Analysis Of Clinical Related Factors Of Postoperative Epilepsy Of Meningioma In Earlier Period

Meningioma is the commonest tumor of central nervous system except neurogliocytoma. Epilepsy is one of the severe postoperative complications of brain tumor. Postoperative epilepsy of meningioma in earlier period is the secondary epilepsy which happens in a week after operation. According to the researches, there are many kinds of factors related to postoperative epilepsy of meningioma in earlier period. The related factors discovered by present researches are preoperative epileptic attack history, language barrier, dyskinesia, tumor position, tumor size, tumor infiltration, excision extent, histology subtypes, operative time, postoperative hydrocephalus, encephaledema, encephalorrhagia and anti-epileptic prevention. However, the report about systemic analysis and risk evaluation of related factors of postoperative epilepsy of meningioma in earlier period is very rare at present.Objective: To explore the relationship between meningioma postoperative epilepsy in earlier period and each clinical relating factor, analyze the main risk factor and protective factor, establish thelogistic stepwise regression equation to make risk assessment of postoperative epilepsy in earlier period of meningioma.Methods: Collecting the clinical data of 222 meningioma operative cases of our hospital between March 2006 and March 2007 and extract eighteen variables including gender, age, recurrence, preoperative epilepsy, language barrier, dyskinesia, tumor place, tumor direction, tumor diameter, peritumoral edema, preoperative or postoperative preventive drug, operative time, excision extent, tumor root, adherence, bloodstream and postoperative epilepsy in earlier period from the clinical data. Taking gender, age, recurrence, preoperative epilepsy, language barrier, dyskinesia, tumor place, tumor direction, tumor diameter, peritumoral edema, preoperative or postoperative preventive drug, operative time, excision extent, tumor root, adherence, bloodstream as observed indexes to analyze the relationship between these 17 factors and meningioma postoperative epilepsy in earlier period and establish the logistic stepwise regression equation to make risk assessment of postoperative epilepsy in earlier period of meningioma using statistic software SPSS 15.0.Result:1.In the 222 meningioma cases, there were 52 cases complicated with postoperative epilepsy in early period. Its incidence was 23.42%. According to the contingency coefficient C, the sequence of clinical factors'dependability to postoperative epilepsy of meningioma in earlier period was tumor root(0.272), tumor place(0.255), preoperative epilepsy(0.17), postoperative preventive drug(0.168), peritumoral edema(0.141), preoperative preventive drug(0.135), preoperative dyskinesia(0.134), age(0.12),tumor direction(0.081), tumor bolldstream(0.073), operative time(0.064), preoperative language barrier(0.03), gender(0.02), recurrence history(0.02), tumor diameter(0.02), excision exten(t0.017) and tumor adherence(0.006)。2.The postoperative epilepsy in earlier period incidence rates of the patients have preoperative epilepsy or not,the patients have preoperative preventive medication or not , the patients have dyskinesia or not,the patients have peritumoral edema or not,the patients have postoperative preventive medication or not ,the patients have the meningioma in different places, the patient have the meningioma in different roots have significant difference(P<0.05).The other factor that gender, age, recurrence, language barrier, tumor direction, tumor diameter, operative time, excision extent, adherence, bloodstream statistics didn't correlate with postoperative epilepsy in earlier period in statistics analysis(P>0.05).3 . C value of dyskinesia, preoperative preventive drug ,peritumoral edema, postoperative preventive drug , preoperative epilepsy, tumor place,tumor root equal 0.134,0.135,0.141,0.168,0.191,0.255,0.272(P<0.05),the higher of the value , the closer of the correlation between variable and postoperative epilepsy in earlier period stronger。4.Relative risk coefficient of preoperative epilepsy, dyskinesia, peritumoral edema exceed one,means these factors were risk factors,if these factors existence,the risk of postoperative epilepsy in earlier period is high. Relative risk coefficient of preoperative preventive drug,postoperative preventive drug less than one,means these factors were protection factors if these factors existence , the risk of postoperative epilepsy in earlier period is high.5.From logistic regression analysis the relative risk coefficient of 1st, 2nd, 3rd and 4th tumor place groups was respectively <0.001,1.178, 0.981 and 1. Among them and OR value the risk degree of Group 3 and 4 was high and similar. Their corresponding place is mainly convexity of brain, approaching domain and deep supratentorial part. The relative risk coefficient of 1st, 2nd, 3rd and 4th tumor root groups was respectively 0.104, 0.302, 0.504 and 1. Among them the risk degree of Group 3 and 4 was high and similar. Their corresponding place is choroid plexus, tuberculum sellae, cerebral falx, olfactory groove and sagittal sinus, mainly cortex, approaching cortex and deep supratentorial part.6. The logistic regression equation for the prediction of postoperative epilepsy in earlier period:In this equation,'Poutcome=1(epilepsy)'represents the generating possibility of postoperative epilepsy in earlier period. If P=0, it predicts no epilepsy. If P=1, it predicts epilepsy. The meaning of each variate is preoperative epilepsy(Epi-pre), dyskinesia(DK), tumor place(place), preoperative preventive drug(D-pre), tumor root(root), postoperative preventive drug(D-post). The grouping of variates"place"and"root"can be found in table 4 and table 6 and their dumb variates coding can be found in table 10. Other variates should be'1'if the related clinical factors exit and should be'0'if not. The result of Pearson goodness of fittest test of this logistic regression equation is P=0.884(the equation has statistical significance when P>0.05. The larger of P value, the better of the model). The sensitivity is 40.8%,the specificity is 90.6%,the positive predictive value is 56.1% and the negative predictive value is 83.9%.Conclusion:1. The incidence of postoperative epilepsy in earlier period is about 23.42%.2. The relationship of dyskinesia, preoperative preventive drug,peritumoral edema, postoperative preventive drug , preoperative epilepsy, tumor place and tumor root to postoperative epilepsy is closer gradually(P<0.05).3. The incidence of postoperative epilepsy in earlier period of patients who have preoperative epilepsy, dyskinesia and peritumoral edema is high. So they are risk factors. The incidence of postoperativeepilepsy in earlier period of patients who have preoperative or postoperative drug prevention is low. So they are protective factors.4 .If the meningioma is in cortex, approaching cortex or approaching functional area, the incidence of postoperative epilepsy in earlier period is high. If the meningioma is in deep part, the incidence of postoperative epilepsy in earlier period is low. But the very incidence of deep supratentorial part is higher than it of infratentorial part.5,The logistic regression equation for the prediction of postoperative epilepsy in earlier period:This equation has high goodness of fittest. The sensitivity is 40.8% and the specificity is 90.6%. The positive predictive value is 56.1% and the negative predictive value is 83.9%. If the logistic regression equation Poutcome=1(癫痫)=1,it means about 56% patients will have postoperative epilepsy in earlier period. If the logistic regression equation Poutcome=1(癫痫)=0,it means about 84% patients will not have postoperative epilepsy in earlier period.