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Nadeem M, Goyal-Honavar A, Sravya P, Beniwal M, Santosh V, Dwarakanath S. Prognostic Factors and Outcomes in World Health Organization Grade 1 and Grade 2 Intracranial Meningiomas-5-Year Institutional Experience. World Neurosurg 2024:S1878-8750(24)00655-7. [PMID: 38649022 DOI: 10.1016/j.wneu.2024.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Meningiomas are the most frequent primary intracranial tumor. While histological grade and grade of excision are established predictors of recurrence, the predictive ability of other clinical features, such as the role of radical excision of dural attachment and postoperative radiation therapy in intermediate-risk groups, remains unknown. METHODS Clinical and radiological features and surgical details were analyzed in 451 World Health Organization (WHO) grade 1 intracranial meningiomas and 248 WHO grade 2 meningiomas operated on between 2010 and 2015. Outcomes were assessed in 352 WHO grade 1 and 208 WHO grade 2 meningiomas, studying the effect of extent of resection and use of radiation therapy. Kaplan-Meier analysis was used to determine differences in survival by extent of resection and use of postoperative radiation therapy in the treatment of the meningiomas. RESULTS The mean age of the cohort was 46.3 years, with a female predominance. On univariate analysis, sex, WHO grade, and Simpson grade were significant predictors of recurrence. On multivariate analysis, WHO grade and Simpson grade remained significant predictors of recurrence. Recurrence was significantly associated with poor performance status and mortality. Postoperative radiation significantly improved progression-free survival among patients with grade 2 meningiomas who underwent gross total resection, but not among patients with grade 1 and grade 2 meningiomas who underwent subtotal resection. CONCLUSIONS WHO grade and Simpson grade are independent predictors of recurrence in meningiomas. Regardless of WHO grade, gross total resection must be performed when possible, and postoperative radiation therapy may be recommended in grade 2 meningiomas.
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Affiliation(s)
- Mohammed Nadeem
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Abhijit Goyal-Honavar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Palavalasa Sravya
- Research Associate, Neuro-oncology Laboratory, Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Srinivas Dwarakanath
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
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Petrella G, Piazza A, Fava A, Gorgoglione N, De Angelis M, Vangelista T, Morganti R, di Russo P, Esposito V. Parasagittal Meningiomas: The Impact of Sinus Opening and Grade of Resection on Clinical Outcome and Recurrence in a Consecutive Series of Patients. World Neurosurg 2024:S1878-8750(24)00593-X. [PMID: 38608810 DOI: 10.1016/j.wneu.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Surgical management of parasagittal meningiomas (PMs) remains controversial in the literature. The need to pursue a resection as radical as possible and the high risk of venous injuries contribute to making the sinus opening a widely argued choice. This study aimed to analyze factors affecting the risk of recurrence and to assess clinical outcomes of patients who underwent surgical resection of PMs with conservative or aggressive management of the intrasinusal portion. METHODS A single-institution retrospective review of all patients with PM surgically treated between January 2013 and March 2021 was conducted. RESULTS Among 56 patients, the sinus was opened in 32 patients (57%), and a conservative approach was used in 24 patients (43%). The sinus opening was found to be a predictive factor of radical resection (Simpson grade [SG] I-II) (P = 0.007). SG was the only predictive factor of recurrence (P < 0.001). The radical resection group (SG I-II) showed recurrence-free survival at 72 months of about 90% versus 30% in the non-radical resection group (SG III-IV) (log-rank test = 14.21, P < 0.001). Aggressive management of the sinus and radical resection were not found to be related to permanent deficit (P = 0.214 and P = 0.254) or worsening of Karnofsky performance scale score (P = 0.822 and P = 0.933). CONCLUSIONS Removal of the intrasinusal portion of the tumor using standard procedures is not associated with a higher risk of permanent deficit or worsening of Karnofsky performance scale and reduces the risk of recurrence.
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Affiliation(s)
- Giandomenico Petrella
- Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy; Department of Neurosurgery, Policlinico di Bari, Bari, Italy
| | - Amedeo Piazza
- Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy; University of Rome, Rome, Italy; Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Arianna Fava
- Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy; University of Rome, Rome, Italy
| | | | | | | | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Paolo di Russo
- Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy.
| | - Vincenzo Esposito
- Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy; University of Rome, Rome, Italy
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Krischek B, Goldbrunner R. Paradigm Shift in the Treatment of Meningiomas. Adv Exp Med Biol 2023; 1416:1-4. [PMID: 37432615 DOI: 10.1007/978-3-031-29750-2_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Meningiomas are the most common brain tumor in adults with rising incidence rates due to an aging population globally, increased availability of neuroimaging, and increased awareness of this condition by treating clinicians and primary care physicians. Surgical resection remains the mainstay of treatment, with adjuvant radiotherapy reserved for higher grade meningiomas or tumors that undergo incomplete resections. Whereas these tumors were classically defined by their histopathological features and subtypes, recent work has uncovered the molecular alterations that may lead to tumor development and have important prognostic implications. However, there remain important clinical questions regarding the management of meningiomas and current clinical guidelines continue to evolve as additional studies add onto the growing body of work that enables us to better understand these tumors.
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Affiliation(s)
- Boris Krischek
- Department of Neurosurgery, Hopitaux Robert Schuman, Luxembourg, Luxembourg
- Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, University Hospital of Cologne, Cologne, Germany.
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4
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Wang JZ, Nassiri F, Saladino A, Zadeh G. Surgical Therapy of Non-Skull Base Meningiomas. Adv Exp Med Biol 2023; 1416:79-94. [PMID: 37432621 DOI: 10.1007/978-3-031-29750-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
In a previous chapter, the surgical management of skull base meningiomas were discussed. However, the most common meningiomas that are diagnosed and operated on are non-skull base tumors located in the parasagittal/parafalcine region and convexity, and more rarely along the tentorium, and in an intraventricular location. These tumors present their own unique set of challenges given their unique anatomy and tend to be more biologically aggressive compared to skull base meningiomas, thereby reinforcing the importance of obtaining a gross total resection if possible, in order to delay recurrence. In this chapter we will cover the surgical management of non-skull base meningiomas with technical considerations for tumors located in each of the anatomical areas listed above.
