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

Authors: Komotar, R. J.; Raper, D. M. S.; Starke, R. M.; Iorgulescu, J. B.; Gutin, P. H.
Article 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: treatment outcome; cancer surgery; review; postoperative period; drug efficacy; drug withdrawal; unspecified side effect; neurosurgery; surgical approach; oncology; postoperative complication; etiracetam; meningeal neoplasms; systematic review; prophylaxis; recurrent disease; surgical mortality; therapy effect; perioperative period; seizure; meningioma; anticonvulsive agent; epilepsy; phenytoin; anticonvulsants; valproic acid; carbamazepine; neurosurgical procedures; seizures; lamotrigine; antiepileptic drug; prophylactic treatment; supratentorial tumor; valproate semisodium; supratentorial meningioma
Journal Title: Journal of Neurosurgery
Volume: 115
Issue: 3
ISSN: 0022-3085
Publisher: American Association of Neurological Surgeons  
Date Published: 2011-09-01
Start Page: 483
End Page: 490
Language: English
DOI: 10.3171/2011.4.jns101585
PROVIDER: scopus
PUBMED: 21639698
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 3 October 2011" - "CODEN: JONSA" - "Source: Scopus"
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MSK Authors
  1. Philip H Gutin
    148 Gutin
  2. Ricardo Jorge Komotar
    13 Komotar