Meningiomas-Related Epilepsy After Surgery

Meningioma-related epilepsy (MRE) is observed in approximately 30% of patients. Although studies focus on identifying risk factors related to pre- and postoperative MRE, there is no clear evidence regarding the timing for discontinuing antiseizure medications (ASMs) after surgical resection.

We retrospectively collected data from a series of naïve supratentorial meningiomas treated with surgical resection. Preoperative MRI was used to calculate the meningioma and peritumoral edema (PE) volumes through a voxel-based system. We analyzed the frequency of pre- and postoperative epilepsy in the group of meningiomas with and without perilesional edema (with PE > 1 cm³ as the cut-off).

From a clinical series of 507 patients, we included 128 who underwent surgical resection in our center between January 2020 and December 2022, with a mean follow-up of 30.1 ± 19.8 months. Surgical treatment had a curative effect on MRE (41.4% preoperative vs. 19.5% postoperative; p = 0.0001). We observed a statistically significant reduction in the seizure rate in cases with preoperative PE (45.3% preoperative vs. 18.9% postoperative; p = 0.0002) and a non-statistically significant reduction in cases without PE (32.5% preoperative vs. 21.4% postoperative; p = 0.24). We observed ASM continuation in 37.8% of Engel IA patients.

PE increases the likelihood of MRE resolution with surgery. Our results show that surgical resection directly impacts MRE and ASM discontinuation in the presence of preoperative PE. The PE is a reassuring factor in decision-making regarding the timing of ASM discontinuation after surgery.