Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection: A systematic analysis of efficacy - A review

Ricardo J Komotar, Daniel M S Raper, Robert M. Starke, J. Bryan Iorgulescu, Philip H. Gutin

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Object. Meningiomas are one of the more common intracranial neoplasms. The risk of seizures and secondary aspiration, brain edema, and brain injury often leads practitioners to administer prophylactic antiepileptic drugs (AEDs) perioperatively. The efficacy of this practice remains controversial, however, with prior investigations reaching conflicting results and recent studies focusing on AED side effects. The authors performed a systematic analysis of outcomes following supratentorial meningioma resection with and without prophylactic AED administration in the hope of clarifying the role of AEDs in the perioperative care of patients with these lesions. Methods. A MEDLINE search of the literature (1979-2010) was performed. Comparisons were made for patient and tumor characteristics as well as success of repair, morbidity, and seizure outcome. Statistical analyses of categorical variables were undertaken using chi-square and Fisher exact tests. Results. Nineteen studies, involving 698 patients, were included. There were no significant differences in the extent of resection, perioperative mortality, or recurrence between the AED and no-AED cohorts. Likewise, there were no significant differences in the incidence of early or late seizures between the cohorts. Conclusions. The results of this systematic analysis supports the conclusion that the prophylactic administration of anticonvulsants during resection of supratentorial meningiomas provides no benefit in the prevention of either early or late postoperative seizures. Despite their traditional role in this patient population, the routine use of AEDs should be carefully reconsidered.

Original languageEnglish
Pages (from-to)483-490
Number of pages8
JournalJournal of Neurosurgery
Volume115
Issue number3
DOIs
StatePublished - Sep 1 2011
Externally publishedYes

Fingerprint

Meningioma
Anticonvulsants
Drug Therapy
Seizures
Perioperative Care
Brain Edema
Drug-Related Side Effects and Adverse Reactions
MEDLINE
Brain Neoplasms
Brain Injuries
Morbidity
Recurrence
Mortality
Incidence
Population

Keywords

  • Antiepileptic drug
  • Epilepsy
  • Meningioma
  • Oncology
  • Prophylactic treatment
  • Seizures
  • Supratentorial tumor

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection : A systematic analysis of efficacy - A review. / Komotar, Ricardo J; Raper, Daniel M S; Starke, Robert M.; Iorgulescu, J. Bryan; Gutin, Philip H.

In: Journal of Neurosurgery, Vol. 115, No. 3, 01.09.2011, p. 483-490.

Research output: Contribution to journalArticle

Komotar, Ricardo J ; Raper, Daniel M S ; Starke, Robert M. ; Iorgulescu, J. Bryan ; Gutin, Philip H. / Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection : A systematic analysis of efficacy - A review. In: Journal of Neurosurgery. 2011 ; Vol. 115, No. 3. pp. 483-490.
@article{9ad7476ae7d44f8fb5c0152bfea44d2b,
title = "Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection: A systematic analysis of efficacy - A review",
abstract = "Object. Meningiomas are one of the more common intracranial neoplasms. The risk of seizures and secondary aspiration, brain edema, and brain injury often leads practitioners to administer prophylactic antiepileptic drugs (AEDs) perioperatively. The efficacy of this practice remains controversial, however, with prior investigations reaching conflicting results and recent studies focusing on AED side effects. The authors performed a systematic analysis of outcomes following supratentorial meningioma resection with and without prophylactic AED administration in the hope of clarifying the role of AEDs in the perioperative care of patients with these lesions. Methods. A MEDLINE search of the literature (1979-2010) was performed. Comparisons were made for patient and tumor characteristics as well as success of repair, morbidity, and seizure outcome. Statistical analyses of categorical variables were undertaken using chi-square and Fisher exact tests. Results. Nineteen studies, involving 698 patients, were included. There were no significant differences in the extent of resection, perioperative mortality, or recurrence between the AED and no-AED cohorts. Likewise, there were no significant differences in the incidence of early or late seizures between the cohorts. Conclusions. The results of this systematic analysis supports the conclusion that the prophylactic administration of anticonvulsants during resection of supratentorial meningiomas provides no benefit in the prevention of either early or late postoperative seizures. Despite their traditional role in this patient population, the routine use of AEDs should be carefully reconsidered.",
keywords = "Antiepileptic drug, Epilepsy, Meningioma, Oncology, Prophylactic treatment, Seizures, Supratentorial tumor",
author = "Komotar, {Ricardo J} and Raper, {Daniel M S} and Starke, {Robert M.} and Iorgulescu, {J. Bryan} and Gutin, {Philip H.}",
year = "2011",
month = "9",
day = "1",
doi = "10.3171/2011.4.JNS101585",
language = "English",
volume = "115",
pages = "483--490",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "3",

