour site and histological type. Early and late postoperative seizure occurrence was considered in the different groups of patients. The results suggest the usefulness of a short term preventive treatment with AEDs after surgey in patients without preoperative seizures. In patients with preoperative epilepsy, AEDs should be continued after surgery. However long-term AEDs treatment should not be recommended in patients without preoperative epilepsy. In fact, no significant difference in late seizure occurrence was found between preventively treated and untreated patients.","DOI":"10.1007/BF01420191","ISSN":"0001-6268, 0942-0940","journalAbbreviation":"Acta neurochir","language":"en","author":[{"family":"Franceschetti","given":"S."},{"family":"Binelli","given":"S."},{"family":"Casazza","given":"M."},{"family":"Lodrini","given":"S."},{"family":"Panzica","given":"F."},{"family":"Pluchino","given":"F."},{"family":"Solero","given":"C. L."},{"family":"Avanzini","given":"G."}],"issued":{"date-parts":[["1990",3]]}}},{"id":1602,"uris":[""],"uri":[""],"itemData":{"id":1602,"type":"article-journal","title":"Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizures","container-title":"Surgical Neurology","page":"361-364","volume":"31","issue":"5","source":"ScienceDirect","abstract":"Phenytoin (15 mg/kg) was administered intravenously to 189 patients shortly before their intracranial, supratentorial surgery was completed. Intravenous phenytoin of 5–6 mg/kg/day in three divided doses was administered daily for the first 3 postoperative days. Therapeutic serum levels (10–20 μg/mL) were achieved in 113 (59.8%) patients. An equally constituted, randomized control group of 185 patients received a placebo under identical conditions. The group receiving phenytoin had only one immediate and two early postoperative seizures. The 185 controls had four immediate and nine early postoperative seizures. None of the follow-up computed tomography scans of the patients with seizures showed postoperative hematoma. One patient had a significant tension pneumocranium, a possible cause of postoperative seizures.\n\nTo avoid a decrease in the serum anticonvulsant level due to intraoperative blood loss, it is suggested that for patients who need an urgent or emergent craniotomy, prophylatic anticonvulsant medication should be given at least 20 minutes before completion of wound closure.","DOI":"10.1016/0090-3019(89)90067-0","ISSN":"0090-3019","journalAbbreviation":"Surgical Neurology","author":[{"family":"Lee","given":"Shih-Tseng"},{"family":"Lui","given":"Tai-Ngar"},{"family":"Chang","given":"Chen-Nen"},{"family":"Cheng","given":"Wan-Chun"},{"family":"Wang","given":"Dah-Jium"},{"family":"Heimburger","given":"Robert F."},{"family":"Lin","given":"Chii-Guang"}],"issued":{"date-parts":[["1989",5]]}}}],"schema":""} 34–36 more recent studies have shown similarly low rates of post-operative seizures among the two cohorts of meningioma patients; namely patients administered prophylactic AEDs and patients that have not. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"TkK2rsK3","properties":{"formattedCitation":"{\\rtf (10,11,17\\uc0\\u8211{}25)}","plainCitation":"(10,11,17–25)"},"citationItems":[{"id":85,"uris":[""],"uri":[""],"itemData":{"id":85,"type":"article-journal","title":"Open Transcranial Resection of Small (<35 mm) Meningiomas of the Anterior Midline Skull Base in Current Microsurgical Practice","container-title":"World Neurosurgery","page":"741-750","volume":"84","issue":"3","source":"ScienceDirect","abstract":"Objective\nDespite technical surgical advance, the ultimate management of midline anterior skull base meningiomas remains to be defined. Open transcranial surgery is usually the first treatment option for large meningiomas, while less invasive techniques such as endoscopic surgery or radiosurgery might represent an alternative to open microsurgery for smaller lesions. The aim of our study is to investigate the outcome of open transcranial microsurgery in the resection of small (&lt;35 mm) meningiomas of the midline anterior cranial base.\nMethods\nClinical and surgical data from 43 patients affected by small midline anterior skull base meningiomas operated via an open transcranial approach were retrospectively reviewed.\nResults\nThe tumor diameter on its major axis ranged from 12 to 35 mm, with a mean diameter of 28 mm. Gross total resection (Simpson grades I–II) was achieved in 100% of cases through a pterional approach. Postoperative overall morbidity was 9%. It was 3% among patients &lt;70 years. No mortality was reported. Postoperative visual outcome was significantly associated with preoperative visual performance (P?= 0.02), but not with preoperative optic nerve compression as detected by magnetic resonance imaging (P?= 0.116). Age &gt;70 years was associated with postoperative visual impairment, although not significantly (P?= 0.06). Visual function was preserved or improved in 95% of cases, in 100% of patients &lt;70 years, and in 71% of patients with preoperative visual impairment.\nConclusions\nIn our experience, open transcranial surgery proved safe and effective for midline anterior skull base meningiomas smaller than 35 mm in all patients &lt;70 years and in patients &gt;70 years without preoperative visual deficit. Our data are consistent with the literature. Conversely, the standard of treatment for the subgroup of patients &gt;70 years with preoperative visual deficit has not yet been defined. This specific subgroup of patients offers a topic for further investigation.","DOI":"10.1016/j.wneu.2015.04.055","ISSN":"1878-8750","journalAbbreviation":"World Neurosurgery","author":[{"family":"Della Puppa","given":"Alessandro"},{"family":"Avella","given":"Elena","non-dropping-particle":"d’"},{"family":"Rossetto","given":"Marta"},{"family":"Volpin","given":"Francesco"},{"family":"Rustemi","given":"Oriela"},{"family":"Gioffrè","given":"Giorgio"},{"family":"Lombardi","given":"Giuseppe"},{"family":"Rolma","given":"Giuseppe"},{"family":"Scienza","given":"Renato"}],"issued":{"date-parts":[["2015",9]]}}},{"id":121,"uris":[""],"uri":[""],"itemData":{"id":121,"type":"article-journal","title":"Giant olfactory groove meningioma: ophthalmological and cognitive outcome after bifrontal microsurgical approach","container-title":"ACTA NEUROCHIRURGICA","page":"1117-1126","volume":"150","issue":"11","source":"EBSCOHost","abstract":"Olfactory groove meningiomas arise in the midline along the dura of the cribriform plate and may reach a large size before producing symptoms. We conducted a retrospective study of patients with these lesions focused on pre- and post-operative investigations for ophthalmological, personality and cognitive disturbances.","ISSN":"00016268","shortTitle":"Giant olfactory groove meningioma","journalAbbreviation":"ACTA NEUROCHIRURGICA","author":[{"family":"Gazzeri","given":"R"},{"family":"Galarza","given":"M"},{"family":"Gazzeri","given":"G"}],"issued":{"date-parts":[["2008",11]]}}},{"id":118,"uris":[""],"uri":[""],"itemData":{"id":118,"type":"article-journal","title":"Tuberculum sellae meningiomas: Microsurgical anatomy and surgical technique","container-title":"NEUROSURGERY","page":"1432-1439","volume":"51","issue":"6","source":"EBSCOHost","abstract":"OBJECTIVE: Despite Cushing's accurate description of the anatomic origin of tuber-culum sellae meningiomas, many subsequent authors have included tumors originating from the neighboring Sella region in this classification. This has led to difficulty in evaluating the surgical results and consensus for an optimal surgical technique. W e think this confusion has arisen from Cushing's description of these tumors under,the heading \"suprasellar meningiomas,\" which referred-to their distinctive clinical symptoms toms and not their anatomic origin. We describe the microsurgical anatomy and tumor, growth patterns to reemphasize the original classification of Cushing's tuberculum sellae meningiomas. Additionally, we describe our surgical approach, which creases the risk of injury to anterior visual pathways and anterior cerebral circulation arteries.","ISSN":"0148396X","shortTitle":"Tuberculum sellae meningiomas","journalAbbreviation":"NEUROSURGERY","author":[{"family":"Jallo","given":"Gi"},{"family":"Benjamin","given":"V"}],"issued":{"date-parts":[["2002",12]]}}},{"id":133,"uris":[""],"uri":[""],"itemData":{"id":133,"type":"article-journal","title":"Outcome following surgery for intracranial meningiomas in the aging","container-title":"Acta Neurologica Scandinavica","page":"161-169","volume":"127","issue":"3","source":"Wiley Online Library","abstract":"Objective\n\nTo prospectively assess mortality, morbidity and the functional and symptomatic outcome following intracranial surgery for meningiomas in elderly patients at two neurosurgical institutions in Norway.\n\n\nMethods\n\nPatients ≥60?years who underwent craniotomies for intracranial meningiomas at Oslo University Hospital and Haukeland University Hospital in 2008 and 2009 were included (n?=?54). Outcome was assessed at 6?months.\n\n\nResults\n\nThirty-five females and 19 males of median age 70 (60–84)?years were assessed pre- and post-operatively, 87% attended follow-up at 6?months. The surgical mortality rate was 5.6% at 30?days and 7.4% at 3 and 6?months. The rates of complications were: post-operative hematomas 5.6%, deep venous thrombosis 1.9%, osteitis 1.9%, cerebrospinal fluid disturbances 13.0% and neurological sequelae 13.0%. Surgery resulted in a significant improvement in the MMSE score, with a further 14.9% obtaining scores of ≥25 without a significant change in the level of independence according to the Karnofsky performance scale. QoL assessments showed good functioning post-operatively compared to other cancer patient groups, yet slightly reduced when compared to data from the general population.\n\n\nConclusion\n\nIn our series, we found that meningioma surgery in the aging patient carries a higher risk of mortality and morbidity compared to intracranial tumor surgery in general. Our findings indicate, however, that the survivors have improved cognitive function and acceptable QoL, and we did not see any significant decrease in the proportion of independent patients according to the KPS.","DOI":"10.1111/j.1600-0404.2012.01692.x","ISSN":"1600-0404","journalAbbreviation":"Acta Neurol Scand","language":"en","author":[{"family":"Konglund","given":"A."},{"family":"Rogne","given":"S. G."},{"family":"Lund-Johansen","given":"M."},{"family":"Scheie","given":"D."},{"family":"Helseth","given":"E."},{"family":"Meling","given":"T. R."}],"issued":{"date-parts":[["2013",3,1]]}}},{"id":112,"uris":[""],"uri":[""],"itemData":{"id":112,"type":"article-journal","title":"Tuberculum and diaphragma sella meningioma – surgical technique and visual outcome in a series of 20 cases operated over a 2.5-year period","container-title":"Acta Neurochirurgica","page":"1199-1204","volume":"149","issue":"12","source":"link.","abstract":"Summary Background. A retrospective analysis of 20 cases of tuberculum sella meningioma with emphasis on the surgical technique and visual outcome. Methods. Between 2003 and 2006 twenty patients with tuberculum and diaphragma sella meningioma were treated at the Tel Aviv medical center. There were 17 females and 3 males. The age range was 28–83. Most patients presented with visual deterioration. Surgery was performed using the subfrontal approach. The visual function before and after surgery was evaluated as the main outcome parameter of the surgical treatment of these tumours. Findings. In 16 patients complete tumour resection was achieved and in 4 subtotal removal was performed. Visual acuity improved in 32% of the eyes and deterioration was observed in two eyes (5%). Visual field improved in 28% of the eyes and deteriorated in 14%. There was no complete vision loss as a result of surgery. There was no mortality in our series. Conclusions. Tuberculum and diaphragma sella meningioma can be safely resected using the subfrontal approach with preservation and even improvement of visual function after surgery. Early surgery with better pre-operation visual function and smaller tumour size were associated with a better outcome.","DOI":"10.1007/s00701-007-1280-4","ISSN":"0001-6268, 0942-0940","journalAbbreviation":"Acta Neurochir (Wien)","language":"en","author":[{"family":"Margalit","given":"N."},{"family":"Kesler","given":"A."},{"family":"Ezer","given":"H."},{"family":"Freedman","given":"S."},{"family":"Ram","given":"Z."