Secondary surgical epilepsy as a predictive recurrence factor in patients with grade I meningioma: An observational clinical study

Objectives The World Health Organization (WHO) grade I intracranial meningiomas (IMs) maintain a certain risk of recurrence (~10%) even if a gross total resection is achieved. Most studies analyzing predictive factors of benign meningioma recurrence focus on histological changes and factors related to radiologic-therapeutic follow-up. Few authors have speculated on the role of meningioma-related epilepsy on the risk of developing recurrence. The presence of seizures and the factors predictive of their onset have remained relatively understudied to date in meningioma patients. Materials and Methods In this retrospective observational analysis, we studied clinical, radiological, and biological factors in 291 grade I IMs. In multivariate analysis of radiological and clinical variables, we evaluated the outcome and the risk of recurrence. A special focus was given to the presence of seizures: We reported patients who had seizures at onset and compared them with patients who experienced seizures in the postoperative phase and who developed secondary epilepsy after surgery. Results We found that grade I IMs who developed a secondary form of epilepsy after surgery have a significant correlation with the presence of recurrence diagnosed during the follow-up (17/50 patients with seizures 34%, P = 0.02). Yet, IM patients who debuted with seizures do not have a significant risk of developing recurrence during follow-up. We recognize that there is a significant difference in the expression of ki67% ( t = −2.03; df = 105; P = 0.04) between the group that showed recurrence (M = 8.79) and the one that never had recurrence (M = 5.14). Conclusion Our analysis suggests the role of post-operative epilepsy as an independent prognostic factor, not correlated with pre-operative seizure on meningioma recurrence. We confirmed that a significant cell replication factor such as ki67 significantly correlates with the risk of recurrence and probably indirectly correlates with the risk of developing post-operative epilepsy.