BACKGROUND Evidence supporting routine postoperative antiepileptic drug (AED) prophylaxis following oncologic neurosurgery is limited, and actual practice patterns are largely unknown beyond survey data. OBJECTIVE To describe patterns and predictors of postoperative AED prophylaxis following intracranial tumor surgery. METHODS The MarketScan Database was used to analyze pharmacy claims data and clinical characteristics in a national sample over a 5-year period. RESULTS Among 5895 patients in the cohort, levetiracetam was the most widely used AED for prophylaxis (78.5%) followed by phenytoin (20.5%). Prophylaxis was common but highly variable for patients who underwent open resection of supratentorial intraparenchymal tumors (62.5%, reference) or meningiomas (61.9%). In multivariate analysis, biopsies were less likely to receive prophylaxis (44.8%, OR 0.47, 95% CI 0.33-0.67), and there was near consensus against prophylaxis for infratentorial (9.7%, OR 0.07, CI 0.05-0.09) and transsphenoidal procedures (0.4%, OR 0.003, CI 0.001-0.010). Primary malignancies (52.1%, reference) and secondary metastases (42.2%) were more likely to receive prophylaxis than benign tumors (23.0%, OR 0.63, CI 0.48-0.83), as were patients discharged with home services and patients in the Northeast. There was a large spike in duration of AED use at approximately 30 days. CONCLUSIONS Use of seizure prophylaxis following intracranial biopsies and supratentorial resections is highly variable, consistent with a lack of guidelines or consensus. Current practice patterns do not support a clear standard of care and may be driven in part by geographic variation, availability of post-discharge services, and electronic prescribing defaults rather than evidence. Given uncertainty regarding effectiveness, indications, and appropriate duration of AED prophylaxis, well-powered trials are needed.

中文翻译：

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肿瘤神经外科手术后预防癫痫发作的模式。

背景技术支持肿瘤神经外科手术后常规预防术后抗癫痫药物（AED）的证据是有限的，除了调查数据以外，实际的实践模式还很未知。目的描述颅内肿瘤手术后预防AED的模式和预测因素。方法使用MarketScan数据库分析5年内全国样本中的药房索赔数据和临床特征。结果在该队列的5895名患者中，左乙拉西坦是使用最广泛的AED预防药物（78.5％），其次是苯妥英钠（20.5％）。对行幕上肌实质内肿瘤（62.5％，参考）或脑膜瘤（61.9％）进行开放切除的患者，预防是常见的，但变化很大。在多变量分析中，活组织检查接受预防的可能性较小（44。8％或OR 0.47，95％CI 0.33-0.67），并且对于预防下颌骨（9.7％，OR 0.07，CI 0.05-0.09）和经蝶窦手术（0.4％，OR 0.003，CI 0.001-0.010）的预防几乎达成共识。与出院服务的患者和东北地区的患者相比，原发性恶性肿瘤（52.1％，参考）和继发性转移（42.2％）比良性肿瘤（23.0％，OR 0.63，CI 0.48-0.83）更有可能接受预防。在大约30天时，AED的使用时间有很大的增加。结论颅内活检和幕上切除术后癫痫发作的预防方法变化很大，这与缺乏指南或共识缺乏一致。当前的实践模式不支持明确的护理标准，部分原因可能是地域差异，出院后服务的可用性，电子处方违约而不是证据。鉴于AED预防的有效性，适应症和适当的持续时间尚不确定，因此需要功能强大的试验。