}],"issued":{"date-parts":[["2007",10,29]]}}},{"id":126,"uris":[""],"uri":[""],"itemData":{"id":126,"type":"article-journal","title":"Surgical management of tuberculum sellae meningioma: Role of selective extradural anterior clinoidectomy","container-title":"British Journal of Neurosurgery","page":"129-138","volume":"20","issue":"3","source":"EBSCOhost","abstract":"A retrospective analysis of 32 patients with tuberculum sellae meningiomas who underwent surgery via a unilateral pterional approach was performed. A selective extradural anterior clinoidectomy (SEAC) technique was added in 20 patients. All patients had visual dysfunction preoperatively. Macroscopically complete removal with Simpson grade II was performed in 28 patients (87.5%). The postoperative visual function improved in 25 (78.1%), did not change in 3 (9.4%), and worsened in 4 patients (12.5%). The SEAC technique was effective, especially for removal of the tumour extending into the sellae/pituitary stalk (9 patients), the optic canal (4 patients) and hypothalamus (4 patients) with preservation of the visual and endocrinological function. These results were superior to those of surgery without SEAC technique. This technique is therefore recommended for complete resection of the tuberculum sellae meningiomas extending to the surrounding anatomical structures as the SEAC procedure reduces the risk of intraoperative optic nerve injury considerably.","DOI":"10.1080/02688690600776747","ISSN":"02688697","shortTitle":"Surgical management of tuberculum sellae meningioma","journalAbbreviation":"British Journal of Neurosurgery","author":[{"family":"Otani","given":"Naoki"},{"family":"Muroi","given":"Carl"},{"family":"Yano","given":"Hirohito"},{"family":"Khan","given":"Nadia"},{"family":"Pangalu","given":"Athina"},{"family":"Yonekawa","given":"Yasuhiro"}],"issued":{"date-parts":[["2006",6]]}}},{"id":129,"uris":[""],"uri":[""],"itemData":{"id":129,"type":"article-journal","title":"Outcome comparison between younger and older patients undergoing intracranial meningioma resections","container-title":"Journal of Neuro-Oncology","page":"219-227","volume":"114","issue":"2","source":"link.","abstract":"Studies directly comparing the outcomes of intracranial meningioma resection between elderly and younger patients are currently limited. This study aimed to assess the perioperative complications, mortalities and functional outcomes in these two groups. Consecutive elderly patients (aged ≥65) and tumor-location-matched younger patients who underwent intracranial meningioma resections were retrospectively reviewed. Outcomes were assessed at 30-day, 90-day, 6-month and 1-year. We used a standardized classification of operative complications, and conducted subgroup analyses based on tumor location [convexity, parasagittal and falcine (CPF) as one group; skull base (SB) as another]. There were 92 patients in each group. The mean age was 74.6 ± 6.4 years in the elderly and 49.3 ± 10.1 years in the younger groups. The cumulative 30-day, 90-day and 1-year mortality rates were 0, 2.2 and 4.3 % for the elderly, respectively, and 1.1 % for all time points in the young. These differences were not statistically significant. Overall, the elderly suffered from more perioperative complications (P = 0.010), and these were mostly minor complications according to the classification of operative complications. However, these differences were observed only in the SB but not in the CPF subgroup. More elderly patients had impaired functional outcome 1-year after surgery. Significantly more elderly patients had new neurological deficits 1-year after surgery (26.1 vs. 6.6 %; P = 0.001). Comparable mortality rates were observed in elderly and younger patients. However, the elderly had more minor complications and poorer functional outcomes. Patient selection remains key to good clinical outcome.","DOI":"10.1007/s11060-013-1173-8","ISSN":"0167-594X, 1573-7373","journalAbbreviation":"J Neurooncol","language":"en","author":[{"family":"Poon","given":"Michael Tin-Chung"},{"family":"Fung","given":"Linus Hing-Kai"},{"family":"Pu","given":"Jenny Kan-Suen"},{"family":"Leung","given":"Gilberto Ka-Kit"}],"issued":{"date-parts":[["2013",6,5]]}}},{"id":107,"uris":[""],"uri":[""],"itemData":{"id":107,"type":"article-journal","title":"The value of routine electroencephalographic recordings in predicting postoperative seizures associated with meningioma surgery","container-title":"Neurosurgical Review","page":"108-112","volume":"26","issue":"2","source":"link.","abstract":". We analyzed the incidence of postoperative seizures in patients undergoing craniotomy for meningioma removal in order to determine whether EEG recordings are able to predict the incidence of postoperative seizures. We included 102 patients who had undergone surgery on intracranial meningiomas. Pre- and postoperative EEG images were divided into groups showing epileptiform activity including spikes or sharp waves, focal slowing, and normal activity. Follow-up was carried out using a standardized telephone questionnaire by an independent investigator after a mean of 889 days. Seizure outcome was determined by patient reports to the interviewer. Preoperatively obtained, abnormal EEGs correlated significantly to preoperative seizures (P<0.0005), but neither preoperative nor postoperative EEGs correlated to the incidence of postoperative seizures. It would seem that, while evaluation of some clinical parameters revealed a statistically significant correlation, pre- and early postoperative EEGs after meningioma surgery are not useful in determining the risk of postoperative seizures.","DOI":"10.1007/s10143-002-0240-y","ISSN":"0344-5607, 1437-2320","journalAbbreviation":"Neurosurg Rev","language":"en","author":[{"family":"Rothoerl","given":"Ralf D."},{"family":"Bernreuther","given":"D."},{"family":"Woertgen","given":"C."},{"family":"Brawanski","given":"A."}],"issued":{"date-parts":[["2002",10,10]]}}},{"id":23,"uris":[""],"uri":[""],"itemData":{"id":23,"type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"date-parts":[["2011",3]]}}},{"id":1568,"uris":[""],"uri":[""],"itemData":{"id":1568,"type":"article-journal","title":"Prospective Study of Postoperative Seizure in Intracranial Meningioma","container-title":"Psychiatry and Clinical Neurosciences","page":"331-334","volume":"47","issue":"2","source":"Wiley Online Library","DOI":"10.1111/j.1440-1819.1993.tb02094.x","ISSN":"1440-1819","language":"en","author":[{"family":"Tsuji","given":"Masahiro"},{"family":"Shinomiya","given":"Shigeko"},{"family":"Inoue","given":"Reiichi"},{"family":"Sato","given":"Kiyoshi"}],"issued":{"date-parts":[["1993",6,1]]}}},{"id":12,"uris":[""],"uri":[""],"itemData":{"id":12,"type":"article-journal","title":"Predicting outcome of epilepsy after meningioma resection","container-title":"Neuro-Oncology","page":"nov303","source":"neuro-oncology.","abstract":"Background Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.\nMethods Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.\nResults Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32–5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53–22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35–7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25–6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17–5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36–4.67]), younger age (OR: 1.74 [(95% CI: 1.18–2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16–3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25–0.85], P = .013).\nConclusion We suggest prospective validation of a score (“STAMPE2”) based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.","DOI":"10.1093/neuonc/nov303","ISSN":"1522-8517, 1523-5866","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Wirsching","given":"Hans-Georg"},{"family":"Morel","given":"Corinne"},{"family":"Gmür","given":"Corinne"},{"family":"Neidert","given":"Marian Christoph"},{"family":"Baumann","given":"Christian Richard"},{"family":"Valavanis","given":"Antonios"},{"family":"Rushing","given":"Elisabeth Jane"},{"family":"Krayenbühl","given":"Niklaus"},{"family":"Weller","given":"Michael"}],"issued":{"date-parts":[["2015",12,18]]}}}],"schema":""} 10,11,17–25 Nevertheless, neurosurgeons continue to administer prophylactic AEDs as a preventative measure against post-operative seizures in patients undergoing meningioma surgery despite the lack of evidence to support this practice. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"unpHYwrp","properties":{"formattedCitation":"(37)","plainCitation":"(37)"},"citationItems":[{"id":1623,"uris":[""],"uri":[""],"itemData":{"id":1623,"type":"article-journal","title":"Prophylactic antiepileptic drug administration following brain tumor resection: results of a recent AANS/CNS Section on Tumors survey","container-title":"Journal of Neurosurgery","page":"1-7","source":" (Atypon)","DOI":"10.3171/2016.4.JNS16245","ISSN":"0022-3085","shortTitle":"Prophylactic antiepileptic drug administration following brain tumor resection","journalAbbreviation":"Journal of Neurosurgery","author":[{"family":"Dewan","given":"Michael C."},{"family":"Thompson","given":"Reid C."},{"family":"Kalkanis","given":"Steven N."},{"family":"Barker","given":"Fred G."},{"family":"Hadjipanayis","given":"Constantinos G."}],"issued":{"date-parts":[["2016",6,24]]}}}],"schema":""} 37 Previous recommendations from the American Academy of Neurology (AAN) advised against the routine use of prophylactic AEDs in newly diagnosed brain tumour patients; however, this practice parameter was retired by the AAN Board of Directors on June 4, 2012. The pathogenesis of post-operative seizures in meningioma patients is not fully understood and is likely to be due to a variety of tumour and surgical factors. Meningiomas are extra-axial tumours and have been hypothesised to distort the peritumoural cortex, release amino acids, alter the acid-base status and disturb the neurotransmitters pathway, particularly of glutamate. All these factors have been shown to contribute to the?epileptogenicity of meningiomas. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"9oTd0vUf","properties":{"formattedCitation":"(38,39)","plainCitation":"(38,39)"},"citationItems":[{"id":1529,"uris":[""],"uri":[""],"itemData":{"id":1529,"type":"article-journal","title":"Brain Tumor and Seizures: Pathophysiology and Its Implications for Treatment Revisited","container-title":"Epilepsia","page":"1223-1232","volume":"44","issue":"9","source":"Wiley Online Library","abstract":"Summary:? Seizures affect ～50% of patients with primary and metastatic brain tumors. Partial seizures have the highest incidence, followed by secondarily generalized, depending on histologic subtype, location, and tumor extent. The underlying pathophysiologic mechanisms of tumor-associated seizures are poorly understood and include theories of altered peritumoral amino acids, regional metabolism, pH, neuronal or glial enzyme and protein expression, as well as immunologic activity. An involvement of changed distribution and function of N-methyl-d-aspartate subclass of glutamate receptors also has been suggested. The often unpredictable responses to seizures after surgical tumor removal add substantial evidence that multiple factors are involved. The therapy of tumor-related seizures is far from perfect. Several factors contribute to these treatment difficulties, such as tumor growth and drug interactions; however, one of the main reasons for poor seizure control may result from the insufficient or even absent influence of the currently available antiepileptic drugs (AEDs) on most of the pathophysiologic mechanisms of tumor-related seizures. Studies are needed to elucidate more clearly the pathophysiologic mechanisms of tumor-related seizures and to identify and develop the optimal AEDs.","DOI":"10.1046/j.1528-1157.2003.05203.x","ISSN":"1528-1167","shortTitle":"Brain Tumor and Seizures","language":"en","author":[{"family":"Schaller","given":"Bernhard"},{"family":"Rüegg","given":"Stephan J."}],"issued":{"date-parts":[["2003",9,1]]}}},{"id":1526,"uris":[""],"uri":[""],"itemData":{"id":1526,"type":"article-journal","title":"Brain tumors and epilepsy: pathophysiology of peritumoral changes","container-title":"Neurosurgical Review","page":"275-285","volume":"32","issue":"3","source":"link.","abstract":"Epilepsy commonly develops among patients with brain tumors, frequently even as the presenting symptom, and such patients consequently experience substantial morbidity from both the seizures and the underlying disease. At clinical presentation, these seizures are most commonly focal with secondary generalization and conventional medical management is often met with less efficacy. The molecular pathophysiology of these seizures is being elucidated with findings that both the tumoral and peritumoral microenvironments may exhibit epileptogenic phenotypes owing to disordered neuronal connectivity and regulation, impaired glial cell function, and the presence of altered vascular supply and permeability. Neoplastic tissue can itself be the initiation site of seizure activity, particularly for tumors arising from neuronal cell lines, such as gangliogliomas or dysembryoblastic neuroepithelial tumors. Conversely, a growing intracranial lesion can both structurally and functionally alter the surrounding brain tissue with edema, vascular insufficiency, inflammation, and release of metabolically active molecules, hence also promoting seizure activity. The involved mechanisms are certain to be multifactorial and depend on specific tumor histology, integrity of the blood brain barrier, and characteristics of the peritumoral environment. Understanding these changes that underlie tumor-related epilepsy may have roles in both optimal medical management for the seizure symptom and optimal surgical objective and management of the underlying disease.","DOI":"10.1007/s10143-009-0191-7","ISSN":"0344-5607, 1437-2320","shortTitle":"Brain tumors and epilepsy","journalAbbreviation":"Neurosurg Rev","language":"en","author":[{"family":"Shamji","given":"Mohammed F."},{"family":"Fric-Shamji","given":"Elana C."},{"family":"Benoit","given":"Brien G."}],"issued":{"date-parts":[["2009",2,11]]}}}],"schema":""} 38,39 Intraoperatively, the surgical resection could contribute to the development of seizures, through a combination of brain retraction, manipulation and cortical irritation. In the post-operative period, complications such as haematoma, infection, hydrocephalus and particularly perifocal cerebral oedema could influence the risk of seizures. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1av95qjr04","properties":{"formattedCitation":"(28,40)","plainCitation":"(28,40)"},"citationItems":[{"id":56,"uris":[""],"uri":[""],"itemData":{"id":56,"type":"article-journal","title":"Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors","container-title":"Epilepsy Research","page":"45-52","volume":"38","issue":"1","source":"PubMed","abstract":"In a retrospective study of a consecutive series of 222 surgically treated meningiomas, it was found that 26.6% of the patients presented epilepsy as their initial symptom. In this group, surgical excision of the intracranial meningiomas stopped the epilepsy in about 62.7% of the patients. But approximately one-fifth of the patients with intracranial meningiomas and no history of preoperative epilepsy developed new onset postoperative seizures. Of the patients with early onset of postoperative epilepsy, epilepsy appeared in 66.7% within first 48 h after surgery. Of the patients with postoperative epilepsy, 71.2% were seizure-free following 1 year of anticonvulsant therapy. Regarding preoperative existing factors, intracranial meningiomas located at supratentorium, convexity, and with evidence of or severe peritumoral edema significantly contributed to preoperative epilepsy. And in patients with preoperative epilepsy, those tumors with evidence of or severe perifocal edema and cerebral edema at the operative site were significantly more likely to suffer from postoperative epilepsy.","ISSN":"0920-1211","shortTitle":"Intracranial meningiomas and epilepsy","journalAbbreviation":"Epilepsy Res.","language":"eng","author":[{"family":"Lieu","given":"A. S."