Intraoperative Seizures in Glioma Surgery: Is It Really Only an Intraoperative Issue?

Intraoperative seizures (IOS) occur frequently during glioma surgery, but their impact on long-term seizure control and clinical outcomes remains unclear. This study retrospectively analyzed 154 patients with tumor-related epilepsy (TRE) who underwent glioma surgery, assessing seizure and clinical outcomes at 12 and 24 months. IOS were observed in 26% of patients, mostly during awake surgery, without changing anesthetic management. Early post-operative seizures (POS) occurred in 18.5% of patients. IOS did not significantly affect seizure control or clinical outcomes at both time points. However, early POS were associated with worse seizure control at 12 months, though this association weakened by 24 months. No significant correlation was found between early POS and clinical outcome. These findings suggest that while IOS may be disruptive intraoperatively, they do not influence long-term prognosis. In contrast, early POS have a more pronounced impact, particularly in the first post-operative year.