Introduction
Objectives
Methods
Patient selection
Clinical and radiological characteristics
Data analysis
Data validation
Meningioma surgery and AED practice
Results
Study population
Total no. of patients | Preoperative seizures | OR (95% CI) | P | ||
---|---|---|---|---|---|
(N = 283) | Yes (N = 68) | No (N = 215) | |||
Focal-aware | |||||
Motor (%) | 16 (23.5) | ||||
Non-motor (%) | 9 (13.2) | ||||
Focal-impaired awareness (%) | 7 (10.3) | ||||
Focal to bilateral (%) | 36 (52.9) | ||||
Age at diagnosis (years) | |||||
Mean (SD) | 57.7 (13.0) | 56.2 (14.1) | 58.2 (12.6) | 0.410 | |
Gender (%) | |||||
Female | 214 (75.6) | 47 (69.1) | 167 (77.7) | ||
Male | 69 (24.4) | 21 (30.9) | 48 (22.3) | 1.56 (0.85–2.85) | 0.152 |
WHO grade (%) | |||||
I | 233 (82.3) | 54 (79.4) | 179 (83.3) | ||
II | 47 (16.6) | 13 (19.1) | 34 (15.8) | 1.29 (0.65–2.57) | 0.469 |
III | 3 (1.1) | 1 (1.5) | 2 (0.9) | 1.59 (0.14–17.81) | 0.707 |
Tumour location (%) | |||||
Non-skull base | 207 (73.1) | 49 (72.1) | 158 (73.5) | 0.93 (0.51–1.71) | 0.871 |
Convexity | 98 (34.6) | 25 (36.8) | 73 (34.0) | 1.13 (0.64–1.20) | 0.671 |
Parafalcine | 39 (13.8) | 15 (22.1) | 24 (11.2) | 2.25 (1.10–4.60) | 0.023 |
Tentorial | 24 (8.5) | 2 (2.9) | 22 (10.2) | 0.27 (0.06–1.16) | 0.060 |
Convexity/parafalcine | 17 (6.0) | 2 (2.9) | 15 (7.0) | 0.40 (0.09–1.81) | 0.222 |
Parasagittal | 12 (4.2) | 4 (5.9) | 8 (3.7) | 1.61 (0.47–5.55) | 0.441 |
Posterior fossa | 5 (1.8) | 0 | 5 (2.3) | N/A | N/A |
Others | 12 | 1 | 11 | N/A | N/A |
Skull base | 76 (26.9) | 19 (27.9) | 57 (26.5) | ||
Sphenoid | 34 (12.0) | 10 (14.7) | 24 (11.2) | 1.37 (0.62–3.04) | 0.433 |
Olfactory groove | 18 (6.4) | 5 (7.4) | 13 (6.0) | 1.23 (0.42–3.40) | 0.700 |
Suprasellar | 10 (3.5) | 1 (1.5) | 9 (4.2) | 0.34 (0.04–2.75) | 0.290 |
Posterior fossa | 2 (0.7) | 0 | 2 (0.9) | N/A | N/A |
Others | 12 | 3 | 9 | N/A | N/A |
Side | |||||
Right | 123 (43.5) | 36 (52.9) | 87 (40.5) | 1.66 (0.96–2.86) | 0.070 |
Left | 125 (44.2) | 27 (39.7) | 98 (45.6) | 0.79 (0.45–1.37) | 0.395 |
Bilateral | 35 (12.4) | 5 (7.4) | 30 (14.0) | 0.49 (0.18–1.32) | 0.150 |
Relation to brain lobes | |||||
Frontal | 138 (48.8) | 37 (54.4) | 101 (47.0) | 1.35 (0.78–2.33) | 0.285 |
Parietal | 34 (12.0) | 17 (25.0) | 17 (7.9) | 3.88 (1.85–8.13) | < 0.001 |
Temporal | 29 (10.3) | 8 (11.8) | 21 (9.8) | 1.23 (0.52–2.92) | 0.636 |
Fronto-parietal | 16 (5.7) | 3 (4.4) | 13 (6.0) | 0.72 (0.19–2.59) | 0.611 |
Fronto-temporal | 12 (4.2) | 0 | 12 (5.6) | N/A | N/A |
Occipital | 9 (3.2) | 1 (1.5) | 8 (3.7) | 0.39 (0.05–3.14) | 0.357 |
Preoperative radiological characteristics | |||||
Tumour volume (cm3)b (%) | |||||
Median (IQR) | 24.8 (37.8) | 28.1 (27.7) | 37.2 (39.8) | 0.195 | |
≤ 10 cm3 | 57 (20.5) | 12 (17.9) | 45 (21.3) | ||