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Affiliation(s)
- Justin Z Wang
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The University of Toronto, Toronto, ON, Canada
| | - Farshad Nassiri
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada.
- Division of Neurosurgery, Department of Surgery, The University of Toronto, Toronto, ON, Canada.
| | - Andrea Saladino
- Unit of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gelareh Zadeh
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The University of Toronto, Toronto, ON, Canada
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5
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Migliorati K, Spatola G, Giudice L, de Graaf N, Bassetti C, Giorgi C, Fontanella M, Vivaldi O, Bignardi M, Franzin A. Post Surgical Management of WHO Grade II Meningiomas: Our Experience, the Role of Gamma Knife and a Literature Review. Life (Basel) 2022; 13:life13010037. [PMID: 36675987 PMCID: PMC9865644 DOI: 10.3390/life13010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/25/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
Purpose: Grade II meningiomas are rarer than Grade I, and when operated on, bear a higher risk of local recurrence, with a 5-year progression free survival (PFS) ranging from 59 to 90%. Radiotherapy (RT) or radiosurgery, such as Gamma Knife radiosurgery (GKRS) can reduce the risk of relapse in patients with residual disease, even if their role, particularly after gross total resection (GTR), is still under debate. Main goal of this study was to compare the outcomes of different post-surgical management of grade II meningiomas, grouped by degree of surgical removal (Simpson Grade); next in order we wanted to define the role of GKRS for the treatment of residual disease or relapse. Methods: from November 2016 to November 2020 all patients harboring grade II meningiomas, were divided into three groups, based on post-surgical management: (1) wait and see, (2) conventional adjuvant radiotherapy and (3) stereotactic GKRS radiosurgery. Relapse rate and PFS were registered at the time of last follow up and results were classified as stable, recurrence next to or distant from the surgical cavity. In the second part of the study we collected data of all patients who underwent GKRS in our Centers from November 2017 to November 2020. Results: A total of 37 patients were recruited, including seven patients with multiple meningiomas. Out of 47 meningiomas, 33 (70.2%) were followed with a wait and see strategy, six (12.7%) were treated with adjuvant radiotherapy, and 8 patients (17.0%) with adjuvant GKRS. Follow up data were available for 43 (91.4%) meningiomas. Within the wait and see group, recurrence rates differed based on Simpson grades, lower recurrence rates being observed in three Simpson I cases (30%) compared to twelve relapses (60%) in patients with Simpson grade II/III. Finally, out of the 24 meningiomas undergoing GKRS (8 residual and 16 recurrence), 21 remained stable at follow up. Conclusions: Gross total resection (GTR) Simpson II and III have a significantly worse outcome as compared to Simpson I. The absence of adjuvant treatment leads to significant worsening of the disease progression curve. Adjuvant radiotherapy, especially GKRS, provides good local control of the disease and should be considered as an adjuvant treatment in all cases where Simpson I resection is not possible.
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Affiliation(s)
- Karol Migliorati
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Giorgio Spatola
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Lodoviga Giudice
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Nine de Graaf
- Department of General Surgery, Fondazione Poliambulanza, 25124 Brescia, Italy
- Cancer Center Amsterdam, Department of Surgery, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Chiara Bassetti
- Medical Physics Unit, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Cesare Giorgi
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Marco Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25124 Brescia, Italy
| | - Oscar Vivaldi
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Mario Bignardi
- Department of Radiation Oncology, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Alberto Franzin
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
- Correspondence:
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El-Hajj VG, Pettersson-Segerlind J, Fletcher-Sandersjöö A, Edström E, Elmi-Terander A. Current Knowledge on Spinal Meningiomas-Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2). Cancers (Basel) 2022; 14. [PMID: 36551706 DOI: 10.3390/cancers14246221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Most of the knowledge on spinal meningiomas is extrapolated from their intracranial counterparts, even though they are considered separate entities. This review aimed to systematically summarize studies covering different aspects of spinal meningiomas and their management. Methods: Databases were searched for all studies concerning spinal meningiomas dating from 2000 and onwards. When possible, a meta-analysis was performed. Results: Neurological outcomes of surgery were consistently favorable across studies, with a complication rate of 7.9% and 78.9% of the patients demonstrating good postoperative neurological function (McCormick score 1−2). The most relevant predictors of unfavorable outcomes were poor preoperative status, longer time from diagnosis to surgery, and surgery of recurrent tumors. The recurrence rate after surgery was estimated at 6%. Meta-analysis and/or survival analysis revealed that higher WHO grade (p < 0.001), higher Simpson grade (p < 0.001), ventral tumor location (p = 0.02), and male sex (p = 0.014) were all associated with higher odds of recurrence. However, the meta-analysis did not show any difference between Simpson grade 1 and grade 2 with respect to the odds of recurrence (p = 0.94). Surgery provided immediate and durable health-related quality-of-life improvement, as well as a high frequency of return to work. Conclusion: Spinal meningioma surgery is a relatively safe procedure with a low risk of tumor recurrence and high likelihood of favorable postoperative outcomes.
