MENINGIOMA OEDEMA AND SEIZURES – A META-ANALYSIS

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Abstract AIMS Meningiomas are primary intracranial neoplasms. Oedema and seizures can occur in the pre and postoperative period and oedema is commonly cited as a risk factor for seizures. A meta-analysis of eight studies published in 2016 identified preoperative oedema as a risk factor for preoperative seizures. Our aim is to perform an updated review. The literature base has grown and there are studies presenting data on postoperative seizures. METHOD The meta-analysis protocol is uploaded to INPLASY (DOI: 10.37766/inplasy2023.7.0101). Existing literature from seven databases was collected and Cochrane guidance was followed. Data was analysed using packages within R programming software. Part of this work was presented in draft form at ILAE 2023 and here we present updated work. RESULTS Our search identified 44 unique studies for meta-analysis. Many studies were biased by subjective oedema measurement or lack of seizure definition. Preoperative oedema increased the odds of preoperative seizures; odds ratio (OR) 3.41, 95% confidence interval (CI) 3.00 to 3.87, p <.001, studies (k) 24, participants (n) 6,917, low heterogeneity (I2) 0%. There were no subgroup differences by oedema measurement or use of seizure definition. Preoperative oedema was associated with increased odds of early postoperative seizure (within one week of surgery) but the difference was not significant; OR 1.39, CI 0.97-1.99, p =.063, k = 6, n = 2,445, I2 = 0% (low). Preoperative oedema increased the odds of late postoperative seizures; OR 1.95, CI 1.55-2.45, p <.001, k = 7, n = 1,722, I2 = 0% (low). Oedema was associated with seizures following stereotactic radiosurgery in two studies. CONCLUSION Preoperative oedema is associated with seizures prior to and following treatment. While there is a positive association between preoperative oedema and early postoperative seizure it is not statistically significant.