},{"family":"Howng","given":"S. L."}],"issued":{"date-parts":[["2000",1]]}}},{"id":1605,"uris":[""],"uri":[""],"itemData":{"id":1605,"type":"article-journal","title":"Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management","container-title":"The Lancet. Neurology","page":"421-430","volume":"6","issue":"5","source":"PubMed","abstract":"Epilepsy is common in patients with brain tumours and can substantially affect daily life, even if the tumour is under control. Several factors affect the mechanism of seizures in brain tumours, including tumour type, tumour location, and peritumoral and genetic changes. Prophylactic use of antiepileptic drugs is not recommended, and potential interactions between antiepileptic and chemotherapeutic agents persuades against the use of enzyme-inducing antiepileptic drugs. Multidrug-resistance proteins prevent the access of antiepileptic drugs into brain parenchyma, which partly explains why seizures are frequently refractory to treatment. Lamotrigine, valproic acid, and topiramate are first-line treatments of choice; if insufficient, add-on treatment with levetiracetam or gabapentin can be recommended. On the basis of clinical studies, we prefer to start treatment with valproic acid, adding levetiracetam if necessary. Risks of cognitive side-effects with antiepileptic drugs can add to previous damage by surgery or radiotherapy, and therefore appropriate choice and dose of antiepileptic drug is crucial.","DOI":"10.1016/S1474-4422(07)70103-5","ISSN":"1474-4422","note":"PMID: 17434097","shortTitle":"Epilepsy in patients with brain tumours","journalAbbreviation":"Lancet Neurol","language":"eng","author":[{"family":"Breemen","given":"Melanie S. M.","non-dropping-particle":"van"},{"family":"Wilms","given":"Erik B."},{"family":"Vecht","given":"Charles J."}],"issued":{"date-parts":[["2007",5]]},"PMID":"17434097"}}],"schema":""} 28,40 Such factors are not exclusive to supratentorial lesions and could precipitate seizures in all intracranial meningioma patients. Due to limitations in the reported data, it was not possible to determine whether there was a significant association between the seizures that arose post-operatively in this group of patients and any of the aforementioned factors.Specific tumour characteristics have been shown to increase the epileptogenic potential of operated meningiomas in seizure-na?ve patients. Parietal convexity meningioma, non-skull base location and tumour diameter have all been shown to increase the risk of developing early post-operative seizures. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ywO4Aq5T","properties":{"formattedCitation":"(28,41,42)","plainCitation":"(28,41,42)"},"citationItems":[{"id":300,"uris":[""],"uri":[""],"itemData":{"id":300,"type":"article-journal","title":"Clinical multifactorial analysis of early postoperative seizures in elderly patients following meningioma resection","container-title":"Molecular and Clinical Oncology","page":"501-505","volume":"3","issue":"3","source":"PubMed Central","abstract":"The aim of the present study was to identify the major factors correlated with early postoperative seizures in elderly patients who had undergone a meningioma resection, and subsequently, to develop a logistic regression equation for assessing the seizures risk. Fourteen factors possibly correlated with early postoperative seizures in a cohort of 209 elderly patients who had undergone meningioma resection, as analyzed by multifactorial stepwise logistic regression. Phenobarbital sodium (0.1 g, intramuscularly) was administered to all 209 patients 30 min prior to undergoing surgery. All the patients had no previous history of seizures. The correlation of the 14 clinical factors (gender, tumor site, dyskinesia, peritumoral brain edema (PTBE), tumor diameter, pre- and postoperative prophylaxes, surgery time, tumor adhesion, circumscription, blood supply, intraoperative transfusion, original site of the tumor and dysphasia) was assessed in association with the risk for post-operative seizures. Tumor diameter, postoperative prophylactic antiepileptic drug (PPAD) administration, PTBE and tumor site were entered as risk factors into a mathematical regression model. The odds ratio (OR) of the tumor diameter was >1, and PPAD administration showed an OR >1, relative to a non-prophylactic group. A logistic regression equation was obtained and the sensitivity, specificity and misdiagnosis rates were 91.4, 74.3 and 25.7%, respectively. Tumor diameter, PPAD administration, PTBE and tumor site were closely correlated with early postoperative seizures; PTBE and PPAD administration were risk and protective factors, respectively.","DOI":"10.3892/mco.2015.493","ISSN":"2049-9450","note":"PMID: 26137257\nPMCID: PMC4471514","journalAbbreviation":"Mol Clin Oncol","author":[{"family":"Zhang","given":"Bo"},{"family":"Wang","given":"Dan"},{"family":"Guo","given":"Yunbao"},{"family":"Yu","given":"Jinlu"}],"issued":{"date-parts":[["2015",5]]},"PMID":"26137257","PMCID":"PMC4471514"}},{"id":"3MuUnfCE/uOW3UDUK","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/uOW3UDUK","type":"article-journal","title":"Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors","container-title":"Epilepsy Research","page":"45-52","volume":"38","issue":"1","source":"PubMed","abstract":"In a retrospective study of a consecutive series of 222 surgically treated meningiomas, it was found that 26.6% of the patients presented epilepsy as their initial symptom. In this group, surgical excision of the intracranial meningiomas stopped the epilepsy in about 62.7% of the patients. But approximately one-fifth of the patients with intracranial meningiomas and no history of preoperative epilepsy developed new onset postoperative seizures. Of the patients with early onset of postoperative epilepsy, epilepsy appeared in 66.7% within first 48 h after surgery. Of the patients with postoperative epilepsy, 71.2% were seizure-free following 1 year of anticonvulsant therapy. Regarding preoperative existing factors, intracranial meningiomas located at supratentorium, convexity, and with evidence of or severe peritumoral edema significantly contributed to preoperative epilepsy. And in patients with preoperative epilepsy, those tumors with evidence of or severe perifocal edema and cerebral edema at the operative site were significantly more likely to suffer from postoperative epilepsy.","ISSN":"0920-1211","shortTitle":"Intracranial meningiomas and epilepsy","journalAbbreviation":"Epilepsy Res.","language":"eng","author":[{"family":"Lieu","given":"A. S."},{"family":"Howng","given":"S. L."}],"issued":{"year":2000,"month":1},"page-first":"45","title-short":"Intracranial meningiomas and epilepsy","container-title-short":"Epilepsy Res."}},{"id":303,"uris":[""],"uri":[""],"itemData":{"id":303,"type":"article-journal","title":"Risk Factors of Preoperative and Early Postoperative Seizures in Patients with Meningioma: A Retrospective Single-Center Cohort Study","container-title":"World Neurosurgery","page":"538-546","volume":"97","source":"ScienceDirect","abstract":"Objective\nWell-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.\nMethods\nA 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.\nResults\nPreoperative 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 &lt; 0.001), and a tumor volume of &gt;8 cm3 (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 &gt;40% (OR, 9.8; P?&lt; 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.\nConclusions\nSeizure 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.","DOI":"10.1016/j.wneu.2016.10.062","ISSN":"1878-8750","shortTitle":"Risk Factors of Preoperative and Early Postoperative Seizures in Patients with Meningioma","journalAbbreviation":"World Neurosurgery","author":[{"family":"Skardelly","given":"Marco"},{"family":"Rother","given":"Christian"},{"family":"Noell","given":"Susan"},{"family":"Behling","given":"Felix"},{"family":"Wuttke","given":"Thomas V."},{"family":"Schittenhelm","given":"Jens"},{"family":"Bisdas","given":"Sotirios"},{"family":"Meisner","given":"Christoph"},{"family":"Rona","given":"Sabine"},{"family":"Tabatabai","given":"Ghazaleh"},{"family":"Roser","given":"Florian"},{"family":"Tatagiba","given":"Marcos Soares"}],"issued":{"date-parts":[["2017",1]]}}}],"schema":""} 28,41,42 Late post-operative sequelae including seizures have been previously reported as a result of meningioma regrowth or recurrence. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1fcnmrha06","properties":{"formattedCitation":"(27)","plainCitation":"(27)"},"citationItems":[{"id":"xyJOXs15/DsWXW75a","uris":[""],"uri":[""],"itemData":{"id":"xyJOXs15/DsWXW75a","type":"article-journal","title":"Epilepsy and intracranial meningiomas","container-title":"Zhonghua Yi Xue Za Zhi = Chinese Medical Journal; Free China Ed","page":"151-155","volume":"55","issue":"2","source":"PubMed","abstract":"BACKGROUND: Only a few studies have reflected the incidence and causes of preoperative and postoperative seizures in meningiomas. This study concerned the incidence and types of preoperative epilepsy, and the predisposing factors for postoperative epilepsy in meningiomas.\nMETHODS: Epilepsy occurred in 323 surgically treated intracranial meningiomas. The focus here is different types of seizures, tumor locations, onset of seizures and the histopathological features of the meningiomas.\nRESULTS: From analysis of 323 patients with intracranial meningiomas, aged 10 to 79, 98 (30.3%) were found to have different types of preoperative epilepsy; in 32 (32.7%) of them, the seizures persisted postoperatively. Among 225 patients without preoperative seizures, 39 (17.3%) developed postoperative seizures. Thus, a history of preoperative seizures is a significant index (p < 0.005) for predicting the occurrence of postoperative seizures. In a total of 71 patients with postoperative seizures, the precipitating factors in the first week were cerebral edema and hemorrhage at the surgical sites. In late postoperative seizures (onset beyond one week post-surgery), the main cause was tumor recurrence. Patients with sagittal and convexity meningiomas had a higher incidence of seizures. There is no relationship between the histopathological features of the tumor and the occurrence of epilepsy in meningiomas.\nCONCLUSIONS: There is a significant incidence of postoperative seizures in meningioma patients with a history of preoperative seizures. Surgical excision of tumor, absence of postoperative hemorrhage or edema and anticonvulsant therapy reduced the occurrence of postoperative seizures.","ISSN":"0578-1337","note":"PMID: 7750055","journalAbbreviation":"Zhonghua Yi Xue Za Zhi (Taipei)","language":"eng","author":[{"family":"Chow","given":"S. Y."},{"family":"Hsi","given":"M. S."},{"family":"Tang","given":"L. M."},{"family":"Fong","given":"V. H."}],"issued":{"year":1995,"month":2},"PMID":"7750055","page-first":"151","container-title-short":"Zhonghua Yi Xue Za Zhi Chin. Med. J. Free China Ed"}}],"schema":""} 27 Benign WHO grade I lesions constitute the majority of meningiomas and their recurrence is dependent on the degree of surgical resection, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ijacOxct","properties":{"formattedCitation":"(43,44)","plainCitation":"(43,44)"},"citationItems":[{"id":306,"uris":[""],"uri":[""],"itemData":{"id":306,"type":"article-journal","title":"Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma","container-title":"Journal of Neurosurgery","page":"201-211","volume":"126","issue":"1","source":" (Atypon)","DOI":"10.3171/2016.1.JNS151842","ISSN":"0022-3085","journalAbbreviation":"Journal of Neurosurgery","author":[{"family":"Nanda","given":"Anil"},{"family":"Bir","given":"Shyamal C."},{"family":"Maiti","given":"Tanmoy K."},{"family":"Konar","given":"Subhas K."},{"family":"Missios","given":"Symeon"},{"family":"Guthikonda","given":"Bharat"}],"issued":{"date-parts":[["2016",4,8]]}}},{"id":309,"uris":[""],"uri":[""],"itemData":{"id":309,"type":"article-journal","title":"WHO grade 1 meningioma recurrence: Are location and Simpson grade still relevant?","container-title":"Clinical Neurology and Neurosurgery","page":"117-121","volume":"141","source":"ScienceDirect","abstract":"Objective\nTo examine whether Simpson grade and pathology location are still predictors of recurrence/progression free survival (RPFS) in WHO grade 1 cranial meningiomas.\nMethods\nA retrospective case series of all WHO grade 1 cranial meningiomas undergoing surgical resection at our institution between 2002 to 2007 was performed. Demographic and outcome data included: Simpson grade, extent of resection [gross total (Simpson 1–3) and sub total (Simpson 4–5)], tumour location, timing of post-operative imaging and outpatient review, time to recurrence and subsequent management. Statistical analysis was by Kaplan–Meier survival curves.\nResults\n145 cases were included of which 75% were female, with an overall median age of 55 years. 24% had parasagittal, 23% convexity and 53% skull base meningioma. 21% had a grade 1 Simpson resection, 43% grade 2, 35% grade 4 and 1% grade 5. The median follow up period was 60 months with a median 5.5 outpatient appointments and 5 post-operative imaging studies. 10 cases (6.9%) had recurrence/progression at a median period of 42 months. Of these, 4 remained under active surveillance, 3 received stereotactic radiosurgery and 3 were treated with fractionated radiotherapy. 5 year recurrence/progression free survival (RPFS) for Simpson grade 1 was 96.8%, 2: 100%, 4: 82.4% and 5: 0%. Simpson grade (p = 0.01) and gross total/sub total resection (p = 0.001) were significant predictors of RPFS. Meningioma location was not a significant predictor of RPFS (p-value 0.836).\nConclusion\nSimpson grade remains a significant predictor of RPFS in WHO grade 1 meningioma surgery. However, tumour location was not significant in this series. We advocate different post-operative imaging surveillance protocols depending on gross total or sub total surgical resection.","DOI":"10.1016/j.clineuro.2016.01.006","ISSN":"0303-8467","shortTitle":"WHO grade 1 meningioma recurrence","journalAbbreviation":"Clinical Neurology and Neurosurgery","author":[{"family":"Gallagher","given":"Mathew J."