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Martínez-Pérez R, Tsimpas A, Marin-Contreras F, Maturana R, Hernandez-Alvarez V, Labib MA, Poblete T, Rubino P, Mura J. The Minimally Invasive Posterolateral Transcavernous-Transtentorial Approach. Technical Nuances, Proof of Feasibility, and Surgical Outcomes Throughout a Case Series of Sphenopetroclival Meningiomas. World Neurosurg 2021; 155:e564-e575. [PMID: 34478889 DOI: 10.1016/j.wneu.2021.08.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sphenopetroclival (SPC) meningiomas are considered among the most complex skull-base neoplasms to approach surgically. We aim to determine whether some SPC meningiomas can be safely and effectively treated using a modified minimally invasive pterional posterolateral transcavernous-transtentorial approach (MIPLATTA). METHODS Fourteen patients harboring SPC meningiomas were surgically treated through a MIPLATTA. MIPLATTA includes a minipterional craniotomy, anterior extradural clinoidectomy, peeling of the temporal fossa, decompression of cranial nerves (CNs) in the cavernous sinus, and sectioning of the tentorium to reach the upper part of the posterior fossa. RESULTS Gross total resection was achieved in 11 of 14 patients (78%), whereas near-total resection was accomplished in the other 3 patients (22%), each of whom underwent a further complementary retrosigmoid approach for gross total tumor resection. There were no deaths, and 13 of 14 patients were independent at 6 months follow-up (modified Rankin Scale score ≤2). One patient had pontine infarction after the procedure and experienced moderate disability at follow-up (modified Rankin Scale score 3). All patients had some degree of CN impairment. Of 38 cranial neuropathies, 15 (39%) improved, 20 (53%) remained stable, and 3 (8%) worsened postoperatively. Four new CN deficits were observed postoperatively in 3 patients (fourth CN, 2 patients; third CN, 1; fifth CN, 1). CONCLUSIONS MIPLATTA is a useful and safe treatment alternative that allows resection of large SPC tumors with dominant invasion of cavernous sinus and middle fossa, preserves hearing and facial motor function, and provides good chances of recovery of visual and oculomotor deficits.
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Affiliation(s)
- Rafael Martínez-Pérez
- Department of Neurosurgery, Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA; Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile.
| | - Asterios Tsimpas
- Department of Neurosurgery, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Francisco Marin-Contreras
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile
| | - Rolando Maturana
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile
| | | | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tomas Poblete
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile; Department of Anatomy and Legal Medicine, University of Chile School of Medicine, Santiago, Chile
| | - Pablo Rubino
- Department of Neurosurgery, Hospital el Cruce, Buenos Aires, Argentina
| | - Jorge Mura
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile; Department of Neurological Sciences, Universidad de Chile, Santiago, Chile; Department of Neurosurgery, Clinica Las Condes, Santiago, Chile
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8
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Gillespie CS, Taweel BA, Richardson GE, Mustafa MA, Keshwara SM, Babar RK, Alnaham KE, Kumar S, Bakhsh A, Millward CP, Islim AI, Brodbelt AR, Mills SJ, Jenkinson MD. Volumetric growth of residual meningioma - A systematic review. J Clin Neurosci 2021; 91:110-117. [PMID: 34373014 DOI: 10.1016/j.jocn.2021.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/28/2022]
Abstract
Surgical resection of meningioma leaves residual solid tumour in over 25% of patients. Selection for further treatment and follow-up strategy may benefit from knowledge of volumetric growth and factors associated with re-growth. The aim of this review was to evaluate volumetric growth and variables associated with growth in patients that underwent incomplete resection of a meningioma without the use of adjuvant radiotherapy. A systematic review was conducted in accordance with the PRISMA statement and registered a priori with PROSPERO (registration number: CRD42020177052). Six databases were searched up to May 2020. Full text articles analysing volumetric growth rates in at least 10 patients who had residual meningioma after surgery were assessed. Four single-centre, retrospective studies totalling 238 patients were included, of which 99% of meningioma were WHO grade 1. The absolute tumour growth rate ranged from 0.09 to 4.94 cm3 per year. The relative growth rate ranged from 5.11 to 14.18% per year. Varying methods of volumetric assessment and definitions of growth impeded pooled analysis. Pre-operative and residual tumour volume, and hyperintensity on T2 weighted MRI were identified as variables associated with residual meningioma growth, however this was inconsistent across studies. Risk of bias was high in all studies. Radiological regrowth occurred in 42-67% of cases. Our review identified that volumetric growth of residual meningioma is scarcely reported. Sufficiently powered studies are required to delineate volumetric growth and prognostic factors to stratify management.
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Affiliation(s)
- Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - Basel A Taweel
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - George E Richardson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sumirat M Keshwara
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Roshan K Babar
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Siddhant Kumar
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK
| | - Ali Bakhsh
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK
| | - Christopher P Millward
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Samantha J Mills
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Dedeciusova M, Majovsky M, Pecen L, Benes V, Netuka D. Long-term outcome of Simpson IV meningioma resection: Would it improve with adjuvant SRS? Clin Neurol Neurosurg 2021; 207:106766. [PMID: 34166979 DOI: 10.1016/j.clineuro.2021.106766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Subtotal meningioma resection (STR) is often performed to minimize surgical morbidity. Nevertheless, only a few studies have reported on patient outcome after STR. We studied the long-term outcome of SIV (Simpson grade IV) resection and identified predictive factors of overall survival (OS), progression-free survival (PFS) and time to progression (TTP). METHODS A retrospective analysis was performed on 68 patients who underwent SIV resection of meningioma (grade I) from 2004 to 2010. Data were collected from clinical, surgical and pathology records and radiological imaging. Long-term outcomes were evaluated at least 10 years after surgery. RESULTS Permanent morbidity was 11.8%, 30-day mortality 2.9% and progression rate 50.0% for a median follow-up duration of 126.6 months. Median TTP was 86.2 months. Adjuvant SRS was the only significant factor associated with longer PFS (p = 0.0052) and TTP (p = 0.0079). Higher age (p = 0.0022), KPS (p = 0.0182), postoperative ECOG score (p = 0.0182) were reliable predictors of shortened OS and aSRS (p = 0.0445) was reliable predictor of longer OS. CONCLUSION STR in intracranial meningioma is still viable and often the only treatment option available in high-risk patients or high-risk tumors. Although surgical morbidity and mortality are high, the OS rate was 85.3% at 5 years and 79.4% at 10 years. Because of the considerable progression rate and rather a long term OS the adjuvant SRS should be considered following SIV resection.
