Is There a High Risk of Epilepsy After Craniotomy?

Following a craniotomy, the likelihood of developing epilepsy is generally low. However, the probability varies depending on the specific area of the brain involved in the surgery. Below is a breakdown of different surgical scenarios and their associated risks.

Posterior Fossa Surgery

Procedures involving the posterior fossa, such as those targeting the cerebellum, brainstem, or cerebellopontine angle, carry an extremely low risk of postoperative seizures. These areas are located below the tentorium cerebelli and are less likely to interfere with the cerebral cortex, which is primarily responsible for seizure activity.

Brain Tumor Surgery in the Cerebral Hemispheres

When surgery is performed on tumors located within the cerebral hemispheres—especially those close to the cerebral cortex—the risk of developing epilepsy increases. Research indicates that approximately 10% of patients who undergo surgery for cortical or near-cortical tumors may experience postoperative seizures. These seizures are often related to surgical trauma or scarring in the cortical regions.

Frontal, Temporal, and Parietal Lobes

Among cerebral surgeries, operations involving the frontal, temporal, and parietal lobes present the highest risk for postoperative epilepsy. These areas are densely populated with neurons and are more susceptible to abnormal electrical discharges following surgical intervention.

Meningioma Surgery

While meningiomas located on the surface of the cerebral hemispheres may seem to pose a risk, the presence of a separating layer such as the arachnoid membrane often reduces the chance of seizure development. In many cases, the surgical removal of such tumors does not lead to significant cortical irritation, thereby maintaining a low probability of epilepsy after surgery.

Postoperative Management and Medication

In summary, the risk of epilepsy is most significant for patients undergoing surgery in the cerebral hemispheres, particularly when the tumor is near the cortex. To mitigate this risk, patients should follow their neurologist's recommendations regarding the use of antiepileptic drugs. The decision to prescribe medication and the duration of treatment are typically based on the patient's individual risk profile and postoperative recovery progress.