scholarly journals Comparative analysis of monotherapy versus duotherapy antiseizure drug management for postoperative seizure control in patients undergoing an awake craniotomy

2018 ◽  
Vol 128 (6) ◽  
pp. 1661-1667 ◽  
Author(s):  
Chikezie I. Eseonu ◽  
Francisco Eguia ◽  
Oscar Garcia ◽  
Peter W. Kaplan ◽  
Alfredo Quiñones-Hinojosa
Keyword(s):  
Logistic Regression ◽  
Seizure Control ◽  
Brain Lesion ◽  
Tumor Resection ◽  
Awake Craniotomy ◽  
Seizure Outcome ◽  
Monotherapy Group ◽  
Seizure Rate ◽  
Postoperative Seizure ◽  
Craniotomy For Tumor Resection

OBJECTIVEPostoperative seizures are a common complication in patients undergoing an awake craniotomy, given the cortical manipulation during tumor resection and the electrical cortical stimulation for brain mapping. However, little evidence exists about the efficacy of postoperative seizure prophylaxis. This study aims to determine the most appropriate antiseizure drug (ASD) management regimen following an awake craniotomy.METHODSThe authors performed a retrospective analysis of data pertaining to patients who underwent an awake craniotomy for brain tumor from 2007 to 2015 performed by a single surgeon. Patients were divided into 2 groups, those who received a single ASD (the monotherapy group) and those who received 2 types of ASDs (the duotherapy group). Patient demographics, symptoms, tumor characteristics, hospitalization details, and seizure outcome were evaluated. Multivariable logistic regression was used to evaluate numerous clinical variables associated with postoperative seizures.RESULTSA total of 81 patients underwent an awake craniotomy for tumor resection of an eloquent brain lesion. Preoperative baseline characteristics were comparable between the 2 groups. The postoperative seizure rate was 21.7% in the monotherapy group and 5.7% in the duotherapy group (p = 0.044). Seizure outcome at 6 months’ follow-up was assessed with the Engel classification scale. The duotherapy group had a significantly higher proportion of seizure-free (Engel Class I) patients than the monotherapy group (90% vs 60%, p = 0.027). The length of stay was similar, 4.02 days in the monotherapy group and 4.51 days in the duotherapy group (p = 0.193). The 90-day readmission rate was higher for the monotherapy group (26.1% vs 8.5% in the duotherapy group, p = 0.044). Multivariate logistic regression showed that preoperative seizure history was a significant predictor for postoperative seizures following an awake craniotomy (OR 2.08, 95% CI 0.56–0.90, p < 0.001).CONCLUSIONSPatients with a preoperative seizure history may be at a higher risk for postoperative seizures following an awake craniotomy and may benefit from better postoperative seizure control with postoperative ASD duotherapy.

Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

2014 ◽  
Vol 120 (1) ◽  
pp. 12-23 ◽  
Author(s):  
Tamara Ius ◽  
Giada Pauletto ◽  
Miriam Isola ◽  
Giorgia Gregoraci ◽  
Riccardo Budai ◽  
...  
Keyword(s):  
Seizure Control ◽  
Tumor Resection ◽  
Low Grade Glioma ◽  
Seizure Outcome ◽  
Low Grade ◽  
Class Iii ◽  
The Difference ◽  
Drug Resistant Epilepsy ◽  
Postoperative Seizure ◽  
The Impact

Object Although a number of recent studies on the surgical treatment of insular low-grade glioma (LGG) have demonstrated that aggressive resection leads to increased overall patient survival and decreased malignant progression, less attention has been given to the results with respect to tumor-related epilepsy. The aim of this investigation was to evaluate the impact of volumetric, histological, and intraoperative neurophysiological factors on seizure outcome in patients with insular LGG. Methods The authors evaluated predictors of seizure outcome with special emphasis on both the extent of tumor resection (EOR) and the tumor's infiltrative pattern quantified by computing the difference between the preoperative T2- and T1-weighted MR images (ΔVT2T1) in 52 patients with preoperative drug-resistant epilepsy. Results The 12-month postoperative seizure outcome (Engel class) was as follows: seizure free (Class I), 67.31%; rare seizures (Class II), 7.69%; meaningful seizure improvement (Class III), 15.38%; and no improvement or worsening (Class IV), 9.62%. Poor seizure control was more common in patients with a longer preoperative seizure history (p < 0.002) and higher frequency of seizures (p = 0.008). Better seizure control was achieved in cases with EOR ≥ 90% (p < 0.001) and ΔVT2T1 < 30 cm3 (p < 0.001). In the final model, ΔVT2T1 proved to be the strongest independent predictor of seizure outcome in insular LGG patients (p < 0.0001). Conclusions No or little postoperative seizure improvement occurs mainly in cases with a prevalent infiltrative tumor growth pattern, expressed by high ΔVT2T1 values, which consequently reflects a smaller EOR.