> 10 cm3 | 221 (79.5) | 55 (82.1) | 166 (78.7) | 1.24 (0.61–2.52) | 0.546 |
Midline shift (%) | |||||
Yes | 155 (54.8) | 40 (58.8) | 115 (53.5) | 1.24 (0.72–2.16) | 0.441 |
No | 128 (45.2) | 28 (41.2) | 100 (46.5) | ||
Calcificationa (%) | |||||
Yes | 66 (23.3) | 15 (22.1) | 51 (23.7) | ||
No | 216 (76.3) | 53 (77.9) | 163 (75.8) | 1.11 (0.57–2.13) | 0.815 |
Presence of peritumoural signal intensity (%) | |||||
6–100% (present) | 158 (55.8) | 54 (79.4) | 104 (48.4) | 4.12 (2.16–7.85) | < 0.001 |
0–5% (absent) | 125 (44.2) | 14 (20.6) | 111 (51.6) | ||
Preoperative headaches (%) | |||||
Yes | 125 (44.2) | 26 (38.2) | 99 (46.0) | ||
No | 158 (55.8) | 42 (61.8) | 116 (54.0) | 1.38 (0.79–2.41) | 0.258 |
Preoperative neurological deficits (%) | |||||
Yes | 201 (71.0) | 33 (48.5) | 168 (78.1) | ||
No | 82 (29.0) | 35 (51.5) | 47 (21.9) | 3.79 (2.13–6.74) | < 0.001 |
Preoperative ECOG performance status (%) | |||||
0–2 | 264 (93.3) | 63 (92.6) | 201 (93.5) | ||
3–4 | 19 (6.7) | 5 (7.4) | 14 (6.5) | 0.71 (0.34–1.51) | 0.370 |
Predictors of preoperative seizures
Predictors of postoperative seizures
Whole study population
Characteristic | All patients (N = 283) | Seizure-naïve patients (N = 215) | ||||||
---|---|---|---|---|---|---|---|---|
Postoperative seizures | Univariate analysis | Postoperative seizures | Univariate analysis | |||||
Yes (N = 48) | No (N = 235) | OR (95% CI) | P | Yes (N = 29) | No (N = 186) | OR (95% CI) | P | |
Age at diagnosis (years) | ||||||||
Mean (SD) | 57.6 (11.4) | 57.7 (13.3) | 0.751 | 59.0 (11.9) | 58.1 (12.7) | 0.744 | ||
Gender (%) | ||||||||
Female | 31 (64.6) | 183 (77.9) | 17 (58.6) | 150 (80.6) | ||||
Male | 17 (35.4) | 52 (22.1) | 1.93 (0.99–3.76) | 0.051 | 12 (41.4) | 36 (19.4) | 2.94 (1.29–6.70) | 0.008 |
WHO grade (%) | ||||||||
I | 39 (81.3) | 194 (82.6) | 23 (79.3) | 156 (83.9) | ||||
II | 8 (16.7) | 39 (16.6) | 1.09 (0.49–2.43) | 0.829 | 6 (20.7) | 28 (15.1) | 1.36 (0.51–3.61) | 0.541 |
III | 1 (2.1) | 2 (0.9) | 2.48 (0.22–27.89) | 0.462 | 0 | 2 (1.1) | N/A | N/A |
Tumour location (%) | ||||||||
Non-skull base | 37 (77.1) | 170 (72.3) | 1.29 (0.62–2.67) | 0.499 | 24 (82.8) | 134 (72.0) | 1.86 (0.67–5.14) | 0.224 |
Convexity | 24 (50.0) | 74 (31.5) | 2.18 (1.16–4.08) | 0.014 | 17 (58.6) | 56 (30.1) | 2.83 (1.27–6.34) | 0.003 |
Parafalcine | 10 (20.8) | 29 (12.3) | 1.87 (0.84–4.15) | 0.120 | 6 (20.7) | 18 (9.7) | 2.43 (0.87–6.76) | 0.080 |
Tentorial | 1 (2.1) | 23 (9.8) | 0.20 (0.03–1.49) | 0.115 | 0 | 22 (11.8) | N/A | N/A |
Convexity/parafalcine | 1 (2.1) | 16 (6.8) | 0.29 (0.04–2.25) | 0.209 | 0 | 15 (8.1) | N/A | N/A |
Parasagittal | 1 (2.1) | 11 (4.7) | 0.43 (0.05–3.44) | 0.416 | 1 (3.4) | 7 (3.8) | 0.91 (0.11–7.71) | 0.934 |
Posterior fossa | 0 | 5 (2.1) | N/A | N/A | 0 (0.0) | 5 (2.7) | N/A | N/A |
