Abstract
Early postoperative seizures (EPS) are a common complication of brain tumour surgery. This paper investigates risk factors, management and clinical relevance of EPS. We retrospectively analysed the occurrence of EPS, clinical and laboratory parameters, imaging and histopathological findings in a cohort of 679 consecutive patients who underwent craniotomies for intracranial tumours between 2015 and 2017. EPS were observed in 34/679 cases (5.1%), with 14 suffering at least one generalized seizure. Patients with EPS had a worse postoperative Karnofsky performance index (KPI; with EPS, KPI < 70 vs. 70–100: 11/108, 10.2% vs. 23/571, 4.0%; p = 0.007). Preoperative seizure history was a predictor for EPS (none vs. 1 vs. ≥ 2 seizures: p = 0.037). Meningioma patients had the highest EPS incidence (10.1%, p < 0.001). Cranial imaging identified a plausible cause in most cases (78.8%). In 20.6%, EPS were associated with a persisting new neurological deficit that could not otherwise be explained. 34.6% of the EPS patients had recurrent seizures within one year. EPS require an emergency work-up. Multiple EPS and recurrent seizures are frequent, which indicates that EPS may also reflect a more chronic condition i.e. epilepsy. EPS are often associated with persisting neurological worsening.
Highlights
Postoperative seizures (EPS) are a common complication of brain tumour surgery
We identified all 679 consecutive patients who underwent a craniotomy for an intracranial tumour between January 2015 and August 2017 in the Department of Neurosurgery, Evangelisches Klinikum Bethel, Bielefeld, Germany, by searching the departmental electronic database
Patients operated for medication-refractory epilepsy within the epilepsy surgery program were excluded from this analysis, i.e. all cases referred to us following a presurgical work-up aiming at the establishment of a surgical concept for epilepsy rather than tumour control[10]
Summary
Postoperative seizures (EPS) are a common complication of brain tumour surgery. EPS are often categorized as acute symptomatic seizures[1,2] They are usually felt to reflect acute medical or surgical conditions that may require emergency treatment. There is the issue of distinguishing between incidental or acute symptomatic seizures with no or a very low risk of recurrent seizures and true postoperative chronic e pilepsy[1,2,3] The latter condition requires chronic treatment with antiepileptic drugs and comes with relevant socioeconomic sequelae such as restriction of driving privileges. This may be a important issue for patients with benign tumours such as many meningiomas who have a good chance of a surgical cure of their tumour. We have reviewed our recent institutional experience with EPS after brain tumour surgery between 2015 and 2017
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