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Barrenechea IJ, Marquez LM, Pastor M. Use of Saito technique to resect an anterior lumbar spine meningioma: Technical note. Surg Neurol Int 2021; 12:276. [PMID: 34221607 PMCID: PMC8247670 DOI: 10.25259/sni_383_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Complete (Simpson Grade I: total removal) resections for anterior spinal meningiomas are especially challenging. This is largely attributed to difficulty obtaining a water-tight dural repair where the tumor has infiltrated the dura requiring duroplasty, thus often resulting in just a Simpson Grade II resection (i.e. coagulation of the dural implantation site). Here, we present a 56-year-old female who underwent resection of a ventral lumbar meningioma utilizing the Saito technique, that effectively separated the dura into two layers, removing just the inner layer but leaving the outer layer intact for direct dural repair. Methods: A 56-year-old female underwent a L1–L2 laminectomy. The anterior intradural resection of tumor was achieved with the Saito technique; this required cutting circumferentially around the tumor insertion site, and removing only the inner layer. Results: Postoperatively, the patient did well without tumor recurrence over 8 years. The postoperative biopsy confirmed a World Health Organization Grade I meningothelial meningioma. Conclusion: Saito’s technique proved to be a safe and effective method for achieving gross total resection of an anterior lumbar meningioma.
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Affiliation(s)
| | - Luis M Marquez
- Department of Neurosurgery, Hospital Privado de Rosario, Argentina
| | - Marcelo Pastor
- Department of Orthopedics, Sanatorio Centro, Rosario, Santa Fe, Argentina
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11
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Mooney MA, Abolfotoh M, Bi WL, Tavanaiepour D, Almefty RO, Bassiouni H, Pravdenkova S, Dunn IF, Al-Mefty O. Is Falcine Meningioma a Diffuse Disease of the Falx? Case Series and Analysis of a "Grade Zero" Resection. Neurosurgery 2021; 87:900-909. [PMID: 32294205 DOI: 10.1093/neuros/nyaa038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/28/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Falcine meningiomas have unique characteristics including their high rates of recurrence, association with high grade pathology, increased male prevalence, and potential for diffuse involvement of the falx. OBJECTIVE To address these issues in a substantial series of falcine meningiomas and report on the impact of extent of resection for this distinct meningioma entity. METHODS Retrospective analysis of characteristics and outcomes of 59 falcine meningioma patients who underwent surgery with the senior author. A "Grade Zero" category was used when an additional resection margin of 2 to 3 cm from the tumor insertion was achieved. RESULTS For de novo falcine meningiomas, gross total resection (GTR) was associated with significantly decreased recurrence incidence compared with subtotal resection (P ≤ .0001). For recurrent falcine meningiomas, median progression-free survival (PFS) was significantly improved for GTR cases (37 mo vs 12 mo; P = .017, hazard ratio (HR) .243 (.077-.774)). "Grade Zero" resection demonstrated excellent durability for both de novo and recurrent cases, and PFS was significantly improved with "Grade Zero" resection for recurrent cases (P = .003, HR 1.544 (1.156-2.062)). The PFS benefit of "Grade Zero" resection did not achieve statistical significance over Simpson grade 1 during the limited follow-up period (mean 2.8 yr) for these groups. CONCLUSION The recurrence of falcine meningiomas is related to the diffuse presence of tumor between the leaflets of the falx. Increased extent of resection including, when possible, a clear margin of falx surrounding the tumor base was associated with the best long-term outcomes in our series, particularly for recurrent tumors.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohammad Abolfotoh
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky.,Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daryoush Tavanaiepour
- Department of Neurosurgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Rami O Almefty
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Hischam Bassiouni
- Department of Neurosurgery, Klinikum Amberg, Amberg, Germany.,Department of Neurosurgery, Klinikum Weiden, Weiden, Germany
| | - Svetlana Pravdenkova
- Department of Neurosurgery, Arkansas Neuroscience Institute, Little Rock, Arkansas
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Prat-Acín R, Guarín-Corredor MJ, Galeano-Senabre I, Ayuso-Sacido A, Vera-Sempere F. Value of KI-67/MIB-1 labeling index and simpson grading system to predict the recurrence of who grade I intracranial meningiomas compared to who grade II. J Clin Neurosci 2021; 86:32-37. [PMID: 33775343 DOI: 10.1016/j.jocn.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 12/21/2022]
Abstract
Simpson grading of resection has been used as a predictor of intracranial meningioma (IM) recurrence. Histopathological findings, like the Ki-67/MIB-1 labeling index, may be useful in the assessment risk of recurrence. Our objective was to analyze the predictive value of meningioma recurrence using both parameters. We retrospectively studied 322 consecutive patients with histopathological diagnosis of IM WHO grade I and 43 patients with IM WHO grade II in a 13-year period. Multivariate survival analysis was performed. In the WHO grade I IM group, recurrence was observed in 28 patients (8.69%). The Cox regression model for WHO grade I IM, provided a significative hazard ratio (HR) for Ki-67/MIB-1 index ≥3 (HR = 36.35, p < 0.001) and Simpson's grading resection, grade II (HR = 2.03, p = 0.045), grade III (HR = 3.41, p = 0.034) and grade IV (HR = 19.75, p ≥ 0.001). In the WHO grade II IM group, recurrence was observed in 10 patients (23.25%). The Cox regression model for WHO grade II IM, provided a significative hazard ratio (HR) for Ki-67/MIB-1 index ≥3% (HR = 1.66, p < 0.001) and Simpson's grading resection grade III (HR = 3.96, p = 0.027). The Kaplan-Meier survival curve showed a similar distribution of survival between WHO grade I IM with Ki-67/MIB-1 ≥3% and WHO grade II IM. In WHO grade I meningiomas, the Ki-67/MIB-1 index and Simpson grading were both independent predictors of recurrence. A similar management protocol should be advisable for WHO grade I with Ki-67/MIB-1 ≥3% and WHO grade II meningiomas.
