INTRODUCTION Seizures after meningioma surgery are common, with a distinct impact on postoperative life quality. Sufficient risk factors for seizure development are sparsely known but needed to improve perioperative patient counseling and, eventually, antiepileptic treatment. MATERIALS AND METHODS Correlations between clinical, radiological and histological variables and the onset of new seizures following surgery for initially diagnosed cranial meningioma were retrospectively analyzed in uni- and multivariate analyses. RESULTS 752 preoperatively seizure-naïve patients (569 females, 76 % and 183 males, 24 %) with a median age of 57 years were included. Postoperative seizures occurred in 69 cases (9 %). In univariate analyses, seizures were correlated with preoperative Karnofsky Score < 80 (OR: 1.91, 95 % CI 1.01-3.59; p = .045), convexity/parasagittal tumor location (OR: 1.77, 95 % CI 1.06-2.95; p = .030), heterogenous contrast-enhancement of the tumor (OR: 2.24, 95 % CI 1.14-4.39; p = .019) and intratumoral calcifications (OR: 3.35, 95 % CI 1.59-7.05; p = .001). Multivariable analyses revealed age at the time of surgery (OR: 1.04, 95 % CI 1.01-1.07; p = .009) and intratumoral calcifications on preoperative imaging (OR: 3.70, 95 % CI 1.73-7.92; p = .001) as risk factors for postoperative seizures. Based on multivariate analyses, a score for discrimination of patients at low (3 %), intermediate (11 %) and high risk (17 %) of postoperative seizures (AUC: 0.7, p < .001) was conducted. In subgroup analyses, postoperative hemorrhage (OR: 2.90, 95 % CI 1.13-7.46; p = .028) and hydrocephalus (OR: 3.65, 95 % CI 1.48-9.01; p = .005) were correlated with postoperative seizures. CONCLUSION Risk factors for postoperative seizures after meningioma surgery are sparse and can be basically taken from preoperative imaging. Among surgical complications, postoperative hemorrhage and hydrocephalus are strong seizure predictors.

中文翻译：

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预测脑膜瘤术后癫痫发作的发展——临床、组织学和放射学危险因素分析

引言 脑膜瘤手术后癫痫发作很常见，对术后生活质量有明显影响。癫痫发作的足够危险因素鲜为人知，但需要改善围手术期患者咨询，并最终进行抗癫痫治疗。材料和方法 在单变量和多变量分析中回顾性分析了临床、放射学和组织学变量与初始诊断的颅脑膜瘤手术后新癫痫发作的发生之间的相关性。结果 752 名术前未发生癫痫的患者（569 名女性，76% 和 183 名男性，24%）被纳入，中位年龄为 57 岁。69 例 (9 %) 发生术后癫痫发作。在单变量分析中，癫痫发作与术前 Karnofsky 评分 < 80 相关（OR：1.91，95 % CI 1.01-3.59；p = .045），凸面/矢状旁肿瘤位置（OR：1.77，95 % CI 1.06-2.95；p = .030），肿瘤的异质对比增强（OR：2.24，95 % CI 1.14-4.39；p = .019）和肿瘤内钙化（OR：3.35，95% CI 1.59-7.05；p = .001）。多变量分析显示手术时的年龄（OR：1.04，95 % CI 1.01-1.07；p = .009）和术前影像学的肿瘤内钙化（OR：3.70，95 % CI 1.73-7.92；p = .001）为术后癫痫发作的危险因素。基于多变量分析，对术后癫痫发作的低（3 %）、中（11 %）和高（17 %）风险（AUC：0.7，p < .001）的患者进行了区分评分。在亚组分析中，术后出血（OR：2.90，95 % CI 1.13-7.46；p = .028）和脑积水（OR：3.65，95 % CI 1.48-9.01；p = .005）与术后癫痫发作相关。结论脑膜瘤手术后癫痫发作的危险因素较少，基本可从术前影像学中获取。在手术并发症中，术后出血和脑积水是强烈的癫痫发作预测因素。