}

TY - JOUR

T1 - Prophylactic antiepileptic drug therapy in patients undergoing supratentorial meningioma resection

T2 - A systematic analysis of efficacy - A review

AU - Komotar, Ricardo J

AU - Raper, Daniel M S

AU - Starke, Robert M.

AU - Iorgulescu, J. Bryan

AU - Gutin, Philip H.

PY - 2011/9/1

Y1 - 2011/9/1

N2 - Object. Meningiomas are one of the more common intracranial neoplasms. The risk of seizures and secondary aspiration, brain edema, and brain injury often leads practitioners to administer prophylactic antiepileptic drugs (AEDs) perioperatively. The efficacy of this practice remains controversial, however, with prior investigations reaching conflicting results and recent studies focusing on AED side effects. The authors performed a systematic analysis of outcomes following supratentorial meningioma resection with and without prophylactic AED administration in the hope of clarifying the role of AEDs in the perioperative care of patients with these lesions. Methods. A MEDLINE search of the literature (1979-2010) was performed. Comparisons were made for patient and tumor characteristics as well as success of repair, morbidity, and seizure outcome. Statistical analyses of categorical variables were undertaken using chi-square and Fisher exact tests. Results. Nineteen studies, involving 698 patients, were included. There were no significant differences in the extent of resection, perioperative mortality, or recurrence between the AED and no-AED cohorts. Likewise, there were no significant differences in the incidence of early or late seizures between the cohorts. Conclusions. The results of this systematic analysis supports the conclusion that the prophylactic administration of anticonvulsants during resection of supratentorial meningiomas provides no benefit in the prevention of either early or late postoperative seizures. Despite their traditional role in this patient population, the routine use of AEDs should be carefully reconsidered.

AB - Object. Meningiomas are one of the more common intracranial neoplasms. The risk of seizures and secondary aspiration, brain edema, and brain injury often leads practitioners to administer prophylactic antiepileptic drugs (AEDs) perioperatively. The efficacy of this practice remains controversial, however, with prior investigations reaching conflicting results and recent studies focusing on AED side effects. The authors performed a systematic analysis of outcomes following supratentorial meningioma resection with and without prophylactic AED administration in the hope of clarifying the role of AEDs in the perioperative care of patients with these lesions. Methods. A MEDLINE search of the literature (1979-2010) was performed. Comparisons were made for patient and tumor characteristics as well as success of repair, morbidity, and seizure outcome. Statistical analyses of categorical variables were undertaken using chi-square and Fisher exact tests. Results. Nineteen studies, involving 698 patients, were included. There were no significant differences in the extent of resection, perioperative mortality, or recurrence between the AED and no-AED cohorts. Likewise, there were no significant differences in the incidence of early or late seizures between the cohorts. Conclusions. The results of this systematic analysis supports the conclusion that the prophylactic administration of anticonvulsants during resection of supratentorial meningiomas provides no benefit in the prevention of either early or late postoperative seizures. Despite their traditional role in this patient population, the routine use of AEDs should be carefully reconsidered.

KW - Antiepileptic drug

KW - Epilepsy

KW - Meningioma

KW - Oncology

KW - Prophylactic treatment

KW - Seizures

KW - Supratentorial tumor

UR - http://www.scopus.com/inward/record.url?scp=80052354983&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052354983&partnerID=8YFLogxK

U2 - 10.3171/2011.4.JNS101585

DO - 10.3171/2011.4.JNS101585

M3 - Article

C2 - 21639698

AN - SCOPUS:80052354983

VL - 115

SP - 483

EP - 490

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 3

ER -