},{"family":"Jenkinson","given":"Michael D."},{"family":"Brodbelt","given":"Andrew R."},{"family":"Mills","given":"Samantha J."},{"family":"Chavredakis","given":"Emmanuel"}],"issued":{"date-parts":[["2016",2]]}}}],"schema":""} 43,44 whereas atypical and anaplastic meningiomas have an inherently higher recurrence rate regardless of treatment, and therefore could influence seizure rates. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ej6flbhc","properties":{"formattedCitation":"{\\rtf (45\\uc0\\u8211{}47)}","plainCitation":"(45–47)"},"citationItems":[{"id":312,"uris":[""],"uri":[""],"itemData":{"id":312,"type":"article-journal","title":"Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features","container-title":"Journal of Neurology, Neurosurgery & Psychiatry","page":"574-580","volume":"79","issue":"5","source":"jnnp.","abstract":"Objectives: To evaluate patient outcome and investigate the prognostic factors of high-grade meningiomas by adopting the 2000 World Health Organization (WHO) classification system.\nMethods: Between 1986 and 2004, 74 patients were diagnosed with high-grade meningioma: 33 with atypical and 41 with anaplastic meningioma. The mean follow-up was 58.5 months. We reclassified all surgical specimens, according to the 2000 WHO classification system, using two expert neuropathologists.\nResults: Forty of 74 meningiomas were reclassified as atypical meningioma and 24 as anaplastic meningioma. Overall and recurrence-free survivals were significantly longer in patients with atypical than in those with anaplastic meningioma: 142.5 versus 39.8 months and 138.5 versus 32.2 months, respectively (p<0.001). In patients with atypical meningiomas, brain invasion and adjuvant radiotherapy were not associated with survival; however, in the brain invasion subgroup, adjuvant radiotherapy improved patients’ survival. In patients with anaplastic meningioma, the prognostic factors were brain invasion, adjuvant radiotherapy, malignant progression, p53 overexpression and extent of resection. The p53 overexpression was the only factor associated with malignant progression (p = 0.009).\nConclusions: The 2000 WHO classification has identified the truly aggressive meningiomas better than did the previous criteria. A precise meningioma grading system may help to avoid over-treatment of patients with an atypical meningioma as, once the tumour has “declared itself” by recurrence and histological features, it becomes a tumour that is poorly amenable to current therapies.","DOI":"10.1136/jnnp.2007.121582","ISSN":", 1468-330X","note":"PMID: 17766430","shortTitle":"Atypical and anaplastic meningiomas","journalAbbreviation":"J Neurol Neurosurg Psychiatry","language":"en","author":[{"family":"Yang","given":"S.-Y."},{"family":"Park","given":"C.-K."},{"family":"Park","given":"S.-H."},{"family":"Kim","given":"D. G."},{"family":"Chung","given":"Y. S."},{"family":"Jung","given":"H.-W."}],"issued":{"date-parts":[["2008",5,1]]},"PMID":"17766430"}},{"id":319,"uris":[""],"uri":[""],"itemData":{"id":319,"type":"article-journal","title":"Adjuvant radiation therapy, local recurrence, and the need for salvage therapy in atypical meningioma","container-title":"Neuro-Oncology","page":"1547-1553","volume":"16","issue":"11","source":"neuro-oncology.","abstract":"Background The impact of adjuvant radiation in patients with atypical meningioma remains poorly defined. We sought to determine the impact of adjuvant radiation therapy in this population.\nMethods We identified 91 patients with World Health Organization grade II (atypical) meningioma managed at Dana-Farber/Brigham and Women's Cancer Center between 1997 and 2011. A propensity score model incorporating age at diagnosis, gender, Karnofsky performance status, tumor location, tumor size, reason for diagnosis, and era of treatment was constructed using logistic regression for the outcome of receipt versus nonreceipt of radiation therapy. Propensity scores were then used as continuous covariates in a Cox proportional hazards model to determine the adjusted impact of adjuvant radiation therapy on both local recurrence and the combined endpoint of use of salvage therapy and death due to progressive meningioma.\nResults The median follow-up in patients without recurrent disease was 4.9 years. After adjustment for pertinent confounding variables, radiation therapy was associated with decreased local recurrence in those undergoing gross total resection (hazard ratio, 0.25; 95% CI, 0.07–0.96; P = .04). No differences in overall survival were seen in patients who did and did not receive radiation therapy.\nConclusion Patients who have had a gross total resection of an atypical meningioma should be considered for adjuvant radiation therapy given the improvement in local control. Multicenter, prospective trials are required to definitively evaluate the potential impact of radiation therapy on survival in patients with atypical meningioma.","DOI":"10.1093/neuonc/nou098","ISSN":"1522-8517, 1523-5866","note":"PMID: 24891451","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Aizer","given":"Ayal A."},{"family":"Arvold","given":"Nils D."},{"family":"Catalano","given":"Paul"},{"family":"Claus","given":"Elizabeth B."},{"family":"Golby","given":"Alexandra J."},{"family":"Johnson","given":"Mark D."},{"family":"Al-Mefty","given":"Ossama"},{"family":"Wen","given":"Patrick Y."},{"family":"Reardon","given":"David A."},{"family":"Lee","given":"Eudocia Q."},{"family":"Nayak","given":"Lakshmi"},{"family":"Rinne","given":"Mikael L."},{"family":"Beroukhim","given":"Rameen"},{"family":"Weiss","given":"Stephanie E."},{"family":"Ramkissoon","given":"Shakti H."},{"family":"Abedalthagafi","given":"Malak"},{"family":"Santagata","given":"Sandro"},{"family":"Dunn","given":"Ian F."},{"family":"Alexander","given":"Brian M."}],"issued":{"date-parts":[["2014",11,1]]},"PMID":"24891451"}},{"id":316,"uris":[""],"uri":[""],"itemData":{"id":316,"type":"article-journal","title":"Ki-67 proliferative index predicts clinical outcome in patients with atypical or anaplastic meningioma","container-title":"Neuropathology","page":"114-120","volume":"27","issue":"2","source":"Wiley Online Library","abstract":"Meningiomas represent the second most common central nervous system neoplasms in adults and account for 26% of all primary brain tumors. Although most are benign, between 5% and 15% of meningiomas are atypical (grade II) whereas 1–2% are anaplastic meningiomas (grade III). Although histological grade is the most relevant prognostic factor, there are some unusual cases in which establishing a diagnosis of high-grade meningioma following 2000 World Health Organization (WHO) histological criteria is extremely difficult. Therefore, the aim of the present study was to evaluate the predictive value of Ki-67 labeling index and its contribution to current WHO classification in predicting tumor recurrence and overall survival in patients with high-grade meningiomas. A total of 28 patients (with 16 atypical meningiomas and 12 anaplastic meningiomas) were evaluated for demographic, clinical, radiological and therapeutic variables, and for Ki-67 immunohistochemistry. Median Ki-67 labeling index in the whole series was 7.0 (0.5–31.5) with no differences with respect to the histological grade (P?=?0.87). In the univariate analysis, Ki-67 labeling index and postoperative Karnofsky performance status were identified as significant prognostic factors of tumor recurrence and overall survival. The multivariate analysis demonstrated that Ki-67 labeling index is the only independent predictor of both tumor recurrence and overall survival. More importantly, this predictive value was maintained in both patients with atypical and patients with anaplastic meningioma.","DOI":"10.1111/j.1440-1789.2007.00750.x","ISSN":"1440-1789","language":"en","author":[{"family":"Bruna","given":"Jordi"},{"family":"Brell","given":"Marta"},{"family":"Ferrer","given":"Isidre"},{"family":"Gimenez-Bonafe","given":"Pepita"},{"family":"Tortosa","given":"Avelina"}],"issued":{"date-parts":[["2007",4,1]]}}}],"schema":""} 45–47 Similar conclusions on precipitating factors of early and late post-operative seizures could not be drawn using the data in this systematic review and the benefit of prophylactic AEDs in patients included in this review with similar characteristics could not be inferred.In this systematic review, we restricted the search criteria to 1990 – 2016 in order to examine more modern clinical series. Whilst the pathology and biology of meningiomas have not changed since their early description in 1938, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"sl8mkWRb","properties":{"formattedCitation":"(48)","plainCitation":"(48)"},"citationItems":[{"id":1628,"uris":[""],"uri":[""],"itemData":{"id":1628,"type":"article-journal","title":"Meningiomas. Their Classification, Regional Behaviour, Life History, and Surgical End Results","container-title":"Bulletin of the Medical Library Association","page":"185","volume":"27","issue":"2","source":"PubMed Central","ISSN":"0025-7338","note":"PMID: null\nPMCID: PMC233714","journalAbbreviation":"Bull Med Libr Assoc","issued":{"date-parts":[["1938",12]]},"PMCID":"PMC233714"}}],"schema":""} 48 over the last 26 years, imaging and surgical technology have advanced dramatically and these factors may have an impact on the risk of developing seizures following meningioma resection. Indeed, 10 of the 11 papers were published after 2002 and encompass a more ‘modern’ era of neurosurgery. In the AED-cohort, contributed to by 10 of the 11 included papers, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"tKY9De4T","properties":{"formattedCitation":"{\\rtf (10,11,17\\uc0\\u8211{}23,25)}","plainCitation":"(10,11,17–23,25)"},"citationItems":[{"id":1568,"uris":[""],"uri":[""],"itemData":{"id":1568,"type":"article-journal","title":"Prospective Study of Postoperative Seizure in Intracranial Meningioma","container-title":"Psychiatry and Clinical Neurosciences","page":"331-334","volume":"47","issue":"2","source":"Wiley Online Library","DOI":"10.1111/j.1440-1819.1993.tb02094.x","ISSN":"1440-1819","language":"en","author":[{"family":"Tsuji","given":"Masahiro"},{"family":"Shinomiya","given":"Shigeko"},{"family":"Inoue","given":"Reiichi"},{"family":"Sato","given":"Kiyoshi"}],"issued":{"date-parts":[["1993",6,1]]}}},{"id":107,"uris":[""],"uri":[""],"itemData":{"id":107,"type":"article-journal","title":"The value of routine electroencephalographic recordings in predicting postoperative seizures associated with meningioma surgery","container-title":"Neurosurgical Review","page":"108-112","volume":"26","issue":"2","source":"link.","abstract":". We analyzed the incidence of postoperative seizures in patients undergoing craniotomy for meningioma removal in order to determine whether EEG recordings are able to predict the incidence of postoperative seizures. We included 102 patients who had undergone surgery on intracranial meningiomas. Pre- and postoperative EEG images were divided into groups showing epileptiform activity including spikes or sharp waves, focal slowing, and normal activity. Follow-up was carried out using a standardized telephone questionnaire by an independent investigator after a mean of 889 days. Seizure outcome was determined by patient reports to the interviewer. Preoperatively obtained, abnormal EEGs correlated significantly to preoperative seizures (P<0.0005), but neither preoperative nor postoperative EEGs correlated to the incidence of postoperative seizures. It would seem that, while evaluation of some clinical parameters revealed a statistically significant correlation, pre- and early postoperative EEGs after meningioma surgery are not useful in determining the risk of postoperative seizures.","DOI":"10.1007/s10143-002-0240-y","ISSN":"0344-5607, 1437-2320","journalAbbreviation":"Neurosurg Rev","language":"en","author":[{"family":"Rothoerl","given":"Ralf D."},{"family":"Bernreuther","given":"D."},{"family":"Woertgen","given":"C."},{"family":"Brawanski","given":"A."}],"issued":{"date-parts":[["2002",10,10]]}}},{"id":118,"uris":[""],"uri":[""],"itemData":{"id":118,"type":"article-journal","title":"Tuberculum sellae meningiomas: Microsurgical anatomy and surgical technique","container-title":"NEUROSURGERY","page":"1432-1439","volume":"51","issue":"6","source":"EBSCOHost","abstract":"OBJECTIVE: Despite Cushing's accurate description of the anatomic origin of tuber-culum sellae meningiomas, many subsequent authors have included tumors originating from the neighboring Sella region in this classification. This has led to difficulty in evaluating the surgical results and consensus for an optimal surgical technique. W e think this confusion has arisen from Cushing's description of these tumors under,the heading \"suprasellar meningiomas,\" which referred-to their distinctive clinical symptoms toms and not their anatomic origin. We describe the microsurgical anatomy and tumor, growth patterns to reemphasize the original classification of Cushing's tuberculum sellae meningiomas. Additionally, we describe our surgical approach, which creases the risk of injury to anterior visual pathways and anterior cerebral circulation arteries.","ISSN":"0148396X","shortTitle":"Tuberculum sellae meningiomas","journalAbbreviation":"NEUROSURGERY","author":[{"family":"Jallo","given":"Gi"},{"family":"Benjamin","given":"V"}],"issued":{"date-parts":[["2002",12]]}}},{"id":126,"uris":[""],"uri":[""],"itemData":{"id":126,"type":"article-journal","title":"Surgical management of tuberculum sellae meningioma: Role of selective extradural anterior clinoidectomy","container-title":"British Journal of Neurosurgery","page":"129-138","volume":"20","issue":"3","source":"EBSCOhost","abstract":"A retrospective analysis of 32 patients with tuberculum sellae meningiomas who underwent surgery via a unilateral pterional approach was performed. A selective extradural anterior clinoidectomy (SEAC) technique was added in 20 patients. All patients had visual dysfunction preoperatively. Macroscopically complete removal with Simpson grade II was performed in 28 patients (87.5%). The postoperative visual function improved in 25 (78.1%), did not change in 3 (9.4%), and worsened in 4 patients (12.5%). The SEAC technique was effective, especially for removal of the tumour extending into the sellae/pituitary stalk (9 patients), the optic canal (4 patients) and hypothalamus (4 patients) with preservation of the visual and endocrinological function. These results were superior to those of surgery without SEAC technique. This technique is therefore recommended for complete resection of the tuberculum sellae meningiomas extending to the surrounding anatomical structures as the SEAC procedure reduces the risk of intraoperative optic nerve injury considerably.","DOI":"10.1080/02688690600776747","ISSN":"02688697","shortTitle":"Surgical management of tuberculum sellae meningioma","journalAbbreviation":"British Journal of Neurosurgery","author":[{"family":"Otani","given":"Naoki"},{"family":"Muroi","given":"Carl"},{"family":"Yano","given":"Hirohito"},{"family":"Khan","given":"Nadia"},{"family":"Pangalu","given":"Athina"},{"family":"Yonekawa","given":"Yasuhiro"}],"issued":{"date-parts":[["2006",6]]}}},{"id":112,"uris":[""],"uri":[""],"itemData":{"id":112,"type":"article-journal","title":"Tuberculum and diaphragma sella meningioma – surgical technique and visual outcome in a series of 20 cases operated over a 2.5-year period","container-title":"Acta Neurochirurgica","page":"1199-1204","volume":"149","issue":"12","source":"link.","abstract":"Summary Background. A retrospective analysis of 20 cases of tuberculum sella meningioma with emphasis on the surgical technique and visual outcome. Methods. Between 2003 and 2006 twenty patients with tuberculum and diaphragma sella meningioma were treated at the Tel Aviv medical center. There were 17 females and 3 males. The age range was 28–83. Most patients presented with visual deterioration. Surgery was performed using the subfrontal approach. The visual function before and after surgery was evaluated as the main outcome parameter of the surgical treatment of these tumours. Findings. In 16 patients complete tumour resection was achieved and in 4 subtotal removal was performed. Visual acuity improved in 32% of the eyes and deterioration was observed in two eyes (5%). Visual field improved in 28% of the eyes and deteriorated in 14%. There was no complete vision loss as a result of surgery. There was no mortality in our series. Conclusions. Tuberculum and diaphragma sella meningioma can be safely resected using the subfrontal approach with preservation and even improvement of visual function after surgery. Early surgery with better pre-operation visual function and smaller tumour size were associated with a better outcome.","DOI":"10.1007/s00701-007-1280-4","ISSN":"0001-6268, 0942-0940","journalAbbreviation":"Acta Neurochir (Wien)","language":"en","author":[{"family":"Margalit","given":"N."},{"family":"Kesler","given":"A."},{"family":"Ezer","given":"H."},{"family":"Freedman","given":"S."},{"family":"Ram","given":"Z."}],"issued":{"date-parts":[["2007",10,29]]}}},{"id":121,"uris":[""],"uri":[""],"itemData":{"id":121,"type":"article-journal","title":"Giant olfactory groove meningioma: ophthalmological and cognitive outcome after bifrontal microsurgical approach","container-title":"ACTA NEUROCHIRURGICA","page":"1117-1126","volume":"150","issue":"11","source":"EBSCOHost","abstract":"Olfactory groove meningiomas arise in the midline along the dura of the cribriform plate and may reach a large size before producing symptoms. We conducted a retrospective study of patients with these lesions focused on pre- and post-operative investigations for ophthalmological, personality and cognitive disturbances.","ISSN":"00016268","shortTitle":"Giant olfactory groove meningioma","journalAbbreviation":"ACTA NEUROCHIRURGICA","author":[{"family":"Gazzeri","given":"R"},{"family":"Galarza","given":"M"},{"family":"Gazzeri","given":"G"}],"issued":{"date-parts":[["2008",11]]}}},{"id":23,"uris":[""],"uri":[""],"itemData":{"id":23,"type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"date-parts":[["2011",3]]}}},{"id":129,"uris":[""],"uri":[""],"itemData":{"id":129,"type":"article-journal","title":"Outcome comparison between younger and older patients undergoing intracranial meningioma resections","container-title":"Journal of Neuro-Oncology","page":"219-227","volume":"114","issue":"2","source":"link.","abstract":"Studies directly comparing the outcomes of intracranial meningioma resection between elderly and younger patients are currently limited. This study aimed to assess the perioperative complications, mortalities and functional outcomes in these two groups. Consecutive elderly patients (aged ≥65) and tumor-location-matched younger patients who underwent intracranial meningioma resections were retrospectively reviewed. Outcomes were assessed at 30-day, 90-day, 6-month and 1-year. We used a standardized classification of operative complications, and conducted subgroup analyses based on tumor location [convexity, parasagittal and falcine (CPF) as one group; skull base (SB) as another]. There were 92 patients in each group. The mean age was 74.6 ± 6.4 years in the elderly and 49.3 ± 10.1 years in the younger groups. The cumulative 30-day, 90-day and 1-year mortality rates were 0, 2.2 and 4.3 % for the elderly, respectively, and 1.1 % for all time points in the young. These differences were not statistically significant. Overall, the elderly suffered from more perioperative complications (P = 0.010), and these were mostly minor complications according to the classification of operative complications. However, these differences were observed only in the SB but not in the CPF subgroup. More elderly patients had impaired functional outcome 1-year after surgery. Significantly more elderly patients had new neurological deficits 1-year after surgery (26.1 vs. 6.6 %; P = 0.001). Comparable mortality rates were observed in elderly and younger patients. However, the elderly had more minor complications and poorer functional outcomes. Patient selection remains key to good clinical outcome.","DOI":"10.1007/s11060-013-1173-8","ISSN":"0167-594X, 1573-7373","journalAbbreviation":"J Neurooncol","language":"en","author":[{"family":"Poon","given":"Michael Tin-Chung"},{"family":"Fung","given":"Linus Hing-Kai"},{"family":"Pu","given":"Jenny Kan-Suen"},{"family":"Leung","given":"Gilberto Ka-Kit"}],"issued":{"date-parts":[["2013",6,5]]}}},{"id":85,"uris":[""],"uri":[""],"itemData":{"id":85,"type":"article-journal","title":"Open Transcranial Resection of Small (<35 mm) Meningiomas of the Anterior Midline Skull Base in Current Microsurgical Practice","container-title":"World Neurosurgery","page":"741-750","volume":"84","issue":"3","source":"ScienceDirect","abstract":"Objective\nDespite technical surgical advance, the ultimate management of midline anterior skull base meningiomas remains to be defined. Open transcranial surgery is usually the first treatment option for large meningiomas, while less invasive techniques such as endoscopic surgery or radiosurgery might represent an alternative to open microsurgery for smaller lesions. The aim of our study is to investigate the outcome of open transcranial microsurgery in the resection of small (&lt;35 mm) meningiomas of the midline anterior cranial base.\nMethods\nClinical and surgical data from 43 patients affected by small midline anterior skull base meningiomas operated via an open transcranial approach were retrospectively reviewed.\nResults\nThe tumor diameter on its major axis ranged from 12 to 35 mm, with a mean diameter of 28 mm. Gross total resection (Simpson grades I–II) was achieved in 100% of cases through a pterional approach. Postoperative overall morbidity was 9%. It was 3% among patients &lt;70 years. No mortality was reported. Postoperative visual outcome was significantly associated with preoperative visual performance (P?= 0.02), but not with preoperative optic nerve compression as detected by magnetic resonance imaging (P?= 0.116). Age &gt;70 years was associated with postoperative visual impairment, although not significantly (P?= 0.06). Visual function was preserved or improved in 95% of cases, in 100% of patients &lt;70 years, and in 71% of patients with preoperative visual impairment.\nConclusions\nIn our experience, open transcranial surgery proved safe and effective for midline anterior skull base meningiomas smaller than 35 mm in all patients &lt;70 years and in patients &gt;70 years without preoperative visual deficit. Our data are consistent with the literature. Conversely, the standard of treatment for the subgroup of patients &gt;70 years with preoperative visual deficit has not yet been defined. This specific subgroup of patients offers a topic for further investigation.","DOI":"10.1016/j.wneu.2015.04.055","ISSN":"1878-8750","journalAbbreviation":"World Neurosurgery","author":[{"family":"Della Puppa","given":"Alessandro"},{"family":"Avella","given":"Elena","non-dropping-particle":"d’"},{"family":"Rossetto","given":"Marta"},{"family":"Volpin","given":"Francesco"},{"family":"Rustemi","given":"Oriela"},{"family":"Gioffrè","given":"Giorgio"},{"family":"Lombardi","given":"Giuseppe"},{"family":"Rolma","given":"Giuseppe"},{"family":"Scienza","given":"Renato"}],"issued":{"date-parts":[["2015",9]]}}},{"id":12,"uris":[""],"uri":[""],"itemData":{"id":12,"type":"article-journal","title":"Predicting outcome of epilepsy after meningioma resection","container-title":"Neuro-Oncology","page":"nov303","source":"neuro-oncology.","abstract":"Background Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.\nMethods Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.\nResults Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32–5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53–22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35–7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25–6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17–5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36–4.67]), younger age (OR: 1.74 [(95% CI: 1.18–2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16–3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25–0.85], P = .013).\nConclusion We suggest prospective validation of a score (“STAMPE2”) based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.","DOI":"10.1093/neuonc/nov303","ISSN":"1522-8517, 1523-5866","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Wirsching","given":"Hans-Georg"},{"family":"Morel","given":"Corinne"},{"family":"Gmür","given":"Corinne"},{"family":"Neidert","given":"Marian Christoph"},{"family":"Baumann","given":"Christian Richard"},{"family":"Valavanis","given":"Antonios"},{"family":"Rushing","given":"Elisabeth Jane"},{"family":"Krayenbühl","given":"Niklaus"},{"family":"Weller","given":"Michael"}],"issued":{"date-parts":[["2015",12,18]]}}}],"schema":""} 10,11,17–23,25 the incidence rate of early post-operative seizures was only 2.6%. Late post-operative seizures were observed to have affected 6.8% of the?patients. In the no-AED cohort, that was comprised of 3 study populations, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HO7XrRe4","properties":{"formattedCitation":"(11,24,25)","plainCitation":"(11,24,25)"},"citationItems":[{"id":23,"uris":[""],"uri":[""],"itemData":{"id":23,"type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"date-parts":[["2011",3]]}}},{"id":133,"uris":[""],"uri":[""],"itemData":{"id":133,"type":"article-journal","title":"Outcome following surgery for intracranial meningiomas in the aging","container-title":"Acta Neurologica Scandinavica","page":"161-169","volume":"127","issue":"3","source":"Wiley Online Library","abstract":"Objective\n\nTo prospectively assess mortality, morbidity and the functional and symptomatic outcome following intracranial surgery for meningiomas in elderly patients at two neurosurgical institutions in Norway.\n\n\nMethods\n\nPatients ≥60?years who underwent craniotomies for intracranial meningiomas at Oslo University Hospital and Haukeland University Hospital in 2008 and 2009 were included (n?=?54). Outcome was assessed at 6?months.\n\n\nResults\n\nThirty-five females and 19 males of median age 70 (60–84)?years were assessed pre- and post-operatively, 87% attended follow-up at 6?months. The surgical mortality rate was 5.6% at 30?days and 7.4% at 3 and 6?months. The rates of complications were: post-operative hematomas 5.6%, deep venous thrombosis 1.9%, osteitis 1.9%, cerebrospinal fluid disturbances 13.0% and neurological sequelae 13.0%. Surgery resulted in a significant improvement in the MMSE score, with a further 14.9% obtaining scores of ≥25 without a significant change in the level of independence according to the Karnofsky performance scale. QoL assessments showed good functioning post-operatively compared to other cancer patient groups, yet slightly reduced when compared to data from the general population.\n\n\nConclusion\n\nIn our series, we found that meningioma surgery in the aging patient carries a higher risk of mortality and morbidity compared to intracranial tumor surgery in general. Our findings indicate, however, that the survivors have improved cognitive function and acceptable QoL, and we did not see any significant decrease in the proportion of independent patients according to the KPS.","DOI":"10.1111/j.1600-0404.2012.01692.x","ISSN":"1600-0404","journalAbbreviation":"Acta Neurol Scand","language":"en","author":[{"family":"Konglund","given":"A."},{"family":"Rogne","given":"S. G."},{"family":"Lund-Johansen","given":"M."},{"family":"Scheie","given":"D."},{"family":"Helseth","given":"E."},{"family":"Meling","given":"T. R."}],"issued":{"date-parts":[["2013",3,1]]}}},{"id":12,"uris":[""],"uri":[""],"itemData":{"id":12,"type":"article-journal","title":"Predicting outcome of epilepsy after meningioma resection","container-title":"Neuro-Oncology","page":"nov303","source":"neuro-oncology.","abstract":"Background Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.\nMethods Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.\nResults Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32–5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53–22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35–7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25–6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17–5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36–4.67]), younger age (OR: 1.74 [(95% CI: 1.18–2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16–3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25–0.85], P = .013).