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Affiliation(s)
- Ricardo Prat-Acín
- Neurosurgery Department. Hospital Universitario y Politécnico La Fe, Valencia, Spain; Nanomedicine and Sensors Unit, Hospital Universitario y Politécnico La Fe, Universidad Politécnica de Valencia, Spain.
| | | | - Inma Galeano-Senabre
- Neurosurgery Department. Hospital Universitario y Politécnico La Fe, Valencia, Spain; Nanomedicine and Sensors Unit, Hospital Universitario y Politécnico La Fe, Universidad Politécnica de Valencia, Spain
| | - Angel Ayuso-Sacido
- Brain Tumour Laboratory, Fundación Vithas, Grupo Hospitales Vithas, Madrid, Spain; Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
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13
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Yu J, Chen FF, Zhang HW, Zhang H, Luo SP, Huang GD, Lin F, Lei Y, Luo L. Comparative Analysis of the MRI Characteristics of Meningiomas According to the 2016 WHO Pathological Classification. Technol Cancer Res Treat 2020; 19:1533033820983287. [PMID: 33356976 PMCID: PMC7768868 DOI: 10.1177/1533033820983287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTS To evaluate the performance of preoperative magnetic resonance imaging (MRI) in evaluating diagnoses, operation methods and recurrence of meningiomas according to the World health organization (WHO) pathological classification. METHODS MRI characteristics of 127 meningioma patients were retrospectively analysed according to pathological results (WHO grade) and their association with Simpson's grades (resection) and recurrence. RESULTS The T1-weighted imaging (T1WI) signal intensity of WHO grade I meningiomas was slightly hypointense or isointense gray, while the T2-weighted imaging (T2WI) signal intensity was isointense or slightly hyperintense. The T1WI and T2WI signal intensity in WHO grade II and III meningiomas was isointense gray. The enhancement degree and patterns, lobulation, flowing voids, dural tail, maximum diameter, peritumoural oedema, ADC values and margin were significantly different between any 2 grades (P < 0.05). The ADC values were higher for WHO grade I tumors than for WHO grade II and III tumors (P < 0.001). Among all the analyzed characteriscs, ADC values, peritumoural oedema, and margin effectively predicted the diagnosis according to the WHO classification. The operation method and surgical resection were different between WHO grade Ⅰ and WHO grade Ⅱ/Ⅲ meningiomas (P < 0.05). The recurrence rate increased with tumor grade, but there was no statistical difference among the 3 types(P> 0.05). CONCLUSIONS WHO grades and pathological subtypes of meningiomas can generally be determined based on their MRI characteristics. In addition, MRI provides significant guidance for the grading of surgical success and prognosis.
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Affiliation(s)
- Juan Yu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Fan-Fan Chen
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Han-Wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hong Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Si-Ping Luo
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Guo-Dong Huang
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
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14
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Saiwai H, Okada S, Hayashida M, Harimaya K, Matsumoto Y, Kawaguchi KI, Iida KI, Kobayakawa K, Yokota K, Maeda T, Tsuchiya K, Arizono T, Saito T, Nakaie K, Iwamoto Y, Nakashima Y. Long-term outcomes of spinal meningioma resection with outer layer of dura preservation technique. J Clin Neurosci 2020; 83:68-70. [PMID: 33317879 DOI: 10.1016/j.jocn.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/08/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022]
Abstract
Spinal meningioma is a common benign intradural spinal tumor. It has been reported that the local recurrence rate after surgical resection increases with longer follow-up duration. Simpson grade 1 resection could reduce the risk of recurrence, but this procedure needs dural reconstruction, which would cause cerebrospinal fluid (CSF) leakage or iatrogenic spinal cord injury. Saito et al. reported dura preservation technique to reduce the risk of CSF leakage, in which the meningioma together with the inner layer of the dura is removed and the outer layer is preserved for simple dural closure. The long-term outcomes with this technique have never been investigated. In this study, we retrospectively analyzed the data of 38 surgically treated patients (dura preservation technique, 12 patients; Simpson grade 2 resection, 26 patients) to assess the long-term recurrence rate (mean, 121.5 months; range, 60-228 months). The local recurrence rate in the dura preservation group was 8.3% (1 of 12 cases), which was similar to that in Simpson grade 2 resection group (2 of 26 cases [7.7%]). Although this case series did not indicate the significant difference in the recurrence rates between the dura preservation group and Simpson grade 2 group, we consider that this technique still has advantages for surgically less invasiveness in terms of dural reconstruction which is necessary for Simpson grade 1 and higher possibility of complete resection of tumors compared with Simpson grade 2 resection.
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Affiliation(s)
- Hirokazu Saiwai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan.
| | - Seiji Okada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan; Department of Immunobiology and Neuroscience, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Mitsumasa Hayashida
- Department of Orthopedic Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Kyushu University Beppu Hospital, Oita, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Ken-Ichi Kawaguchi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Kei-Ichiro Iida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Kazu Kobayakawa
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Kazuya Yokota
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Kuniyoshi Tsuchiya
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, Fukuoka, Japan
| | - Takeshi Arizono
- Department of Orthopedic Surgery, Kyushu Central Hospital, Fukuoka, Japan
| | - Taichi Saito
- Department of Orthopedic Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - Kazutoshi Nakaie
- Department of Orthopedic Surgery, National Hospital Organization, Fukuoka-Higashi Medical Center, Fukuoka, Japan
| | - Yukihide Iwamoto
- Department of Orthopedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
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15
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Soni P, Davison MA, Shao J, Momin A, Lopez D, Angelov L, Barnett GH, Lee JH, Mohammadi AM, Kshettry VR, Recinos PF. Extent of resection and survival outcomes in World Health Organization grade II meningiomas. J Neurooncol 2020; 151:173-179. [PMID: 33205354 DOI: 10.1007/s11060-020-03632-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE WHO grade II meningiomas behave aggressively, with recurrence rates as high as 60%. Although complete resection in low-grade meningiomas is associated with a relatively low recurrence rate, the impact of complete resection for WHO grade II meningiomas is less clear. We studied the association of extent of resection with overall and progression-free survivals in patients with WHO grade II meningiomas. METHODS A retrospective database review was performed to identify all patients who underwent surgical resection for intracranial WHO grade II meningiomas at our institution between 1995 and 2019. Kaplan-Meier analysis was used to compare overall and progression-free survivals between patients who underwent gross total resection (GTR) and those who underwent subtotal resection (STR). Multivariable Cox proportional-hazards analysis was used to identify independent predictors of tumor recurrence and mortality. RESULTS Of 214 patients who underwent surgical resection for WHO grade II meningiomas (median follow-up 53.4 months), 158 had GTR and 56 had STR. In Kaplan-Meier analysis, patients who underwent GTR had significantly longer progression-free (p = 0.002) and overall (p = 0.006) survivals than those who underwent STR. In multivariable Cox proportional-hazards analysis, GTR independently predicted prolonged progression-free (HR 0.57, p = 0.038) and overall (HR 0.44, p = 0.017) survivals when controlling for age, tumor location, and adjuvant radiation. CONCLUSIONS Extent of resection independently predicts progression-free and overall survivals in patients with WHO grade II meningiomas. In an era of increasing support for adjuvant treatment modalities in the management of meningiomas, our data support maximal safe resection as the primary goal in treatment of these patients.
