We studied perioperative seizures in children with supratentorial tumors with and without preoperative seizures and antiseizure medication (ASM) prescribing practices.

ASMs are prescribed to patients with supratentorial tumors with side effects.  Levetiracetam has few interactions but causes neuropsychiatric side effects.  Weaning ASMs is nonstandard following craniotomy with resection of supratentorial tumors.  Postoperative seizures have previously been infrequent in retrospective cohorts of children and adults and randomized controlled trials in adults after tumor treatment.  We hypothesize rates of postoperative seizures in children with supratentorial tumors without preoperative seizures are low.

We retrospectively studied 341 consecutive children from 2020-2024 with CNS tumors.  Cases with infratentorial tumors and without craniotomy were excluded.  Demographics, tumor type, location, ASMs prescribed/weaned, gross total/partial resection, preoperative/postoperative seizures, and epilepsy at >2 years were assessed (n=140).  

Preoperative seizures predicted postoperative seizures with trend toward significance (13.5%vs5.8%,χ²=3.01,p=0.08).  Tumor location (Temporal,Frontal,Parietal,Occipital,Insular,Multilobar) did not predict postoperative seizures (χ2=2.54,p=0.64).  ASMs were prescribed more often in children with preoperative seizures (97%vs67%,χ2=12.74,p=0.00035).  For children with preoperative seizures, neurologists prescribed ASMs most often (76.4%vs23.5%,χ2=9.52,p=0.002).  Neurosurgeons prescribed ASMs most often for children without preoperative seizures (90.3%vs9.7%,χ2=46.7,p=8.1x10^-12). Gross total versus partial resection did not predict postoperative seizures (7.8%vs7.8%,χ2=0.00032,p=0.98).  Interestingly, for 106 children with >2 year follow up, starting ASMs was associated with epilepsy (46%vs10%,χ2=12.00,p=0.0005).  For 23 children with >2 year follow up and preoperative seizures, gross total versus partial resection did not predict development of epilepsy (50%vs66%,χ2=0.61,p=0.43).  For 83 children with >2 year follow up without preoperative seizures, gross total versus partial resection did not predict development of epilepsy (25%vs31%,χ2=0.37,p=0.53).  Weaning of ASMs was nonstandard with 7 days postoperatively versus other methods (40%vs60%,χ2=1.2,p=0.27).

Postoperative seizures are rare in children with supratentorial tumors with and without preoperative seizures.  ASMs are prescribed more often following preoperative seizures with nonstandard ASM weaning practices.  Prospective study is necessary to standardize practice.