\nConclusion We suggest prospective validation of a score (“STAMPE2”) based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.","DOI":"10.1093/neuonc/nov303","ISSN":"1522-8517, 1523-5866","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Wirsching","given":"Hans-Georg"},{"family":"Morel","given":"Corinne"},{"family":"Gmür","given":"Corinne"},{"family":"Neidert","given":"Marian Christoph"},{"family":"Baumann","given":"Christian Richard"},{"family":"Valavanis","given":"Antonios"},{"family":"Rushing","given":"Elisabeth Jane"},{"family":"Krayenbühl","given":"Niklaus"},{"family":"Weller","given":"Michael"}],"issued":{"date-parts":[["2015",12,18]]}}}],"schema":""} 11,24,25 the incidence rates of early and late post-operative seizures were 2.7% and 7.7% respectively. These are similar to previously reported reviews. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"dwvl6kRF","properties":{"formattedCitation":"{\\rtf (12\\uc0\\u8211{}14)}","plainCitation":"(12–14)"},"citationItems":[{"id":1566,"uris":[""],"uri":[""],"itemData":{"id":1566,"type":"article-journal","title":"Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection: a systematic analysis of efficacy","container-title":"Journal of Neurosurgery","page":"483-490","volume":"115","issue":"3","source":"PubMed","abstract":"OBJECT: Meningiomas are one of the more common intracranial neoplasms. The risk of seizures and secondary aspiration, brain edema, and brain injury often leads practitioners to administer prophylactic antiepileptic drugs (AEDs) perioperatively. The efficacy of this practice remains controversial, however, with prior investigations reaching conflicting results and recent studies focusing on AED side effects. The authors performed a systematic analysis of outcomes following supratentorial meningioma resection with and without prophylactic AED administration in the hope of clarifying the role of AEDs in the perioperative care of patients with these lesions.\nMETHODS: A MEDLINE search of the literature (1979-2010) was performed. Comparisons were made for patient and tumor characteristics as well as success of repair, morbidity, and seizure outcome. Statistical analyses of categorical variables were undertaken using chi-square and Fisher exact tests.\nRESULTS: Nineteen studies, involving 698 patients, were included. There were no significant differences in the extent of resection, perioperative mortality, or recurrence between the AED and no-AED cohorts. Likewise, there were no significant differences in the incidence of early or late seizures between the cohorts.\nCONCLUSIONS: The results of this systematic analysis supports the conclusion that the prophylactic administration of anticonvulsants during resection of supratentorial meningiomas provides no benefit in the prevention of either early or late postoperative seizures. Despite their traditional role in this patient population, the routine use of AEDs should be carefully reconsidered.","DOI":"10.3171/2011.4.JNS101585","ISSN":"1933-0693","note":"PMID: 21639698","shortTitle":"Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Komotar","given":"Ricardo J."},{"family":"Raper","given":"Daniel M. S."},{"family":"Starke","given":"Robert M."},{"family":"Iorgulescu","given":"J. Bryan"},{"family":"Gutin","given":"Philip H."}],"issued":{"date-parts":[["2011",9]]},"PMID":"21639698"}},{"id":"3MuUnfCE/yzPkpqtC","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/yzPkpqtC","type":"article-journal","title":"Seizures in supratentorial meningioma: a systematic review and meta-analysis","container-title":"Journal of Neurosurgery","page":"1552-1561","volume":"124","issue":"6","source":"PubMed","abstract":"OBJECT Meningioma is the most common benign intracranial tumor, and patients with supratentorial meningioma frequently suffer from seizures. The rates and predictors of seizures in patients with meningioma have been significantly under-studied, even in comparison with other brain tumor types. Improved strategies for the prediction, treatment, and prevention of seizures in patients with meningioma is an important goal, because tumor-related epilepsy significantly impacts patient quality of life. METHODS The authors performed a systematic review of PubMed for manuscripts published between January 1980 and September 2014, examining rates of pre- and postoperative seizures in supratentorial meningioma, and evaluating potential predictors of seizures with separate meta-analyses. RESULTS The authors identified 39 observational case series for inclusion in the study, but no controlled trials. Preoperative seizures were observed in 29.2% of 4709 patients with supratentorial meningioma, and were significantly predicted by male sex (OR 1.74, 95% CI 1.30-2.34); an absence of headache (OR 1.77, 95% CI 1.04-3.25); peritumoral edema (OR 7.48, 95% CI 6.13-9.47); and non-skull base location (OR 1.77, 95% CI 1.04-3.25). After surgery, seizure freedom was achieved in 69.3% of 703 patients with preoperative epilepsy, and was more than twice as likely in those without peritumoral edema, although an insufficient number of studies were available for formal meta-analysis of this association. Of 1085 individuals without preoperative epilepsy who underwent resection, new postoperative seizures were seen in 12.3% of patients. No difference in the rate of new postoperative seizures was observed with or without perioperative prophylactic anticonvulsants. CONCLUSIONS Seizures are common in supratentorial meningioma, particularly in tumors associated with brain edema, and seizure freedom is a critical treatment goal. Favorable seizure control can be achieved with resection, but evidence does not support routine use of prophylactic anticonvulsants in patients without seizures. Limitations associated with systematic review and meta-analysis should be considered when interpreting these results.","DOI":"10.3171/2015.4.JNS142742","ISSN":"1933-0693","note":"PMID: 26636386\nPMCID: PMC4889504","shortTitle":"Seizures in supratentorial meningioma","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Englot","given":"Dario J."},{"family":"Magill","given":"Stephen T."},{"family":"Han","given":"Seunggu J."},{"family":"Chang","given":"Edward F."},{"family":"Berger","given":"Mitchel S."},{"family":"McDermott","given":"Michael W."}],"issued":{"year":2016,"month":6},"PMID":"26636386","PMCID":"PMC4889504","page-first":"1552","title-short":"Seizures in supratentorial meningioma","container-title-short":"J. Neurosurg."}},{"id":"3MuUnfCE/Ea4Oakja","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/Ea4Oakja","type":"article-journal","title":"Intracranial meningiomas and seizures: a review of the literature","container-title":"Acta Neurochirurgica","page":"1541-1548","volume":"157","issue":"9","source":"link.","abstract":"Background Seizures are a common manifestation of brain tumors, but literature on the incidence of seizures before and after surgery for meningiomas is limited, and principles for use of antiepileptic drugs (AEDs) are controversial. Methods This review is based on a MEDLINE search for articles from 1994 to 2014 describing intracranial meningioma and seizures or epilepsy, and AEDs treatment during and after surgery. Results Up to 40 % of patients with symptomatic meningiomas present with seizures before operation. Tumor removal usually results in seizure control, but around 20 % of patients continue to have or develop new-onset seizures after surgery. Risk factors for seizures after surgery include preoperative seizures, tumor location, and extent of tumor removal. There are no solid data to support routine pre- or postoperative AED prophylaxis in seizure-free patients, and the decision to treat and the selection of AEDs should follow the general principles of treatment of focal epilepsies. Conclusions Seizures are a common manifestation of meningiomas, but about 80 % patients with preoperative seizures can be seizure free after tumor removal. Prospective controlled AED trials specifically on meningioma patients are much needed.","DOI":"10.1007/s00701-015-2495-4","ISSN":"0001-6268, 0942-0940","shortTitle":"Intracranial meningiomas and seizures","journalAbbreviation":"Acta Neurochir","language":"en","author":[{"family":"Xue","given":"Hai"},{"family":"Sveinsson","given":"Olafur"},{"family":"Tomson","given":"Torbj?rn"},{"family":"Mathiesen","given":"Tiit"}],"issued":{"year":2015,"month":7,"day":11},"page-first":"1541","title-short":"Intracranial meningiomas and seizures","container-title-short":"Acta Neurochir. (Wien)"}}],"schema":""} 12–14In a recent retrospective single-institution study from Switzerland that attempted to define risk factors for post-operative epilepsy amongst meningioma patients, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"i5Y1JOfC","properties":{"formattedCitation":"(25)","plainCitation":"(25)"},"citationItems":[{"id":"3MuUnfCE/gAh8ueKG","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/gAh8ueKG","type":"article-journal","title":"Predicting outcome of epilepsy after meningioma resection","container-title":"Neuro-Oncology","page":"nov303","source":"neuro-oncology.","abstract":"Background Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.\nMethods Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.\nResults Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32–5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53–22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35–7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25–6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17–5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36–4.67]), younger age (OR: 1.74 [(95% CI: 1.18–2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16–3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25–0.85], P = .013).\nConclusion We suggest prospective validation of a score (“STAMPE2”) based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.","DOI":"10.1093/neuonc/nov303","ISSN":"1522-8517, 1523-5866","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Wirsching","given":"Hans-Georg"},{"family":"Morel","given":"Corinne"},{"family":"Gmür","given":"Corinne"},{"family":"Neidert","given":"Marian Christoph"},{"family":"Baumann","given":"Christian Richard"},{"family":"Valavanis","given":"Antonios"},{"family":"Rushing","given":"Elisabeth Jane"},{"family":"Krayenbühl","given":"Niklaus"},{"family":"Weller","given":"Michael"}],"issued":{"year":2015,"month":12,"day":18},"page-first":"nov303","container-title-short":"Neuro-Oncol."}}],"schema":""} 25 the rate of new-onset seizures among patients administered prophylactic AEDs and patients who were not was measured; overall, there were more early and late post-operative seizures in the AED cohort (27.0% vs. 13.1%) (Wirsching H-G, personal communication, April 14, 2016), however, the baseline characteristics between the two groups were not matched. In the AED cohort, there were more patients with WHO grades II and III meningiomas who exhibited active electroencephalograms pre-operatively and experienced more post-operative complications. On the other hand, more patients in the no-AED cohort underwent subtotal resection (STR). The study showed these preceding factors, in addition to tumour progression and the convexity location, to be associated with de novo epilepsy post-operatively. However, it failed to demonstrate whether such groups of meningioma benefited from prophylactic AEDs. Such differences in key clinical factors between the two AED cohorts are likely to have an impact on seizure rates and future studies should be designed to compare matched cohorts. In marked contrast, Sughrue et al. compared patients administered 1 week of prophylactic AEDs to patients with no AED therapy following resection of convexity meningiomas. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ol6vgi95","properties":{"formattedCitation":"(11)","plainCitation":"(11)"},"citationItems":[{"id":"3MuUnfCE/fxzlm1qr","uris":[""],"uri":[""],"itemData":{"id":"3MuUnfCE/fxzlm1qr","type":"article-journal","title":"Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article","container-title":"Journal of Neurosurgery","page":"705-709","volume":"114","issue":"3","source":"PubMed","abstract":"OBJECT: Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures.\nMETHODS: The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared.\nRESULTS: Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant).\nCONCLUSIONS: While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.","DOI":"10.3171/2010.5.JNS091972","ISSN":"1933-0693","shortTitle":"Postoperative seizures following the resection of convexity meningiomas","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Sughrue","given":"Michael E."},{"family":"Rutkowski","given":"Martin J."},{"family":"Chang","given":"Edward F."},{"family":"Shangari","given":"Gopal"},{"family":"Kane","given":"Ari J."},{"family":"McDermott","given":"Michael W."},{"family":"Berger","given":"Mitchel S."},{"family":"Parsa","given":"Andrew T."}],"issued":{"year":2011,"month":3},"page-first":"705","title-short":"Postoperative seizures following the resection of convexity meningiomas","container-title-short":"J. Neurosurg."}}],"schema":""} 11 Demographic and clinical characteristics between the two cohorts were balanced. There was only one reported early post-operative seizure in the entire study population (n=180) and that patient had not received an AED. Details surrounding the prophylactic administration of AEDs lacked across all studies; doses were not specified in any of the studies and in only one of them was the duration noted.11 Moreover, the withdrawal process in patients subjected to prophylaxis was not depicted in any of them. Such information is fundamental to a neurosurgeon’s clinical practice and future meningioma and brain tumour studies should take that into account.None of the studies included reported the adverse of effects of AEDs. However, AEDs are well known to have a poor adverse event profile. Older drugs such as phenytoin cause skin rashes and deranged liver function and 18-43% of patients experience at least one adverse effect. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xIDrOqN5","properties":{"formattedCitation":"{\\rtf (49\\uc0\\u8211{}52)}","plainCitation":"(49–52)"},"citationItems":[{"id":54,"uris":[""],"uri":[""],"itemData":{"id":54,"type":"article-journal","title":"Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects","container-title":"J Neurol Neurosurg Psychiatry","page":"474-80","volume":"67","issue":"4","source":"NLM","archive_location":"10486394","abstract":"OBJECTIVE: To determine the efficacy, tolerability, and impact on quality of life and cognitive functioning of anticonvulsant prophylaxis with phenytoin or sodium valproate in patients after craniotomy. METHODS: A prospective, stratified, randomised, double blind single centre clinical trial was performed, comparing two groups of 50 patients each, who underwent craniotomy for different pathological conditions and who were treated for 1 year after surgery with either 300 mg phenytoin/day or 1500 mg sodium valproate/day. During the study period patients were seen in the outpatient clinic at 1.5, 3, 6, and 12 months, when medical history, adverse events, and drug plasma concentrations were evaluated. Neuropsychological functioning and quality of life were assessed on the last three visits. In cases of a seizure an EEG was performed, drug plasma concentration assessed, and medication subsequently increased. RESULTS: Of the 100 included patients 14 (seven in each group) experienced one or more postoperative seizures. Severity of the seizures was comparable in the two groups. In all patients, drug plasma concentrations were in the low or subtherapeutic ranges at the time of the first postoperative seizure. Five patients in the phenytoin group and two in the valproate group had to stop their treatment due to drug related adverse events. Sixty patients completed the 12 month period. Analysis of neuropsychological and quality of life data showed no significant differences. CONCLUSION: For efficacy, tolerability, impact on cognitive functioning, and quality of life, no major differences were found between phenytoin and valproate prophylaxis. Valproate is an alternative for anticonvulsant prophylaxis in patients after craniotomy.","ISSN":"0022-3050 (Print) 0022-3050 (Linking)","shortTitle":"Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects","language":"eng","author":[{"family":"Beenen","given":"L. F."},{"family":"Lindeboom","given":"J."},{"family":"Kasteleijn-Nolst Trenite","given":"D. G."},{"family":"Heimans","given":"J. J."},{"family":"Snoek","given":"F. J."},{"family":"Touw","given":"D. J."},{"family":"Ader","given":"H. J."},{"family":"Alphen","given":"H. A.","non-dropping-particle":"van"}],"issued":{"date-parts":[["1999",10]]}}},{"id":41,"uris":[""],"uri":[""],"itemData":{"id":41,"type":"article-journal","title":"Tolerability, safety, and side effects of levetiracetam versus phenytoin in intravenous and total prophylactic regimen among craniotomy patients: a prospective randomized study","container-title":"Epilepsia","page":"45-57","volume":"54","issue":"1","source":"PubMed","abstract":"PURPOSE: Practical choice in parenteral antiepileptic drugs (AEDs) remains limited despite formulation of newer intravenous agents and requirements of special patient groups. This study aims to compare the tolerability, safety, and side effect profiles of levetiracetam (LEV) against the standard agent phenytoin (PHT) when given intravenously and in total regimen for seizure prophylaxis in a neurosurgical setting.\nMETHODS: This prospective, randomized, single-center study with appropriate blinding comprised evaluation pertaining to intravenous use 3 days following craniotomy and at discharge, and to total intravenous-plus-oral AED regimen at 90 days. Primary tolerability end points were discontinuation because of side effect and first side effect. Safety combined end point was major side effect or seizure. Seizure occurrence and side effect profiles were compared as secondary outcomes.\nKEY FINDINGS: Of 81 patients randomized, 74 (36 LEV, 38 PHT) received parenteral AEDs. No significant difference attributable to intravenous use was found between LEV and PHT in discontinuation because of side effect (LEV 1/36, PHT 2/38, p = 1.00) or number of patients with side effect (LEV 1/36, PHT 4/38, p = 0.36). No significant difference was found between LEV and PHT total intravenous-plus-oral regimen in discontinuation because of side effect (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.21-2.92, p = 0.72) or number of patients with side effect (HR 1.51, 95% CI 0.77-2.98, p = 0.22). More patients assigned PHT reached the undesirable clinical end point for safety of major side effect or seizure (HR 0.09, 95% CI 0.01-0.70, p = 0.002). Seizures occurred only in patients assigned PHT (n = 6, p = 0.01). Although not significant, trends were observed for major side effect in more patients assigned PHT (p = 0.08) and mild side effect in more assigned LEV (p = 0.09).\nSIGNIFICANCE: Both LEV and PHT are well-tolerated perioperatively in parenteral preparation, and in total intravenous-plus-oral prophylactic regimen. Comparative safety and differing side effect profile of intravenous LEV supports use as an alternative to intravenous PHT.","DOI":"10.1111/j.1528-1167.2012.03563.x","ISSN":"1528-1167","shortTitle":"Tolerability, safety, and side effects of levetiracetam versus phenytoin in intravenous and total prophylactic regimen among craniotomy patients","journalAbbreviation":"Epilepsia","language":"eng","author":[{"family":"Fuller","given":"Karen L."},{"family":"Wang","given":"Yi Yuen"},{"family":"Cook","given":"Mark J."},{"family":"Murphy","given":"Michael A."},{"family":"D'Souza","given":"Wendyl J."}],"issued":{"date-parts":[["2013",1]]}}},{"id":7,"uris":[""],"uri":[""],"itemData":{"id":7,"type":"article-journal","title":"A prospective randomized trial of perioperative seizure prophylaxis in patients with intraparenchymal brain tumors","container-title":"Journal of Neurosurgery","page":"873-883","volume":"118","issue":"4","source":"PubMed","abstract":"OBJECT: Seizures are a potentially devastating complication of resection of brain tumors. Consequently, many neurosurgeons administer prophylactic antiepileptic drugs (AEDs) in the perioperative period. However, it is currently unclear whether perioperative AEDs should be routinely administered to patients with brain tumors who have never had a seizure. Therefore, the authors conducted a prospective, randomized trial examining the use of phenytoin for postoperative seizure prophylaxis in patients undergoing resection for supratentorial brain metastases or gliomas.\nMETHODS: Patients with brain tumors (metastases or gliomas) who did not have seizures and who were undergoing craniotomy for tumor resection were randomized to receive either phenytoin for 7 days after tumor resection (prophylaxis group) or no seizure prophylaxis (observation group). Phenytoin levels were monitored daily. Primary outcomes were seizures and adverse events. Using an estimated seizure incidence of 30% in the observation arm and 10% in the prophylaxis arm, a Type I error of 0.05 and a Type II error of 0.20, a target accrual of 142 patients (71 per arm) was planned.\nRESULTS: The trial was closed before completion of accrual because Bayesian predictive probability analyses performed by an independent data monitoring committee indicated a probability of 0.003 that at the end of the study prophylaxis would prove superior to observation and a probability of 0.997 that there would be insufficient evidence at the end of the trial to choose either arm as superior. At the time of trial closure, 123 patients (77 metastases and 46 gliomas) were randomized, with 62 receiving 7-day phenytoin (prophylaxis group) and 61 receiving no prophylaxis (observation group). The incidence of all seizures was 18% in the observation group and 24% in the prophylaxis group (p = 0.51). Importantly, the incidence of early seizures (< 30 days after surgery) was 8% in the observation group compared with 10% in the prophylaxis group (p = 1.0). Likewise, the incidence of clinically significant early seizures was 3% in the observation group and 2% in the prophylaxis group (p = 0.62). The prophylaxis group experienced significantly more adverse events (18% vs 0%, p < 0.01). Therapeutic phenytoin levels were maintained in 80% of patients.\nCONCLUSIONS: The incidence of seizures after surgery for brain tumors is low (8% [95% CI 3%-18%]) even without prophylactic AEDs, and the incidence of clinically significant seizures is even lower (3%). In contrast, routine phenytoin administration is associated with significant drug-related morbidity. Although the lower-than-anticipated incidence of seizures in the control group significantly limited the power of the study, the low baseline rate of perioperative seizures in patients with brain tumors raises concerns about the routine use of prophylactic phenytoin in this patient population.","DOI":"10.3171/2012.12.JNS111970","ISSN":"1933-0693","journalAbbreviation":"J. Neurosurg.","language":"eng","author":[{"family":"Wu","given":"Adam S."},{"family":"Trinh","given":"Victoria T."},{"family":"Suki","given":"Dima"},{"family":"Graham","given":"Susan"},{"family":"Forman","given":"Arthur"},{"family":"Weinberg","given":"Jeffrey S."},{"family":"McCutcheon","given":"Ian E."},{"family":"Prabhu","given":"Sujit S."},{"family":"Heimberger","given":"Amy B."},{"family":"Sawaya","given":"Raymond"},{"family":"Wang","given":"Xuemei"},{"family":"Qiao","given":"Wei"},{"family":"Hess","given":"Kenneth R."},{"family":"Lang","given":"Frederick F."}],"issued":{"date-parts":[["2013",4]]}}},{"id":1,"uris":[""],"uri":[""],"itemData":{"id":1,"type":"article-journal","title":"Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery","container-title":"Neurology","page":"665-669","volume":"71","issue":"9","source":"","abstract":"Background: Antiepileptic drugs are routinely given after craniotomy. Though phenytoin (PHT) is still the most commonly used agent, levetiracetam (LEV) is increasingly administered for this purpose. This retrospective study compared the use of LEV and PHT as monotherapy prophylaxis following supratentorial neurosurgery.\nMethods: Patients receiving LEV monotherapy after supratentorial craniotomy were reviewed and compared to a control group of patients receiving PHT monotherapy.\nResults: One of 105 patients taking LEV and 9/210 patients taking PHT had seizures within 7 days of surgery (p = 0.17). Adverse drug reactions requiring change in therapy during hospitalization occurred in 1/105 patients taking LEV and 38/210 patients taking PHT (p < 0.001). Among patients followed for at least 12 months, 11/42 (26%) treated with LEV vs 42/117 (36%) treated with PHT developed epilepsy (p = 0.34); 64% remained on LEV, while 26% remained on PHT (p = 0.03).\nConclusions: Both levetiracetam (LEV) and phenytoin (PHT) were associated with a low risk of early postoperative seizures and a moderate risk of later epilepsy. LEV was associated with significantly fewer early adverse reactions than PHT and with a higher retention rate in patients who were followed for at least 1 year and developed epilepsy.","DOI":"10.1212/01.wnl.0000324624.52935.46","ISSN":"0028-3878, 1526-632X","journalAbbreviation":"Neurology","language":"en","author":[{"family":"Milligan","given":"Tracey A."},{"family":"Hurwitz","given":"Shelley"},{"family":"Bromfield","given":"Edward B."}],"issued":{"date-parts":[["2008",8,26]]}}}],"schema":""} 49–52 Newer drugs including levetiracetam are better tolerated, but can still cause side effects such as lethargy, rash and mood changes. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vcoa1RaU","properties":{"formattedCitation":"(50,52)","plainCitation":"(50,52)"},"citationItems":[{"id":41,"uris":[""],"uri":[""],"itemData":{"id":41,"type":"article-journal","title":"Tolerability, safety, and side effects of levetiracetam versus phenytoin in intravenous and total prophylactic regimen among craniotomy patients: a prospective randomized study","container-title":"Epilepsia","page":"45-57","volume":"54","issue":"1","source":"PubMed","abstract":"PURPOSE: Practical choice in parenteral antiepileptic drugs (AEDs) remains limited despite formulation of newer intravenous agents and requirements of special patient groups. This study aims to compare the tolerability, safety, and side effect profiles of levetiracetam (LEV) against the standard agent phenytoin (PHT) when given intravenously and in total regimen for seizure prophylaxis in a neurosurgical setting.\nMETHODS: This prospective, randomized, single-center study with appropriate blinding comprised evaluation pertaining to intravenous use 3 days following craniotomy and at discharge, and to total intravenous-plus-oral AED regimen at 90 days. Primary tolerability end points were discontinuation because of side effect and first side effect. Safety combined end point was major side effect or seizure. Seizure occurrence and side effect profiles were compared as secondary outcomes.\nKEY FINDINGS: Of 81 patients randomized, 74 (36 LEV, 38 PHT) received parenteral AEDs. No significant difference attributable to intravenous use was found between LEV and PHT in discontinuation because of side effect (LEV 1/36, PHT 2/38, p = 1.00) or number of patients with side effect (LEV 1/36, PHT 4/38, p = 0.36). No significant difference was found between LEV and PHT total intravenous-plus-oral regimen in discontinuation because of side effect (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.21-2.92, p = 0.72) or number of patients with side effect (HR 1.51, 95% CI 0.77-2.98, p = 0.22). More patients assigned PHT reached the undesirable clinical end point for safety of major side effect or seizure (HR 0.09, 95% CI 0.01-0.70, p = 0.002). Seizures occurred only in patients assigned PHT (n = 6, p = 0.01). Although not significant, trends were observed for major side effect in more patients assigned PHT (p = 0.08) and mild side effect in more assigned LEV (p = 0.09).\nSIGNIFICANCE: Both LEV and PHT are well-tolerated perioperatively in parenteral preparation, and in total intravenous-plus-oral prophylactic regimen. Comparative safety and differing side effect profile of intravenous LEV supports use as an alternative to intravenous PHT.","DOI":"10.1111/j.1528-1167.2012.03563.x","ISSN":"1528-1167","shortTitle":"Tolerability, safety, and side effects of levetiracetam versus phenytoin in intravenous and total prophylactic regimen among craniotomy patients","journalAbbreviation":"Epilepsia","language":"eng","author":[{"family":"Fuller","given":"Karen L."