early postoperative seizures (epS) are a common complication of brain tumour surgery. this paper investigates risk factors, management and clinical relevance of epS. We retrospectively analysed the occurrence of EPS, clinical and laboratory parameters, imaging and histopathological findings in a cohort of 679 consecutive patients who underwent craniotomies for intracranial tumours between 2015 and 2017. EPS were observed in 34/679 cases (5.1%), with 14 suffering at least one generalized seizure. patients with epS had a worse postoperative Karnofsky performance index (Kpi; with epS, KPI < 70 vs. 70-100: 11/108, 10.2% vs. 23/571, 4.0%; p = 0.007). Preoperative seizure history was a predictor for EPS (none vs. 1 vs. ≥ 2 seizures: p = 0.037). Meningioma patients had the highest EPS incidence (10.1%, p < 0.001). Cranial imaging identified a plausible cause in most cases (78.8%). In 20.6%, EPS were associated with a persisting new neurological deficit that could not otherwise be explained. 34.6% of the EPS patients had recurrent seizures within one year. EPS require an emergency work-up. Multiple EPS and recurrent seizures are frequent, which indicates that EPS may also reflect a more chronic condition i.e. epilepsy. EPS are often associated with persisting neurological worsening. Early postoperative seizures (EPS) are a common complication of brain tumour surgery. EPS are often categorized as acute symptomatic seizures 1,2. They are usually felt to reflect acute medical or surgical conditions that may require emergency treatment. This includes haemorrhages, infectious complications and electrolyte disturbances, but also systemic infections and cardiopulmonary disorders resulting in hypotension and hypoxia. Hence, EPS may have potentially severe consequences. They may result in significant and often persisting (neurological) morbidity and reduced quality of life. Furthermore, they usually prolong the patient's hospital stay. Potential negative consequences include a delayed transfer for rehabilitation therapy, an overall prolonged rehabilitation and, importantly, delayed adjuvant therapy. This latter aspect is of considerable importance e.g. in patients with gliomas and metastasis who will often not realize the benefits of surgery if adjuvant therapy is withhold. In addition, many patients with brain metastases require more or less urgent treatment for their systemic disease. There is also the issue of distinguishing between incidental or acute symptomatic seizures with no or a very low risk of recurrent seizures and true postoperative chronic epilepsy 1-3. The latter condition requires chronic treatment with antiepileptic drugs and comes with relevant socioeconomic sequelae such as restriction of driving privileges. This may be a particularly important issue for patients with benign tumours such as many meningiomas who have a good chance of a surgical cure of their tumour. In such cases, the risk of recurrent seizures may well be their only (neurological) health concern 4,5. There is a growing interest in tumour-assoc...

We retrospectively studied 73 consecutive patients who underwent surgery 2015–2020 for removal of cerebellar metastases (CM). Median overall survival (medOS) varied widely between patients and compared favorably with the more recent literature (9.2, 25–75% IQR: 3.2–21.7 months vs. 5–8 months). Prognostic factors included clinical (but not radiological) hydrocephalus (medOS 11.3 vs. 5.2 months, p = 0.0374). Of note, a third of the patients with a KPI <70% or multiple metastases survived >12 months. Chemotherapy played a prominent prognostic role (medOS 15.5 vs. 2.3, p < 0.0001) possibly reflecting advances in treating systemic vis-à-vis controlled CNS disease. Major neurological (≥30 days), surgical and medical complications (CTCAE III–V) were observed in 8.2%, 13.7%, and 9.6%, respectively. The occurrence of a major complication markedly reduced survival (10.7 vs. 2.5 months, p = 0.020). The presence of extracerebral metastases did not significantly influence OS. Postponing staging was not associated with more complications or shorter survival. Together these data argue for individualized decision making which includes offering surgery in selected cases with a presumably adverse prognosis and also occasional urgent operations in cases without a preoperative oncological work-up. Complication avoidance is of utmost importance.

Imaging biomarkers for prediction of TERT mutation status remain weak and cannot be derived from the VASARI protocol. Tumor-associated seizures are less common in TERT mutated glioblastomas.

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