scholarly journals Seizure Outcome After Surgical Resection of Insular Glioma

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 709-718 ◽  
Author(s):  
Doris D Wang ◽  
Hansen Deng ◽  
Shawn L Hervey-Jumper ◽  
Annette A Molinaro ◽  
Edward F Chang ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Seizure Control ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Seizure Recurrence ◽  
Cox Regression Analysis ◽  
Repeat Operation ◽  
Postoperative Seizure

Abstract BACKGROUND A majority of patients with insular tumors present with seizures. Although a number of studies have shown that greater extent of resection improves overall patient survival, few studies have documented postoperative seizure control after insular tumor resection. OBJECTIVE To (1) characterize seizure control rates in patients undergoing insular tumor resection, (2) identify predictors of seizure control, and (3) evaluate the association between seizure recurrence and tumor progression. METHODS The study population included adults who had undergone resection of insular gliomas between 1997 and 2015 at our institution. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed. RESULTS One-hundred nine patients with sufficient clinical data were included in the study. At 1 yr after surgery, 74 patients (68%) were seizure free. At final follow-up, 42 patients (39%) were seizure free. Median time to seizure recurrence was 46 mo (95% confidence interval 31-65 mo). Multivariate Cox regression analysis revealed that greater extent of resection (hazard ratio = 0.2899 [0.1129, 0.7973], P = .0127) was a significant predictor of seizure freedom. Of patients who had seizure recurrence and tumor progression, seizure usually recurred within 3 mo prior to tumor progression. Repeat resection offered additional seizure control, as 8 of the 22 patients with recurrent seizures became seizure free after reoperation. CONCLUSION Maximizing the extent of resection in insular gliomas portends greater seizure freedom after surgery. Seizure recurrence is associated with tumor progression, and repeat operation can provide additional seizure control.

scholarly journals Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection

2021 ◽  
Author(s):  
Valeri Borger ◽  
Motaz Hamed ◽  
Inja Ilic ◽  
Anna-Laura Potthoff ◽  
Attila Racz ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Temporal Lobectomy ◽  
Secondary Outcome ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Secondary Outcome Measure ◽  
Total Resection ◽  
Class 1 ◽  
Postoperative Seizure ◽  
The Impact

Abstract Introduction The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Methods Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6). Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9). Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.

Preoperative tumor-associated epilepsy in patients with supratentorial meningioma: factors influencing seizure outcome after meningioma surgery

2020 ◽  
Vol 133 (6) ◽  
pp. 1655-1661 ◽  
Author(s):  
Matthias Schneider ◽  
Ági Güresir ◽  
Valeri Borger ◽  
Motaz Hamed ◽  
Attila Rácz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Side Effects ◽  
Tumor Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Who Grade ◽  
Factors Influencing ◽  
Postoperative Seizure ◽  
Meningioma Surgery

OBJECTIVEBoth pre- and postoperative seizures comprise common side effects that negatively impact patient quality of life in those suffering from intracranial meningioma. Therefore, seizure freedom represents an important outcome measure in meningioma surgery. In the current study the authors analyzed their institutional database to identify risk factors for postoperative seizure occurrence after surgical meningioma therapy in patients with preoperative symptomatic epilepsy.METHODSBetween February 2009 and April 2017, 187 patients with preoperative seizures underwent resection of supratentorial meningioma at the authors’ institution. Seizure outcome was assessed retrospectively 12 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class I) versus unfavorable (ILAE classes II–VI). A univariate and multivariate analysis was performed to identify factors influencing seizure outcome.RESULTSOverall 169 (90%) of 187 patients with preoperative seizures achieved favorable outcome in terms of seizure freedom after meningioma resection. Multivariate analysis revealed peritumoral edema > 1 cm in maximal diameter and WHO grade II and III tumors, as well as a low extent of resection (Simpson grades III–V) as independent predictors for postoperative unfavorable seizure outcome.CONCLUSIONSSurgery is highly effective in the treatment of seizures as common side effects of supratentorial meningioma. Furthermore, the present study identified several significant and independent risk factors for postoperative seizure occurrence, enabling one to select for high-risk patients that require special attention in clinical and surgical management.

Use of the laryngeal mask airway during awake craniotomy for tumor resection

2000 ◽  
Vol 12 (8) ◽  
pp. 592-594 ◽  
Author(s):  
W.Kendall Tongier ◽  
Girish P Joshi ◽  
Dennis F Landers ◽  
Bruce Mickey
Keyword(s):  
Laryngeal Mask Airway ◽  
Tumor Resection ◽  
Laryngeal Mask ◽  
Awake Craniotomy ◽  
Craniotomy For Tumor Resection

scholarly journals Outpatient Craniotomy for Brain Tumor: A Pilot Feasibility Study in 46 Patients

2001 ◽  
Vol 28 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Mark Bernstein
Keyword(s):  
Brain Tumor ◽  
Tumor Resection ◽  
Awake Craniotomy ◽  
Cortical Mapping ◽  
Outpatient Procedure ◽  
Image Guided ◽  
Feasible Option ◽  
Intent To Treat ◽  
Craniotomy For Tumor Resection ◽  
Pilot Feasibility Study

