Perioperative Seizure Prophylaxis in Supratentorial Meningioma Surgery
DOI:
https://doi.org/10.5281/zenodo.22310576Keywords:
Meningioma, Seizure prophylaxis, Antiepileptic drugs, Levetiracetam, CraniotomyAbstract
Background: Supratentorial meningioma is the most common primary intracranial tumor in adults. Perioperative seizures are a
recognised concern, and prophylactic antiepileptic drugs (AEDs) are used inconsistently. Objective: To synthesise evidence on perioperative seizure risk and prophylactic AED efficacy and safety in supratentorial meningioma surgery. Methods: Narrative review of randomised trials, meta-analyses, cohort studies, and society guidelines on seizure prophylaxis in meningioma and brain tumor craniotomy. Findings: Postoperative seizures affect roughly one in ten to one in five patients. Risk is concentrated among those with
peritumoral oedema, convexity or parasagittal tumors, brain invasion, or subtotal resection. Trials of phenytoin and valproate
show no reduction in seizures with routine prophylaxis, only added toxicity. Levetiracetam is comparably effective and better
tolerated when prophylaxis is used. Conclusions: Guidelines now recommend against routine prophylaxis in seizure-naive patients, favouring individualised, risk-based decisions and prompt treatment once a seizure occurs.
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