Voxel-Based Mapping of Seizure Risk in Meningioma Identifies the Frontoparietal Interface and Tumor Microenvironment...

Brain invasion (BINV) and peritumoral edema (PTBE) have repeatedly been implicated as major contributors to meningioma-related seizures (MRS). By contrast, the influence of the precise tumor location on seizure risk is still insufficiently characterized. In this study, we systematically investigated clinical and imaging-derived predictors of MRS, integrating them with spatial analyses using voxel-based lesion symptom mapping (VLSM).

We reviewed clinical variables-including seizure history, histopathological subtype, World Health Organization (WHO) grade, BINV, and extent of resection-alongside MRI features such as PTBE, tumor dimensions, and anatomic location in a cohort of 532 meningioma patients. Significant predictors of MRS were identified using multivariate stepwise regression. These predictors were subsequently entered into a multivariate VLSM framework to determine their anatomic distribution.

A total of 93 of 532 patients (17%) experienced seizures prior to surgery. BINV, PTBE, and tumor location emerged as independent predictors of preoperative MRS. VLSM revealed the frontoparietal transition zone (FPTZ) as the region most strongly associated with seizures linked to BINV, whereas PTBE predominantly predicted MRS in frontal convexity and sphenoid wing tumors. Although WHO grade and histological classification displayed distinct spatial patterns, neither was directly related to MRS. Postoperatively, persistent seizure activity occurred in 6% of patients, again implicating the FPTZ as a major risk region. Seizures associated with PTBE were more likely to resolve following tumor removal.

Tumor-intrinsic characteristics such as histology, WHO grade, and lesion size play only a limited role in the development of MRS. Instead, BINV, PTBE, and the anatomic location of the meningioma are the principal determinants of seizure risk. Our findings underscore the FPTZ as a critical region linking tumor invasiveness, seizure generation, and postoperative seizure control.