ABSTRACT:Background:Since 1991 the author has routinely performed awake craniotomy for intra-axial brain tumors with low complication rate and low resource utilization. In late 1996 a pilot study was initiated to assess the feasibility of performing craniotomy for tumor resection as an outpatient procedure.Methods:A rigorous protocol was developed and adhered to, based around the patient's arrival at hospital at 6:00 a.m, undergoing image-guided awake craniotomy with cortical mapping, and being discharged by 6:00 p.m.Results:During the 48 month period from December 1996 to December 2000, 245 awake craniotomies were performed and of those, 46 patients were entered into the outpatient craniotomy protocol. Pathology in the 46 intent-to-treat group was: 21 metastasis, 19 glioma, and six miscellaneous. Four patients required conversion to inpatients and one patient was readmitted later the same evening due to headache. Thus 41/46 patients successfully completed the protocol (89%). There were five complications in the 46 intent-to-treat group (10.9%).Conclusions:Outpatient craniotomy for brain tumor is a feasible option which appears safe and effective for selected patients. Besides being resource-friendly, the procedure may be psychologically less traumatic to patients than standard craniotomy for brain tumor. Proper prospective studies including satisfaction surveys would help resolve these issues and will be the next step.

Spectral Analysis of Heart Rate Variability During Asleep-Awake Craniotomy for Tumor Resection

2009 ◽  
Vol 21 (3) ◽  
pp. 242-247 ◽  
Author(s):  
Valeria Conte ◽  
Stefano Guzzetti ◽  
Alberto Porta ◽  
Eleonora Tobaldini ◽  
Pietro Baratta ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Spectral Analysis ◽  
Tumor Resection ◽  
Awake Craniotomy ◽  
Craniotomy For Tumor Resection

Increased complication and mortality among non-index hospital readmissions after brain tumor resection is associated with low-volume readmitting hospitals

2020 ◽  
Vol 133 (5) ◽  
pp. 1332-1344
Author(s):  
Casey A. Jarvis ◽  
Joshua Bakhsheshian ◽  
Li Ding ◽  
Timothy Wen ◽  
Austin M. Tang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Brain Tumor ◽  
Hospital Readmission ◽  
Tumor Resection ◽  
Factors Associated ◽  
Major Complications ◽  
Brain Tumor Resection ◽  
Procedure Volume ◽  
Index Hospital ◽  
Craniotomy For Tumor Resection

OBJECTIVEFragmentation of care following craniotomy for tumor resection is increasingly common with the regionalization of neurosurgery. Hospital readmission to a hospital (non-index) other than the one from which patients received their original care (index) has been associated with increases in both morbidity and mortality for cancer patients. The impact of non-index readmission after surgical management of brain tumors has not previously been evaluated. The authors set out to determine rates of non-index readmission following craniotomy for tumor resection and evaluated outcomes following index and non-index readmissions.METHODSRetrospective analyses of data from cases involving resection of a primary brain tumor were conducted using data from the Nationwide Readmissions Database (NRD) for 2010–2014. Multivariate logistic regression was used to evaluate the independent association of patient and hospital factors with readmission to an index versus non-index hospital. Further analysis evaluated association of non-index versus index hospital readmission with mortality and major complications during readmission. Effects of readmission hospital procedure volume on mortality and morbidity were evaluated in post hoc analysis.RESULTSIn a total of 17,459 unplanned readmissions, 84.4% patients were readmitted to index hospitals and 15.6% to non-index hospitals. Patient factors associated with increased likelihood of non-index readmission included older age (75+: OR 1.44, 95% CI 1.19–1.75), elective index admission (OR 1.19, 95% CI 1.08–1.30), increased Elixhauser comorbidity score ≥2 (OR 1.18, 95% CI 1.01–1.37), and malignant tumor diagnosis (OR 1.32, 95% CI 1.19–1.45) (all p < 0.04). Readmission to a non-index facility was associated with a 28% increase in major complications (OR 1.28, 95% CI 1.14–1.43, p < 0.001) and 21% increase in mortality (OR 1.21, 95% CI 1.02–1.44, p = 0.032) in initial analysis. Following a second multivariable logistic regression analysis including the readmitting hospital characteristics, low procedure volume of a readmitting facility was significantly associated with non-index readmission (p < 0.001). Readmission to a lower-procedure-volume facility was associated with a 46%–75% increase in mortality (OR 1.46–1.75, p < 0.005) and a 21%–35% increase in major complications (OR 1.21–1.34, p < 0.005). Following adjustment for volume at a readmitting facility, admission to a non-index facility was no longer associated with mortality (OR 0.90, 95% CI 0.71–1.14, p = 0.378) or major complications (OR 1.09, CI 0.94–1.26, p = 0.248).CONCLUSIONSOf patient readmissions following brain tumor resection, 15.6% occur at a non-index facility. Low procedure volume is a confounder for non-index analysis and is associated with an increased likelihood of major complications and mortality, as compared to readmission to high-procedure-volume hospitals. Further studies should evaluate interventions targeting factors associated with unplanned readmission.

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