Antiepileptic Prophylaxis in Skull Base Surgery: A Systematic Review and Meta-analysis

Introduction: The increased risk of seizures with intracranial pathology requiring transcranial surgery is well-demonstrated in the literature. In response to this augmented risk patients are often prescribed antiepileptic drugs (AEDs) to mitigate the likelihood of seizures occurring in both the perioperative and postoperative periods. However, the correlation between skull base surgery and its predisposition to an increased risk of pre- or postoperative seizures, as well as the necessity for prophylactic treatment, remains insufficiently established in current literature. We sought to systematically assess available literature to determine if AED use affected seizure rates in patients undergoing skull base surgery.

Methods: PubMed, Embase, Cochrane, and Web of Science databases were queried for original English articles without any restrictions on date. This review was conducted in accordance with the 2020 PRISMA guidelines. A meta-analysis of pooled success rate with an inverse variance statistical method and fixed effects analysis model was performed using RevMan software (Version 5.3.5; Cochrane Group, London, UK). The methodological index for nonrandomized studies (MINORS) criteria was used to assess quality of studies.

Results: Of 1,442 abstracts initially screened, 9 full-text articles were included in this review, consisting of 2,532 patients. Meningioma was the most common etiology of skull base pathology. Meta-analysis of 5 of 9 studies revealed a pooled pre-operative seizure rate of 11% (95% CI 0.09–0.13, I2 94%). Subsequent meta-analysis including 7 of 9 studies demonstrated a pooled postoperative seizure rate after skull base surgery of 3% (95% CI 0.03–0.04, I2 92%). The average MINORS score of included studies was moderate at 12.5. Only one study explored the differences in postoperative seizure rates based on antiepileptic prophylaxis; Kamenova et al found that seizure rates were not significantly different, with 9.2% in the AED group and 10.1% in the no-AED group.

Conclusion: Although there may be some statistical evidence of low seizure rates after skull base surgery, data is sparse on antiepileptic use in this cohort. Further studies focused on skull base cohorts with multivariate analyses of antiepileptic use and surgical approach (endoscopic vs. open) could help to illuminate this topic further.

Fig. 1

Fig. 2

Publication History

Article published online:
05 February 2024