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Affiliation(s)
- Pranay Soni
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Davison
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
| | - Jianning Shao
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Arbaz Momin
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Diana Lopez
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Lilyana Angelov
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Gene H Barnett
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Joung H Lee
- Department of Neurological Surgery, Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Alireza M Mohammadi
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Varun R Kshettry
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Pablo F Recinos
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA.
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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16
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Abstract
The Simpson grading scale, developed in 1957 by Donald Simpson, has been considered the gold standard for defining the surgical extent of resection for WHO grade I meningiomas. Since its introduction, the scale and its modifications have generated enormous controversy. The Simpson grade is based on an intraoperative visual assessment of resection, which is subjective and notoriously inaccurate. The majority of studies in which the grading system was used were performed before routine postoperative MRI surveillance was employed, rendering assessments of extent of resection and the definition of recurrence inconsistent. The infiltration and proliferation potential of tumor components such as hyperostotic bone and dural tail vary widely based on tumor location, as does the molecular biology of the tumor, rendering a universal scale for all meningiomas unfeasible. While extent of resection is clearly important at reducing recurrence rates, achieving the highest Simpson grade resection should not always be the goal of surgery. Donald Simpson's name and his scale deserve to be recognized and preserved in the historical pantheon of pioneering and transformative neurosurgical concepts. Nevertheless, his eponymous scale is no longer relevant in modern meningioma surgery. While his message of maximizing extent of resection and minimizing morbidity is still germane, a single measure using subjective criteria cannot be applied universally to all meningiomas, regardless of location. Meningioma surgery should be performed with the goal of achieving maximal safe resection, ideally guided by molecularly tagged fluorescent labeling and assessed using objective criteria, including postoperative MRI as well as molecularly tagged scans such as [68Ga]-DOTATATE-PET.
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Affiliation(s)
- Theodore H Schwartz
- 1Department of Neurosurgery, Otolaryngology and Neuroscience, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York; and
| | - Michael W McDermott
- 2Division of Neuroscience, Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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17
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Spille DC, Hess K, Bormann E, Sauerland C, Brokinkel C, Warneke N, Mawrin C, Paulus W, Stummer W, Brokinkel B. Risk of tumor recurrence in intracranial meningiomas: comparative analyses of the predictive value of the postoperative tumor volume and the Simpson classification. J Neurosurg 2020; 134:1764-1771. [PMID: 32679565 DOI: 10.3171/2020.4.jns20412] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In meningiomas, the Simpson grading system is applied to estimate the risk of postoperative recurrence, but might suffer from bias and limited overview of the resection cavity. In contrast, the value of the postoperative tumor volume as an objective predictor of recurrence is largely unexplored. The objective of this study was to compare the predictive value of residual tumor volume with the intraoperatively assessed extent of resection (EOR). METHODS The Simpson grade was determined in 939 patients after surgery for initially diagnosed intracranial meningioma. Tumor volume was measured on initial postoperative MRI within 6 months after surgery. Correlation between both variables and recurrence was compared using a tree-structured Cox regression model. RESULTS Recurrence correlated with Simpson grading (p = 0.003). In 423 patients (45%) with available imaging, residual tumor volume covered a broad range (0-78.5 cm3). MRI revealed tumor remnants in 8% after gross-total resection (Simpson grade I-III, range 0.12-33.5 cm3) with a Cohen's kappa coefficient of 0.7153. Postoperative tumor volume was correlated with recurrence in univariate analysis (HR 1.05 per cm3, 95% CI 1.02-1.08 per cm3, p < 0.001). A tree-structured Cox regression model revealed any postoperative tumor volume > 0 cm3 as a critical cutoff value for the prediction of relapse. Multivariate analysis confirmed the postoperative tumor volume (HR 1.05, p < 0.001) but not the Simpson grading (p = 0.398) as a predictor for recurrence. CONCLUSIONS EOR according to Simpson grading was overrated in 8% of tumors compared to postoperative imaging. Because the predictive value of postoperative imaging is superior to the Simpson grade, any residual tumor should be carefully considered during postoperative care of meningioma patients.
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Affiliation(s)
| | | | - Eike Bormann
- 3Institute of Biostatistics and Clinical Research, University of Münster; and
| | - Cristina Sauerland
- 3Institute of Biostatistics and Clinical Research, University of Münster; and
| | | | | | - Christian Mawrin
- 5Institute of Neuropathology, Otto von Guericke University Magdeburg, Saxony-Anhalt, Germany
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18
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Naito K, Yamagata T, Arima H, Takami T. Low recurrence after Simpson grade II resection of spinal benign meningiomas in a single-institute 10-year retrospective study. J Clin Neurosci 2020; 77:168-174. [PMID: 32360158 DOI: 10.1016/j.jocn.2020.04.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/22/2020] [Indexed: 12/26/2022]
Abstract
The objective of this study was to more fully understand the optimal neurosurgical strategy for spinal benign meningiomas from a medium to long-term perspective. This retrospective study included a cohort of 35 patients with a diagnosis of spinal meningioma who were first operated at our institute over the past 10 years and followed-up for at least 2 years after surgery. The inclusion criterion for the study was the pathological diagnosis finally verified as benign meningioma of World Health Organization (WHO) grade 1. The average follow-up duration after surgery was 61.0 months. The location of the spinal meningioma was classified into ventral or dorsal type based on the operative video record and the preoperative MR images. The extent of resection of the spinal meningioma was carefully determined based on the Simpson grade. The average neurological condition was significantly improved at the final follow-up. Simpson grade I or II resection was achieved in 31 of 35 cases (88.6%). No Simpson grade I or II cases showed local recurrence during follow-up. Tumor recurrence was noted in 2 of 4 cases of Simpson grade IV resection. One case has been followed-up without any re-operation because of no neurological deterioration, and the other case underwent stereotactic radiosurgery. This study suggested that meticulous Simpson grade II resection of spinal benign meningiomas of WHO grade 1 may be good enough from a medium to long-term follow-up perspective, though longer follow-up is absolutely necessary.
