Meningiomas-Related Epilepsy After Surgery

Background: 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. Methods: 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). Results: 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. Conclusions: 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.