DOI: https://doi.org/10.14710/jai.v0i0.73402

Early Seizure Management in Postoperative Brain Tumor Patients

1Anesthesia and Intensive Therapy Department, Medical Faculty of Universitas Padjadjaran, Bandung, Indonesia, Indonesia

2Anesthesia and Intensive Therapy Department, Medical Faculty of Universitas Sebelas Maret/RSUD Dr. Moewardi, Solo, Indonesia, Indonesia

Received: 20 May 2025; Revised: 23 Sep 2025; Accepted: 24 Oct 2025; Available online: 24 Oct 2025.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

Citation Format:
Cover Image
Abstract

Background: Early post-operative seizures (EPS), defined as seizures occurring within seven days following brain surgery, are a common and serious complication, particularly in patients with high-grade gliomas. EPS can prolong hospitalization, impair neurological recovery, and increase the risk of further brain injury. The optimal prophylactic strategy for seizure prevention remains controversial, especially in settings where access to second-generation antiepileptic drugs is limited.

Case: A 53-year-old female presented with progressive headaches and was diagnosed with a supratentorial intraaxial tumour consistent with high-grade glioma. She underwent subtotal tumour resection. Four hours postoperatively, the patient developed two episodes of generalized seizures. Immediate management included intravenous midazolam, endotracheal intubation, and administration of phenytoin. Diagnostic evaluations excluded metabolic or infectious causes. Near-infrared spectroscopy (NIRS) monitoring indicated stable cerebral oxygenation throughout the postoperative course. The patient experienced no further seizures and demonstrated full neurological recovery. Oral phenytoin was continued for 21 days..

Discussion: Early postoperative seizures is associated with multiple risk factors, including tumour location, size, and incomplete resection. In this case, the tumour’s frontal and parietal lobe involvement, large volume, and subtotal excision likely contributed to seizure onset. Phenytoin, despite being a first-generation antiepileptic drug, proved effective in managing EPS and preventing recurrence in the absence of levetiracetam. NIRS served as a useful non-invasive adjunct to monitor cerebral oxygenation post-seizure.

Conclusion: Effective early recognition and treatment of EPS are critical in preventing secondary neurological complications. In resource-limited settings, phenytoin remains a viable monotherapy for seizure control post-craniotomy. Individualized, protocol-driven management strategies, supported by neuromonitoring tools like NIRS, can optimize outcomes in brain tumour surgery.

Note: This article has supplementary file(s).

Fulltext |  Research Instrument
Figure 1
Subject
Type Research Instrument
  Download (242KB)    Indexing metadata
 common.other
Copyright Transfer Agreement
Subject
Type Other
  Download (213KB)    Indexing metadata
Keywords: brain tumor; early postoperative seizure; seizure management

Article Metrics:

Article Info
Section: Case Reports
Language : EN
Recent articles
Comparison of Neck Circumference to Thyromental Distance as A Predictor of Difficulty Visualizing The Larynx in Elective Surgery Patients At Haji Adam Malik General Hospital A COMPARISON OF ENDOTRACHEAL INTUBATION SUCCESS USING VIDEO LARYNGOSCOPY AND RECONSTRUCTED LARYNGOSCOPE AMONG HEALTH WORKERS IN NUSA PENIDA Comparison Between the Use of 10% Lidocaine Spray on the Mole Palate, Posterior Pharynx, Tonsillar Pillar, Hypopharynx, and Endotracheal Tube on Hemodynamics and Post-Intubation Throat Pain Target-Controlled Infusion (TCI) Propofol in Ventriculoperitoneal (VP) Shunt Surgery during the First Trimester of Pregnancy Myocardial Injury after Noncardiac Surgery: A Case Report of Acute Chest Pain and Elevated Troponin Levels, Challenges and Management Strategies Intensive Care Management of a Patient With Pickwickian Syndrome, Obesity, and Congestive Heart Failure More recent articles
Most cited articles
Patofisiologi Penyakit Jantung Koroner Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida More cited articles
  1. Al-Dorzi HM, Alruwaita AA, Marae BO, Alraddadi BS, Tamim HM, Ferayan A, et al. Incidence, risk factors and outcomes of seizures occurring after craniotomy for primary brain tumor resection. Neurosciences. 2017;22(2):107–13
  2. Omerhodzic I, Džurlić A, Ahmetspahić A, Rovčanin B, Kalamujić M, Bilalovic N, et al. Neurosurgical Options for Glioma. In 2019
  3. Greenhalgh J, Weston J, Dundar Y, Nevitt SJ, Marson AG. Antiepileptic drugs as prophylaxis for postcraniotomy seizures. Cochrane Database Syst Rev. 2020;2020(4)
  4. Shetty A, Pardeshi S, Shah VM, Kulkarni A. Anesthesia considerations in epilepsy surgery. Int J Surg [Internet]. 2016;36:454–9. Available from: http://dx.doi.org/10.1016/j.ijsu.2015.07.006
  5. Li L, Li G, Fang S, Zhang K, Huang R, Wang Y, et al. New-Onset Postoperative Seizures in Patients With Diffuse Gliomas: A Risk Assessment Analysis. Front Neurol. 2021;12(June):1–8
  6. Neal A, Kwan P, Morokoff A, O’Brien TJ. Post-operative seizure prophylaxis in gliomas. Transl Cancer Res. 2017;6(14):S1006–9
  7. Le VT, Nguyen AM, Pham TA, Nguyen PL. Tumor-related epilepsy and post-surgical outcomes: tertiary hospital experience in Vietnam. Sci Rep [Internet]. 2023;13(1):1–9. Available from: https://doi.org/10.1038/s41598-023-38049-1
  8. Chen WC, Magill ST, Englot DJ, Baal JD, Wagle S, Rick JW, et al. Factors Associated with Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection. Neurosurgery. 2017;81(2):297–306
  9. Lamsal R, Bista NR. Management of Status Epilepticus. J Neuroanaesth Crit Care. 2019;6(3):267–74
  10. Ascoli M, Ferlazzo E, Gasparini S, Mastroianni G, Citraro R, Roberti R, et al. Epidemiology and outcomes of status epilepticus. Int J Gen Med. 2021;14:2965–73
  11. Bereda G. Ilae classification of seizures and antiepileptic medications apothegmatic: hereafter advancement and clinical practice. J Psychol Clin Psychiatry. 2022;13(1):3–7
  12. Van Der Meer PB, Taphoorn MJB, Koekkoek JAF. Management of epilepsy in brain tumor patients. Curr Opin Oncol. 2022;34(6):685–90
  13. De Bruin ME, Van Der Meer PB, Dirven L, Taphoorn MJB, Koekkoek JAF. Efficacy of antiepileptic drugs in glioma patients with epilepsy: A systematic review. Neuro-Oncology Pract. 2021;8(5):501–17
  14. Dewan MC, White-Dzuro GA, Brinson PR, Zuckerman SL, Morone PJ, Thompson RC, et al. The influence of perioperative seizure prophylaxis on seizure rate and hospital quality metrics following glioma resection. Clin Neurosurg. 2017;80(4):563–9
  15. Jeppesen J, Beniczky S, Johansen P, Sidenius P, Fuglsang-Frederiksen A. Exploring the capability of wireless near infrared spectroscopy as a portable seizure detection device for epilepsy patients. Seizure. 2015;26:43–8
  16. Battaglini D, Pelosi P, Robba C. The Importance of Neuromonitoring in Non Brain Injured Patients. Crit Care. 2022;26(1)

Last update:

No citation recorded.

Last update: 2025-10-29 19:39:31

No citation recorded.