},{"family":"Wang","given":"Yi Yuen"},{"family":"Cook","given":"Mark J."},{"family":"Murphy","given":"Michael A."},{"family":"D'Souza","given":"Wendyl J."}],"issued":{"date-parts":[["2013",1]]}}},{"id":1,"uris":[""],"uri":[""],"itemData":{"id":1,"type":"article-journal","title":"Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery","container-title":"Neurology","page":"665-669","volume":"71","issue":"9","source":"","abstract":"Background: Antiepileptic drugs are routinely given after craniotomy. Though phenytoin (PHT) is still the most commonly used agent, levetiracetam (LEV) is increasingly administered for this purpose. This retrospective study compared the use of LEV and PHT as monotherapy prophylaxis following supratentorial neurosurgery.\nMethods: Patients receiving LEV monotherapy after supratentorial craniotomy were reviewed and compared to a control group of patients receiving PHT monotherapy.\nResults: One of 105 patients taking LEV and 9/210 patients taking PHT had seizures within 7 days of surgery (p = 0.17). Adverse drug reactions requiring change in therapy during hospitalization occurred in 1/105 patients taking LEV and 38/210 patients taking PHT (p < 0.001). Among patients followed for at least 12 months, 11/42 (26%) treated with LEV vs 42/117 (36%) treated with PHT developed epilepsy (p = 0.34); 64% remained on LEV, while 26% remained on PHT (p = 0.03).\nConclusions: Both levetiracetam (LEV) and phenytoin (PHT) were associated with a low risk of early postoperative seizures and a moderate risk of later epilepsy. LEV was associated with significantly fewer early adverse reactions than PHT and with a higher retention rate in patients who were followed for at least 1 year and developed epilepsy.","DOI":"10.1212/01.wnl.0000324624.52935.46","ISSN":"0028-3878, 1526-632X","journalAbbreviation":"Neurology","language":"en","author":[{"family":"Milligan","given":"Tracey A."},{"family":"Hurwitz","given":"Shelley"},{"family":"Bromfield","given":"Edward B."}],"issued":{"date-parts":[["2008",8,26]]}}}],"schema":""} 50,52 The systematic under-reporting of adverse events from AEDs in meningioma series makes it impossible to determine whether the potential benefits outweigh the risks and these factors should be considered in all future studies.There are several limitations to this study including those related to the inherent bias in meta-analysis of data from several studies. In ten of the studies, prophylactic AEDs were administered to all patients (n=766), which reflects clinician bias and preference for treatment. Comparisons of clinical characteristics between the AED and no-AED cohorts revealed imbalances; however, the number of cases valid for each characteristic differed and ranged from 129 to 741. This was also observed for outcome comparisons, which exhibited a significant difference in the proportions of GTR amongst the two cohorts. These significant differences in characteristics and outcomes combined with the disproportional cohort sizes (766 vs 377) limit the interpretation of our results. In addition, only four studies addressed post-operative seizures as their primary outcome, of which two directly compared the AED and no-AED cohorts and these had unequal numbers in each group, which is likely to introduce bias into any statistical analysis. Similarly, the number of patients in each study ranged from 20 to 779 and meta-analysis of data will be biased towards the largest of studies, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2dj8ff4v4e","properties":{"formattedCitation":"(25)","plainCitation":"(25)"},"citationItems":[{"id":"ZB1MlHyc/5WTHQzFn","uris":[""],"uri":[""],"itemData":{"id":"ZB1MlHyc/5WTHQzFn","type":"article-journal","title":"Predicting outcome of epilepsy after meningioma resection","container-title":"Neuro-Oncology","page":"nov303","source":"neuro-oncology.","abstract":"Background Surgical excision is the standard treatment for intracranial meningiomas. Epilepsy is a major cause of morbidity in meningioma patients, but postoperative control of epilepsy is not achieved in a substantial fraction of patients. The purpose of this study was to define risk factors for postoperative epilepsy.\nMethods Patients treated for histologically confirmed intracranial meningioma at the University Hospital Zurich between 2000 and 2013 were retrospectively analyzed. Demographic, clinical, imaging, and electroencephalographic data were assessed. A binary regression model was applied to identify risk factors for postoperative epilepsy.\nResults Of the 779 patients analyzed, epileptic seizures occurred in 244 (31.3%) patients before surgery and in 204 (26.6%) patients after surgery. Of the 244 patients with preoperative epilepsy, 144 (59.0%) became seizure-free after surgery; of the 535 patients without preoperative seizures, 104 (19.4%) suffered from epilepsy after surgery. Risk factors for postoperative epilepsy were preoperative epilepsy (odds ratio [OR]: 3.46 [95% confidence interval {CI}: 2.32–5.16]), major surgical complications including CNS infections (OR: 5.89 [95% CI: 1.53–22.61]), hydrocephalus (OR: 3.27 [95% CI: 1.35–7.95]), recraniotomy (OR: 2.91 [95% CI: 1.25–6.78]), and symptomatic intracranial hemorrhage (OR: 2.60 [95% CI: 1.17–5.76]) as well as epileptiform EEG potentials (OR: 2.52 [95% CI: 1.36–4.67]), younger age (OR: 1.74 [(95% CI: 1.18–2.58]), and tumor progression (OR: 1.92 [95% CI: 1.16–3.18]). Postoperative improvement or recovery from preoperative neurologic deficits was associated with improved seizure control (OR: 0.46 [95% CI: 0.25–0.85], P = .013).\nConclusion We suggest prospective validation of a score (“STAMPE2”) based on clinical findings, EEG, and brain-imaging measures to estimate postoperative seizure risk and guide anticonvulsant treatment in meningioma patients.","DOI":"10.1093/neuonc/nov303","ISSN":"1522-8517, 1523-5866","journalAbbreviation":"Neuro Oncol","language":"en","author":[{"family":"Wirsching","given":"Hans-Georg"},{"family":"Morel","given":"Corinne"},{"family":"Gmür","given":"Corinne"},{"family":"Neidert","given":"Marian Christoph"},{"family":"Baumann","given":"Christian Richard"},{"family":"Valavanis","given":"Antonios"},{"family":"Rushing","given":"Elisabeth Jane"},{"family":"Krayenbühl","given":"Niklaus"},{"family":"Weller","given":"Michael"}],"issued":{"year":2015,"month":12,"day":18},"page-first":"nov303","container-title-short":"Neuro-Oncol."}}],"schema":""} 25 which contributed in total to 46.8% of patients included and 93.7% of seizures reported. These factors limit the quantitative analysis that could be undertaken in our study and subsequent interpretation of results, and ultimately highlight the need for prospective clinical trials. Lastly, there was marked variation in the quality and completeness of the data available reflecting the lack of standardised outcome reporting in neurosurgery studies and the propensity for single institution case-series, which compounds the difficulty in comparing the results of different studies. ConclusionThe results of this systematic review suggest that based on current literature evidence, the routine use of prophylactic AEDs in seizure-na?ve patients undergoing craniotomy and resection of meningioma cannot be justified. However, the data used to reach this conclusion is inadequate, with significant methodological shortcomings including a wide variation in the reporting of outcome measures such as AED-related adverse reactions. Despite the lack of evidence to support the routine use of prophylactic AEDs, these drugs continue to be prescribed in clinical practice. Studies suggest that supratentorial location and post-operative perifocal oedema to be the factors associated with early seizures and recurrence to be the sole factor associated with seizures of late-onset. Unfavourable recurrence rates are observed in high-grade meningiomas. Whether prophylactic AEDs affect seizure rates in these groups of meningioma remains unanswered and only a well-designed prospective randomised controlled trial could help resolve this issue.AcknowledgementsWe would like to thank Dr?Wirsching, Dr Della?Puppa?and Dr Poon for their cooperation in providing additional data regarding their individual studies.ReferencesCea-Soriano L, Wallander M-A, García Rodríguez LA. Epidemiology of meningioma in the United Kingdom. Neuroepidemiology. 2012; 39: 27–34.Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. 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Brain Tumor and Seizures: Pathophysiology and Its Implications for Treatment Revisited. Epilepsia. 2003; 44: 1223–1232. Shamji MF, Fric-Shamji EC, Benoit BG. Brain tumors and epilepsy: pathophysiology of peritumoral changes. Neurosurg Rev. 2009; 32: 275–285. Van Breemen MSM, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumors: epidemiology, mechanisms, and management. Lancet Neurol. 2007; 6: 421–430.Skardelly M, Rother C, Noell S, et al. Risk Factors of Preoperative and Early Postoperative Seizures in Patients with Meningioma: A Retrospective Single-Center Cohort Study. World Neurosurg. 2017; 97: 538–546. Zhang B, Wang D, Guo Y, et al. Clinical multifactorial analysis of early postoperative seizures in elderly patients following meningioma resection. Mol Clin Oncol. 2015; 3: 501–505. Nanda A, Bir SC, Maiti TK, et al. Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma. J Neurosurg. 2016; 126: 201–211. Gallagher MJ, Jenkinson MD, Brodbelt AR, et al. WHO grade 1 meningioma recurrence: Are location and Simpson grade still relevant? Clin Neurol Neurosurg. 2016; 141: 117–121. Yang S-Y, Park C-K, Park S-H, et al. Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry. 2008; 79: 574–580. Aizer AA, Arvold ND, Catalano P, et al. Adjuvant radiation therapy, local recurrence, and the need for salvage therapy in atypical meningioma. Neuro-Oncol. 2014; 16: 1547–1553. Bruna J, Brell M, Ferrer I, et al. Ki-67 proliferative index predicts clinical outcome in patients with atypical or anaplastic meningioma. Neuropathology. 2007; 27: 114–120. Cushing H, Eisenhardt L. Meningiomas. Their classification, regional Behaviour, life history and surgical end results. Springfield, Ill., and Baltimore, Md.: Charles C. Thomas, 1938.Beenen LF, Lindeboom J, Kasteleijn-Nolst Trenite DG, et al. Comparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects. J Neurol Neurosurg Psychiatry. 1999; 67: 474–480.Fuller KL, Wang YY, Cook MJ, et al. Tolerability, safety, and side effects of levetiracetam versus phenytoin in intravenous and total prophylactic regimen among craniotomy patients: a prospective randomized study. Epilepsia. 2013; 54: 45–57. Wu AS, Trinh VT, Suki D, et al. A prospective randomized trial of perioperative seizure prophylaxis in patients with intraparenchymal brain tumors. J Neurosurg. 2013; 118: 873–883. Milligan TA, Hurwitz S, Bromfield EB. Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery. Neurology. 2008; 71: 665–669. Figure and table legendsFigure 1. Flow diagram of the study selection processTable 1. Study characteristics of meningioma cohorts with and without AED prophylaxisTable 2. Patient characteristics in seizure-na?ve meningioma patientsTable 3. The specific AEDs used in seizure-na?ve meningioma patients Table 4. Extent of resection and seizure outcome in seizure-na?ve meningioma patients 10595424765000Authors & yearStudy designTotal No. of patientsMean age (yrs.)FU (mos.)No. of seizure-na?ve patientsAEDNo-AEDEarly post-operative seizuresLate post-operative seizuresAEDNo-AEDAEDNo-AEDTsuji et al., 199310pros2053.724c171701010Rothoerl et al., 200217pros10252.629.6d707000000Jallo et al., 200219retro2357.7111.6d232300000Otani et al., 200620retro3253.538.3d303000000Margalit et al., 200718pros2058.53c202000000Gazzeri et al., 200821retro3656.4111d262600000Sughrue et al., 201111retro18055.51c180129510100Konglund et al., 201324pros54706c350350000Poon et al., 201322aretro18461.912c16616601030Della Puppa et al., 201523retro436324d414100000Wirsching et al., 201525bretro7795767e5352442911894829Abbreviations: AED=antiepileptic drug; pros=prospective; retro=retrospective; FU=follow-up.a(Poon MT-C, personal communication, March 12, 2016).b(Wirsching H-G, personal communication, April 14, 2016).cThe data employed was at this point in time post-operatively. dMean follow-up time.eMedian follow-up time.Table 1. Study characteristics of meningioma cohorts with and without AED prophylaxisCharacteristicsStudies included (N.)N. of valid cases (%) AEDNo-AEDP-valueTotal No. of Patients (%)10, 11, 17–25 (11)1143 (100)766 (67.0)377 (33.0)N/AMean Age 10, 11, 18, 19 (4)240 (20.1)54.058.0N/ASex (F/M)143/4637/140.649Location (%)Non-Skull base10, 11, 18-21, 23 (7)337 (29.5)134 (46.9)51(100)<0.05Skull base152 (53.1)0.00WHO Grade (%)I11, 21, 25 (3)741 (64.8)300 (75.2)293 (85.7)<0.05II/III99 (24.8)49 (14.3)Mean Maximal Tumour Diameter (cm)10, 18-20, 24 (5)129 (11.3)2.81N/AN/AAbbreviations: AED=antiepileptic drug; GTR=gross total resection; STR=subtotal resection; WHO=World Health Organisation.Table 2. Patient characteristics in seizure-na?ve meningioma patientsTable 3. The specific AEDs used in seizure-na?ve meningioma patients AEDStudies included (N.)N. of cases (%)Phenytoin17 ,25 (2)256 (33.4)Levetiracetam 23, 25 (2)55 (7.18)Sodium valproate11, 25 (2)28 (3.66)Carbamazepine 25 (1)15 (1.96)Phenytoin/ levetiracetam* 11 (1)129 (16.8)*This group of patients were described to have received either phenytoin or levetiracetam with no detailed breakdown VariableStudies included (N.)AEDNo-AEDp-valueOccurrence/ total No. of patients%Occurrence/ total No. of patients%Extent of resectionGTR 10, 11, 18, 19, 23, 25 (6)410/47486.5261/34276.3<0.05STR 64/47413.581/34223.7Post-operative seizuresEarly10, 11, 17–25 (11)20/7662.610/3772.70.96Late52/7666.829/3777.70.58Overall72/7669.439/37710.40.62Abbreviations: AED=antiepileptic drug; GTR=gross total resection; STR=subtotal resection.Table 4. Extent of resection and seizure outcome in seizure-na?ve meningioma patients ................
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