Risk Factors for Preoperative Seizures and Loss of Seizure Control in Patients Undergoing Surgery for Metastatic Brain Tumors.
OBJECTIVE
Metastatic brain tumors are the most common brain tumors in adults. Patients with metastatic brain tumors have poor prognoses with median survival of 6-12 months. Seizures are a major presenting symptom and cause of morbidity and mortality. In this article, risk factors for the onset of preoperative seizures and postoperative seizure control are examined.


METHODS
Adult patients who underwent resection of one or more brain metastases at a single institution between 1998 and 2011 were reviewed retrospectively.


RESULTS
Of 565 patients, 114 (20.2%) patients presented with seizures. Factors independently associated with preoperative seizures were preoperative headaches (P = 0.044), cognitive deficits (P = 0.031), more than 2 intracranial metastatic tumors (P = 0.013), temporal lobe location (P = 0.031), occipital lobe location (P = 0.010), and bone involvement by tumor (P = 0.029). Factors independently associated with loss of seizure control after surgical resection were preoperative seizures (P = 0.001), temporal lobe location (P = 0.037), lack of postoperative chemotherapy (P = 0.010), subtotal resection of tumor (P = 0.022), and local recurrence (P = 0.027). At last follow-up, the majority of patients (93.8%) were seizure-free. Thirty patients (5.30%) in total had loss of seizure control, and only 8 patients (1.41%) who did not have preoperative seizures presented with new-onset seizures after surgical resection of their metastases.


CONCLUSIONS
The brain is a common site for metastases from numerous primary cancers, such as breast and lung. The identification of factors associated with onset of preoperative seizures as well as seizure control postoperatively could aid management strategies for patients with metastatic brain tumors. Patients with preoperative seizures who underwent resection tended to have good seizure control after surgery.
['Wu|Adela|A|', 'Weingart|Jon D|JD|', 'Gallia|Gary L|GL|', 'Lim|Michael|M|', 'Brem|Henry|H|', 'Bettegowda|Chetan|C|', 'Chaichana|Kaisorn L|KL|']
D017677:Age Distribution D001932:Brain Neoplasms D015984:Causality D015897:Comorbidity D005260:Female D006261:Headache D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D019635:Neurosurgical Procedures D011183:Postoperative Complications D057234:Preoperative Period D012189:Retrospective Studies D012307:Risk Factors D012640:Seizures D017678:Sex Distribution D015996:Survival Rate
Seizures Surgery Metastatic Brain tumor Cancer Engel class