Older meningioma patients: a retrospective population-based study of risk factors for morbidity and mortality after neurosurgery

Descriptive surgical epidemiology of pituitary adenomas for a Hispanic population in Puerto Rico

Background

Demographics and socioeconomic variables for patients with pituitary adenomas have been reported in the past. However, these studies included operated and nonoperated patients, in addition to microprolactinomas frequently diagnosed in women, revealing an elevated incidence among females. This study aimed to analyze the surgical incidence of pituitary adenomas for an adult Hispanic population in Puerto Rico over 6 years.

Methods

A retrospective and descriptive study was performed to investigate pituitary adenoma surgical incidence (per 100,000 people) among surgically treated pituitary adenomas in an adult (18 years or more) Puerto Rico Hispanic population. All new patients diagnosed with pituitary adenomas who underwent surgery at the Puerto Rico Medical Center between 2017 and 2022 were scrutinized. Inclusion criteria required a histopathological diagnosis of pituitary adenoma. Previously operated cases and non-Hispanic patients were excluded from the study. Patient characteristics were collected, along with the type of surgical treatment, tumor size, and secretory status.

Results

The analysis included 143 patients operated on for pituitary adenomas. Of these, 75 (52%) patients were male, and 68 (48%) were female. The median age of the patients was 56 years (range: 18-85). The average annual surgical incidence of adult Hispanic patients with pituitary adenomas was 0.73 surgeries/100,000 people. About 79% of the patients had non-functioning pituitary adenomas. About 94% of the patients were operated on using transsphenoidal surgery.

Conclusion

There was no sex predominance for surgical-treated pituitary adenomas in Puerto Rico. The surgical incidence for adult pituitary adenoma remained stable between 2017 and 2022.

Male sex and presence of preoperative symptoms are associated with early recurrence of WHO grade I meningiomas after surgical resection: analysis from the nationwide Brain Tumor Registry of Japan

This study aimed to assess the risk factors for the recurrence of WHO grade I intracranial meningiomas using the Brain Tumor Registry of Japan (BTRJ) database. We extracted the data of 4641 patients with intracranial WHO grade I meningiomas treated only by surgical resection between 2001 and 2008. We conducted complete data analysis (n = 3690) and multiple imputation analysis (n = 4641) to adjust for missing data on tumor size. The influence of factors including age, sex, size, extent of resection, location, and preoperative symptoms on PFS was assessed. Univariate analyses of the complete data set showed that age did not affect PFS; however, male sex (p < 0.001), tumor size ≥ 30 mm (p < 0.001), low extent of resection, tumor location at the skull base (p < 0.001), and the presence of preoperative symptoms (p < 0.001) were risk factors for a significantly shorter PFS. Multivariate analysis demonstrated that male sex (p < 0.001) and presence of preoperative symptoms (p = 0.027) were independent risk factors for shorter PFS alongside large tumor size (p < 0.001) and non-gross total resection (p < 0.001). These results were confirmed for the imputed dataset. While most previous large nationwide studies of meningiomas have evaluated overall survival, progression-free survival has yet to be thoroughly examined. This study suggests that even histologically benign meningiomas may have a sex difference in postoperative behavior. This observation may provide clues to understanding the mechanism of meningioma cell proliferation.

Clinical Management of Supratentorial Non-Skull Base Meningiomas

Supratentorial non-skull base meningiomas are the most common primary central nervous system tumor subtype. An understanding of their pathophysiology, imaging characteristics, and clinical management options will prove of substantial value to the multi-disciplinary team which may be involved in their care. Extensive review of the broad literature on the topic is conducted. Narrowing the scope to meningiomas located in the supratentorial non-skull base anatomic location highlights nuances specific to this tumor subtype. Advances in our understanding of the natural history of the disease and how findings from both molecular pathology and neuroimaging have impacted our understanding are discussed. Clinical management and the rationale underlying specific approaches including observation, surgery, radiation, and investigational systemic therapies is covered in detail. Future directions for probable advances in the near and intermediate term are reviewed.