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Affiliation(s)
- Kentaro Naito
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Toru Yamagata
- Department of Neurosurgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 531-0021, Japan.
| | - Hironori Arima
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
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Materi J, Mampre D, Ehresman J, Rincon-Torroella J, Chaichana KL. Predictors of recurrence and high growth rate of residual meningiomas after subtotal resection. J Neurosurg 2020; 134:410-416. [PMID: 31899874 DOI: 10.3171/2019.10.jns192466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The extent of resection has been shown to improve outcomes in patients with meningiomas. However, resection can be complicated by constraining local anatomy, leading to subtotal resections. An understanding of the natural history of residual tumors is necessary to better guide postsurgical management and minimize recurrence. This study seeks to identify predictors of recurrence and high growth rate following subtotal resection of intracranial meningiomas. METHODS Adult patients who underwent primary surgical resection of a WHO grade I meningioma at a tertiary care institution from 2007-2017 were retrospectively reviewed. Volumetric tumor measurements were made on patients with subtotal resections. Stepwise multivariate proportional hazards regression analyses were performed to identify factors associated with time to recurrence, as well as stepwise multivariate regression analyses to assess for factors associated with high postoperative growth rate. RESULTS Of the 141 patients (18%) who underwent radiographic subtotal resection of an intracranial meningioma during the reviewed period, 74 (52%) suffered a recurrence, in which the median (interquartile range, IQR) time to recurrence was 14 (IQR 6-34) months. Among those tumors subtotally resected, the median pre- and postoperative tumor volumes were 17.19 cm3 (IQR 7.47-38.43 cm3) and 2.31 cm3 (IQR 0.98-5.16 cm3), which corresponded to a percentage resection of 82% (IQR 68%-93%). Postoperatively, the median growth rate was 0.09 cm3/year (IQR 0-1.39 cm3/year). Factors associated with recurrence in multivariate analysis included preoperative tumor volume (hazard ratio [HR] 1.008,95% confidence interval [CI] 1.002-1.013, p = 0.008), falcine location (HR 2.215, 95% CI 1.179-4.161, p = 0.021), tentorial location (HR 2.410, 95% CI 1.203-4.829, p = 0.024), and African American race (HR 1.811, 95% CI 1.042-3.146, p = 0.044). Residual volume (RV) was associated with high absolute annual growth rate (odds ratio [OR] 1.175, 95% CI 1.078-1.280, p < 0.0001), with the maximum RV benefit at < 5 cm3 (OR 4.056, 95% CI 1.675-9.822, p = 0.002). CONCLUSIONS By identifying predictors of recurrence and growth rate, this study helps identify potential patients with a high chance of recurrence following subtotal resection, which are those with large preoperative tumor volume, falcine location, tentorial location, and African American race. Higher RVs were associated with tumors with higher postoperative growth rates. Recurrences typically occurred 14 months after surgery.
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Affiliation(s)
- Joshua Materi
- 1Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
| | - David Mampre
- 1Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
| | - Jeff Ehresman
- 1Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
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Mubeen B, Makhdoomi R, Nayil K, Rafiq D, Kirmani A, Salim O, Mustafa F, Aimen A, Khursheed S, Bashir S, Shafi S, Ramzan A. Clinicopathological Characteristics of Meningiomas: Experience from a Tertiary Care Hospital in the Kashmir Valley. Asian J Neurosurg 2019; 14:41-46. [PMID: 30937006 PMCID: PMC6417349 DOI: 10.4103/ajns.ajns_228_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Meningiomas comprise 15%–20% of all primary intracranial tumors. They are generally benign tumors, and most patients are cured after surgery and remain free of recurrence. However, some tumors behave in an aggressive manner, and patients develop local recurrence or metastasis. Overall prognosis is good. Patients and Methods: This is an 11-year retrospective study conducted in the Departments of Pathology and Neurosurgery at Sheri-I-Kashmir Institute of Medical Sciences, Kashmir, India. Besides the demographic profile, the parameters analyzed were location of tumor on imaging, histopathological subtype, and grade of tumor according to the 2007 WHO classification and recurrence at follow-up. Results: A total of 254 patients were included in our study, of which 205 (80.7%) were brain meningiomas and 49 (19.3%) were spinal, with an overall female: male ratio of 2:1. Female: male ratio was more in spinal meningiomas, 15.3:1. Most of our patients were in the 4–6th decade of life with a mean age of 48 years (range: 5–73 years). Meningothelial meningioma was the most common histological type. Of ten patients who showed recurrence, seven cases showed only recurrence, but no progression to higher grade and three cases showed recurrence with progression by one WHO-grade. We also noticed that recurrence was higher in Simpson Grades II and III. Conclusion: Meningiomas are common in females and most of the meningiomas do well after surgery. The recurrence rate was 3.93% in our study and Simpson grade of tumor excision and histopathological grade contribute significantly to the recurrence of the tumor.
