Identifying Risk Factors for New-Onset Postoperative Seizures in Pediatric Brain Tumor Patients: A Comprehensive Retrospective Analysis.

Introduction: Surgical resection of intracranial tumors in pediatric patients poses the potential risk of new-onset postoperative seizures, prompting debates over the prophylactic use of anti-seizure medication (ASMs). This retrospective study focusses on the incidence and risk factors associated with the occurrence of new-onset postoperative seizures within 30 days following surgery in pediatric patients with brain tumors who did not receive ASM prophylaxis pre- and perioperatively.

Methods: A meticulous review of clinical records spanning from June 2018 to December 2022 was conducted, examining data from pediatric patients undergoing craniotomies for intracranial tumors. Patients with preoperative seizures or those taking perioperative ASMs were excluded. The data encompassed demographic details, preoperative variables, tumor characteristics, surgical intricacies, and clinical course including 30-day mortality. The primary outcome was the incidence of new-onset postoperative seizures, further categorized as early (within 1 week) or late (1 week to 30 days). Univariate and multivariate logistic regression analyses were used to explore correlations between various variables and seizure outcomes.

Results: In a cohort of 306 cases, the incidence of new-onset postoperative seizures was 7.8% of whom 4.2% experienced early seizures. Of them, 3 patients developed status epilepticus. Multivariate analysis identified several significant risk factors including postoperative hyponatremia, supratentorial tumor localization, and young age, especially age under 1 year.

Conclusion: In this retrospective study, we identified supratentorial tumor localization, hyponatremia and age younger than 1 year as risk factors for new-onset postoperative seizures among pediatric patients. Especially in infants below the age of 1 year, we recommend meticulous monitoring of postoperative sodium levels and noninvasive epilepsy monitoring after supratentorial tumor resection. Future prospective studies are needed to explore the potential effectiveness of administering perioperative prophylactic antiepileptic drugs (ASMs) within this specific subset of the pediatric population.