Others | 0 | 12 | N/A | N/A | 0 | 11 | N/A | N/A |
Skull base | 11 (22.9) | 65 (27.7) | 5 (17.2) | 52 (28.0) | ||||
Sphenoid | 7 (14.6) | 27 (11.5) | 1.32 (0.54–3.22) | 0.548 | 4 (13.8) | 20 (10.8) | 1.33 (0.42–4.21) | 0.629 |
Olfactory groove | 1 (2.1) | 17 (6.0) | 0.27 (0.03–2.10) | 0.183 | 0 | 13 (7.0) | N/A | N/A |
Suprasellar | 0 | 10 (4.3) | N/A | N/A | 0 | 9 (4.8) | N/A | N/A |
Posterior fossa | 0 | 2 (0.9) | N/A | N/A | 0 | 2 (1.1) | N/A | N/A |
Others | 3 | 9 | N/A | N/A | 1 | 8 | N/A | N/A |
Side | ||||||||
Right | 20 (41.7) | 103 (43.8) | 0.92 (0.49–1.72) | 0.783 | 10 (34.5) | 77 (41.4) | 0.75 (0.33–1.69) | 0.480 |
Left | 26 (54.2) | 99 (42.1) | 1.62 (0.87–3.03) | 0.126 | 18 (62.1) | 80 (43.0) | 2.17 (0.97–4.85) | 0.059 |
Bilateral | 2 (4.2) | 33 (14.0) | 0.27 (0.06–1.15) | 0.058 | 1 (3.4) | 29 (15.6) | 0.19 (0.03–1.48) | 0.113 |
Relation to brain lobes | ||||||||
Frontal | 25 (52.1) | 113 (48.1) | 1.18 (0.63–2.18) | 0.614 | 16 (55.2) | 85 (36.2) | 1.46 (0.67–3.21) | 0.342 |
Parietal | 5 (10.4) | 29 (12.3) | 0.83 (0.30–2.26) | 0.709 | 1 (3.4) | 16 (8.6) | 0.38 (0.05–2.98) | 0.339 |
Temporal | 7 (14.6) | 22 (9.4) | 1.65 (0.66–4.12) | 0.277 | 4 (13.8) | 17 (9.1) | 1.59 (0.50–5.11) | 0.432 |
Fronto-parietal | 7 (14.6) | 9 (3.9) | 4.35 (1.52–12.50) | 0.003 | 6 (20.7) | 7 (3.7) | 6.67 (2.06–21.57) | < 0.001 |
Fronto-temporal | 1 (2.1) | 11 (4.7) | 0.43 (0.05–3.44) | 0.416 | 1 (3.4) | 11 (5.9) | 0.57 (0.07–4.57) | 0.591 |
Occipital | 0 | 9 (3.3) | N/A | N/A | 0 | 8 (4.3) | N/A | N/A |
Preoperative radiological characteristics | ||||||||
Tumour volume (cm3)c (%) | ||||||||
Median (IQR) | 47.5 (56.3) | 32.5 (35.4) | 0.060 | 63.3 (70.3) | 33.2 (36.6) | 0.003 | ||
≤ 10 cm3 | 6 (12.8) | 51 (22.6) | 3 (10.7) | 42 (23.0) | ||||
> 10 cm3 | 41 (87.2) | 180 (77.9) | 1.94 (0.78–4.82) | 0.149 | 25 (89.3) | 141 (77.0) | 2.48 (0.71–8.63) | 0.141 |
Midline shift (%) | ||||||||
Yes | 30 (62.5) | 125 (53.2) | 1.47 (0.78–2.77) | 0.238 | 21 (72.4) | 94 (50.5) | 2.56 (1.09–6.25) | 0.028 |
No | 18 (37.5) | 110 (46.8) | 8 (27.6) | 92 (49.5) | ||||
Calcificationa (%) | ||||||||
Yes | 13 (27.1) | 53 (22.6) | 9 (31.0) | 42 (22.6) | ||||
No | 34 (70.8) | 182 (77.4) | 0.76 (0.38–1.55) | 0.450 | 19 (65.5) | 144 (77.4) | 0.62 (0.26–1.46) | 0.268 |
Presence of peritumoural signal intensity (%) | ||||||||
6–100% (present) | 34 (70.8) | 124 (52.8) | 2.17 (1.11–4.35) | 0.022 | 20 (69.0) | 84 (45.2) | 2.70 (1.16–6.25) | 0.017 |
0–5% (absent) | 14 (29.2) | 111 (47.2) | 9 (31.0) | 102 (54.8) | ||||
Preoperative headaches (%) | ||||||||
Yes | 17 (35.4) | 108 (46.0) | 12 (41.4) | 87 (46.8) | ||||
No | 31 (64.6) | 127 (54.0) | 1.55 (0.81–2.95) | 0.180 | 17 (58.6) | 99 (53.2) | 1.24 (0.56–2.75) | 0.588 |
Preoperative neurological deficits (%) | ||||||||
