Development and internal validation of a nomogram for predicting early postoperative seizures in patients with supratentorial meningioma accompanied by peritumoral brain edema

Patients with supratentorial meningioma accompanied by peritumoral brain edema (PTBE) are at increased risk of early postoperative seizures (EPS), but individualized preoperative risk stratification remains limited. This study aimed to develop and internally validate a nomogram for predicting EPS within 7 days after surgery. This single-center retrospective cohort study included 397 patients with supratentorial meningioma and PTBE. All eligible patients were used for model development. Prespecified preoperative candidate predictors were evaluated using least absolute shrinkage and selection operator regression, followed by multivariable logistic regression. Internal validation was performed using 1,000 bootstrap resamples incorporating the complete model-development process. EPS occurred in 52 patients (13.1%). Five predictors were retained in the final model: Grade 2 PTBE, sensorimotor cortex involvement, larger preoperative tumor volume, higher neutrophil-to-lymphocyte ratio, and lower albumin-corrected serum calcium. The model achieved an apparent AUC of 0.858 (95% CI, 0.807–0.909) and an optimism-corrected AUC of 0.840. The optimism-corrected Brier score was 0.091, with a calibration intercept of − 0.03 and calibration slope of 0.89. Decision curve analysis showed a higher net benefit than treat-all and treat-none strategies across threshold probabilities of approximately 8%–42%. Model performance remained similar across prespecified sensitivity analyses. A preoperative nomogram integrating clinical, imaging, and routinely available laboratory variables showed good internally validated performance for estimating 7-day EPS risk in patients with supratentorial meningioma and PTBE. The model may support individualized perioperative risk assessment but requires external validation before routine clinical implementation.