A New Predictor Score for Postoperative Seizures in Brain Tumor Patients Without a Seizure History (BRAINNN Score)

OBJECTIVE: To identify risk factors for postoperative seizures in patients with brain tumors without preoperative seizures and develop a predictive scoring system to guide antiepileptic drug (AED) prophylaxis. MATERIAL AND METHODS: A retrospective analysis was conducted on patients with intra-axial brain tumors and no history of preoperative seizures or AED use. Logistic regression identified significant predictors of postoperative seizures, and a scoring system was created using receiver operating characteristic (ROC) analysis. Data were drawn from a neuro-oncology database that had been active since 1970. RESULTS: A total of 446 patients were included from 16,918 records, with a mean age of 45.1 years (67.8% male, 345 with gliomas). Over 20% experienced postoperative seizures. Logistic regression identified five significant predictors, including tumor location, patient age, extent of resection, and neoplastic edema. A scoring system was developed to improve seizure risk assessment and seizure control. The BRAINNN Score (Brain tumor-associated Risk Assessment Index developed at the National Institute of Neurology and Neurosurgery, INNN) is a newly designed predictive tool to estimate the risk of postoperative seizures in brain tumor patients without a prior history of seizures. CONCLUSIONS: This study proposes a personalized approach to AED prophylaxis using a novel, objective scoring system based on clinically relevant factors. This framework has the potential to optimize perioperative care and improve outcomes for patients with brain tumors.