Yes | 30 (62.5) | 175 (74.5) | 24 (82.8) | 144 (77.4) | ||||
No | 18 (37.5) | 60 (25.5) | 1.75 (0.91–3.37) | 0.093 | 5 (17.2) | 42 (22.6) | 0.71 (0.26–1.99) | 0.518 |
Preoperative ECOG performance status (%) | ||||||||
0–2 | 44 (91.7) | 220 (93.6) | 26 (89.7) | 175 (94.1) | ||||
3–4 | 4 (8.3) | 15 (6.4) | 1.41 (0.66–2.99) | 0.373 | 3 (10.3) | 11 (5.9) | 2.09 (0.87–4.99) | 0.093 |
Simpson grade of resection (%) | ||||||||
GTR | 42 (87.5) | 191 (81.3) | 1.61 (0.65–4.03) | 0.303 | 26 (89.7) | 150 (80.6) | 2.08 (0.59–7.25) | 0.242 |
1 | 16 (33.3) | 49 (20.9) | 1.95 (0.98–3.84) | 0.054 | 11 (37.9) | 36 (19.4) | 2.63 (1.14–5.88) | 0.020 |
2 | 24 (50.0) | 129 (54.9) | 0.82 (0.44–1.53) | 0.535 | 15 (51.7) | 103 (55.4) | 0.86 (0.39–1.89) | 0.713 |
3 | 2 (4.2) | 13 (5.5) | 0.75 (0.16–3.40) | 0.701 | 0 | 11 (5.9) | N/A | N/A |
STR | 6 (12.5) | 44 (18.7) | 3 (10.3) | 36 (19.4) | ||||
4 | 6 (12.5) | 44 (18.7) | 3 (10.3) | 36 (19.4) | ||||
5 | 0 | 0 | N/A | N/A | 0 | 0 | N/A | N/A |
Postoperative residual tumourb (%) | ||||||||
Yes | 7 (14.9) | 43 (18.5) | 3 (10.7) | 32 (17.3) | ||||
No | 40 (85.1) | 189 (81.5) | 1.30 (0.55–3.10) | 0.554 | 25 (89.3) | 153 (82.7) | 1.74 (0.50–6.12) | 0.381 |
Postoperative neurosurgical complicationsb (%) | ||||||||
Yes | 28 (58.3) | 110 (46.8) | 1.63 (0.86–3.09) | 0.128 | 19 (65.5) | 91 (48.9) | 1.94 (0.86–4.40) | 0.108 |
No | 19 (39.6) | 122 (51.9) | 10 (34.5) | 93 (50.0) | ||||
Radiological haemorrhageb (%) | ||||||||
Yes | 27 (56.3) | 104 (44.3) | 1.66 (0.88–3.13) | 0.114 | 18 (62.1) | 85 (45.7) | 1.91 (0.85–4.26) | 0.112 |
No | 20 (41.7) | 128 (54.5) | 11 (37.9) | 99 (53.2) | ||||
Clinical haemorrhage (%) | ||||||||
Yes | 4 (8.3) | 11 (4.7) | 1.85 (0.56–6.08) | 0.303 | 4 (13.8) | 8 (4.3) | 3.57 (1.00-12.50) | 0.038 |
No | 44 (91.7) | 224 (95.3) | 25 (86.2) | 178 (95.7) | ||||
CNS infection (%) | ||||||||
Yes | 4 (8.3) | 9 (3.8) | 2.28 (0.67–7.74) | 0.174 | 4 (13.8) | 9 (4.8) | 3.15 (0.90-10.98) | 0.072 |
No | 44 (91.7) | 226 (96.2) | 25 (86.2) | 177 (95.2) | ||||
Hydrocephalus (%) | ||||||||
Yes | 1 (2.1) | 5 (2.1) | 0.98 (0.11–8.57) | 0.985 | 1 (3.4) | 5 (2.7) | 1.29 (0.15–11.48) | 0.817 |
No | 47 (97.9) | 230 (97.9) | 28 (96.6) | 181 (97.3) | ||||
Preoperative seizures (%) | ||||||||
Yes | 19 (39.6) | 49 (20.9) | 2.50 (1.28–4.76) | 0.006 | 0 | 0 | N/A | N/A |
No | 29 (60.4) | 186 (79.1) | 29 (100) | 186 (100) |
Seizure-naïve patients
Models performance
Antiepileptic drug treatment
Model | Factor | HR (95% CI) | P |
---|---|---|---|
Whole study population | Preoperative AED | 0.62 (0.31–1.26) | 0.187 |
Convexity × FP × preoperative seizures | 1.06 (1.02–1.10) | 0.004 | |
Seizure-naïve patients | Preoperative AED | 0.63 (0.20–2.05) | 0.451 |
Convexity × FP × midline shift | 1.04 (1.01–1.06) | 0.002 |