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Identifying Risk Factors for New-Onset Postoperative Seizures in Pediatric Brain Tumor Patients: A Comprehensive
Ibtisam Yahya1, Kirsten M Van Baarsen1, Hanneke M Van Santen2
1Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Insights
Pediatric brain tumor patients not on anti-seizure medication (ASM) prophylaxis had a 7.8% incidence of new postoperative seizures. Key risk factors include hyponatremia, supratentorial tumors, and young age, especially under one year.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Oncology
Background:
- Postoperative seizures are a risk in pediatric intracranial tumor surgery.
- Debate exists regarding prophylactic anti-seizure medication (ASM) use.
- This study examines seizure incidence without perioperative ASM prophylaxis.
Purpose of the Study:
- To determine the incidence of new-onset postoperative seizures in pediatric brain tumor patients.
- To identify risk factors for these seizures in patients not receiving ASM prophylaxis.
- To inform clinical monitoring and potential prophylactic strategies.
Main Methods:
- Retrospective review of 306 pediatric patients undergoing craniotomy for intracranial tumors (June 2018-December 2022).
- Exclusion of patients with preoperative seizures or perioperative ASM use.
- Multivariate logistic regression to identify seizure risk factors.
Main Results:
- Overall incidence of new-onset postoperative seizures was 7.8%.
- Early seizures (within one week) occurred in 4.2% of cases.
- Significant risk factors identified: postoperative hyponatremia, supratentorial tumor location, and age under one year.
Conclusions:
- Supratentorial tumor location, hyponatremia, and age <1 year are key risk factors for postoperative seizures.
- Recommend close monitoring of sodium levels and non-invasive epilepsy monitoring for infants.
- Further prospective studies needed on prophylactic ASM efficacy in high-risk pediatric subgroups.
Introduction:
Surgical resection of intracranial tumors in pediatric patients poses the potential risk of new-onset postoperative seizures, prompting debates over the prophylactic use of anti-seizure medication (ASMs). This retrospective study focusses on the incidence and risk factors associated with the occurrence of new-onset postoperative seizures within 30 days following surgery in pediatric patients with brain tumors who did not receive ASM prophylaxis pre- and perioperatively.
Methods:
A meticulous review of clinical records spanning from June 2018 to December 2022 was conducted, examining data from pediatric patients undergoing craniotomies for intracranial tumors. Patients with preoperative seizures or those taking perioperative ASMs were excluded. The data encompassed demographic details, preoperative variables, tumor characteristics, surgical intricacies, and clinical course including 30-day mortality. The primary outcome was the incidence of new-onset postoperative seizures, further categorized as early (within 1 week) or late (1 week to 30 days). Univariate and multivariate logistic regression analyses were used to explore correlations between various variables and seizure outcomes.
Results:
In a cohort of 306 cases, the incidence of new-onset postoperative seizures was 7.8% of whom 4.2% experienced early seizures. Of them, 3 patients developed status epilepticus. Multivariate analysis identified several significant risk factors including postoperative hyponatremia, supratentorial tumor localization, and young age, especially age under 1 year.
Conclusion:
In this retrospective study, we identified supratentorial tumor localization, hyponatremia and age younger than 1 year as risk factors for new-onset postoperative seizures among pediatric patients. Especially in infants below the age of 1 year, we recommend meticulous monitoring of postoperative sodium levels and noninvasive epilepsy monitoring after supratentorial tumor resection. Future prospective studies are needed to explore the potential effectiveness of administering perioperative prophylactic antiepileptic drugs (ASMs) within this specific subset of the pediatric population.
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