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Affiliation(s)
- Basharat Mubeen
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rumana Makhdoomi
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Khursheed Nayil
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Danish Rafiq
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Kirmani
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Othman Salim
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Farhat Mustafa
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Aifa Aimen
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sumat Khursheed
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Shazia Bashir
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Saba Shafi
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Ramzan
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Kamamoto D, Saga I, Ohara K, Yoshida K, Sasaki H. Association Between CD133, CD44, and Nestin Expression and Prognostic Factors in High-Grade Meningioma. World Neurosurg 2018; 124:S1878-8750(18)32890-0. [PMID: 30593958 DOI: 10.1016/j.wneu.2018.12.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Meningioma is the most common primary brain tumor. It is graded as I, II, or III based on the World Health Organization (WHO) classification of central nervous system tumors. Meningiomas, especially those classified as grade II-III, have an aggressive history and a high recurrence rate. Cancer stem cells (CSCs) represent a small subset of tumor cells and are considered to be involved in tumor initiation, growth, and/or recurrence. To date, the CSCs of meningioma have not been well established. METHODS We assessed 51 grade II/III meningiomas using immunohistochemistry to determine if a correlation exists with the prognosis by investigating CD133, CD44, and nestin expression as possible CSC markers and age, gender, initial WHO tumor grade, Simpson grade, and the use of adjuvant radiation therapy. RESULTS The median overall survival was 7.1 years, and the median progression-free survival (PFS) was 1.8 years. Univariate analysis using Cox proportional hazards regression revealed a negative correlation between CD133 and nestin expression and PFS (P = 0.0176 and P = 0.0138, respectively), and high expression of CD44 demonstrated a tendency toward a shorter PFS (P = 0.0563), as did the initial WHO grade and Simpson grade found at the initial operation (P = 0.0166 and P 0.0333, respectively). Multivariate analysis showed relevance between CD133 and nestin expression and PFS. CONCLUSIONS CD133 and nestin expression, initial WHO grade and Simpson grade were associated with PFS in patients with grade II/III meningioma. These findings might suggest that these molecules are representative of CSCs in meningioma regarding the aspect of clinical course.
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Affiliation(s)
- Dai Kamamoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
| | - Isako Saga
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Ohara
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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da Silva CE, de Freitas PEP. Classification of Meningiomas Based on Their Surgical Removal, World Health Organization Grade, and Cytogenetic Profile: A Treatment Algorithm. World Neurosurg 2017; 105:289-93. [PMID: 28587980 DOI: 10.1016/j.wneu.2017.05.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Meningiomas are the most common primary intracranial tumor, but the lack of prospective randomized trials has led to different guidelines for their treatment. We proposed a classification of meningiomas that considers surgical removal, histology, and cytogenetic profile, based on a literature review of these 3 criteria. The classification can be used to guide adjuvant treatment and follow-up. METHODS A retrospective literature review was performed of PubMed from 2007 to 2016. Search terms were "meningioma," "surgery," "WHO classification," "cytogenetic," and "algorithm." RESULTS Meningiomas were classified into 5 groups (A-E) according to the Simpson resection grade, World Health Organization grade, and cytogenetic profile. Adjuvant therapy, follow-up magnetic resonance imaging, and management of recurrence and/or regrowth were proposed according to the classification. CONCLUSIONS The proposed meningioma classification was based on our experience and retrospective evidence collated from the literature and supported by recommendations. The application of the classification criteria yielded an algorithm for treatment and follow-up of patients with meningioma.
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Winther TL, Torp SH. Significance of the Extent of Resection in Modern Neurosurgical Practice of World Health Organization Grade I Meningiomas. World Neurosurg 2016; 99:104-110. [PMID: 27867123 DOI: 10.1016/j.wneu.2016.11.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Since the prognostic importance of radical resection was introduced in 1957, the neurosurgery practice has undergone several technologic advancements. The aim of this study was to evaluate whether the prognostic value of the extent of resection is still relevant in modern neurosurgical practice. METHODS Over a 10-year period, all patients with histologic-confirmed World Health Organization grade I meningiomas and who underwent meningioma surgery were retrospectively analyzed. Survival analyses were performed using Kaplan-Meier analysis and univariate and multivariate Cox proportional-hazards regression analyses. RESULTS There were 113 patients included in this study. A better Simpson grade was associated with recurrence-free survival (RFS) 5, 10, and 15 years after surgery (P < 0.001). Comparing Simpson grade I with Simpson grades III and IV, 13.1 and 36.6 times higher hazard ratios were revealed with respect to RFS, respectively. A 7.5 times higher hazard ratio was revealed when comparing Simpson grades II and IV. Additional survival analyses were performed within specific locations and groups with low and high mitotic indices, demonstrating that the extent of resection can add additional information about RFS. CONCLUSIONS Simpson grade remains a highly significant predictor of RFS in meningioma-resected patients in modern neurosurgical practice. Extent of resection should therefore be emphasized when predicting prognosis and considering postoperative treatment and frequency of radiologic follow-up after surgery.
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Affiliation(s)
- Theo L Winther
- Department of Laboratory Medicine, Children's and Women's Health, St. Olavs Hospital, Trondheim, Norway.
| | - Sverre H Torp
- Department of Laboratory Medicine, Children's and Women's Health, St. Olavs Hospital, Trondheim, Norway; Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim, Norway
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Otero-Rodriguez A, Tabernero MD, Munoz-Martin MC, Sousa P, Orfao A, Pascual-Argente D, Gonzalez-Tablas M, Ruiz-Martin L. Re-Evaluating Simpson Grade I, II, and III Resections in Neurosurgical Treatment of World Health Organization Grade I Meningiomas. World Neurosurg 2016; 96:483-8. [PMID: 27637164 DOI: 10.1016/j.wneu.2016.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Since 1957, the Simpson grading system has been considered a predictive system for meningioma recurrence. However, since then, surgical equipment and neurosurgical technique have developed extensively, so this grading system should be re-evaluated. This study aims to assess if the recurrence rate and recurrence-free survival (RFS) are different after Simpson grade I, II, and III resections in World Health Organization (WHO) grade I meningiomas. METHODS We retrospectively reviewed the data of patients who underwent surgical treatment of WHO grade I meningiomas located in the convexity (group 1), falx/parasagittal (group 2), skull base, and tentorium (group 3) between June 1991 and December 2011. We compared the recurrence rates and RFSs between Simpson grade I, II, and III resections in both overall cases and tumor subsets according to their localization. RESULTS A total of 224 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson grades I, II, and III. In each of the location groups, no significant differences were noted between the different degrees of Simpson. CONCLUSIONS We have shown that complete resection of WHO grade I meningiomas achieves excellent tumor control, regardless of Simpson grades. More aggressive attempts at tumor resection (ie, Simpson grade I) must be balanced against the risks of removing dura or damaging critical neurovascular structures.
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Nanda A, Bir SC, Maiti TK, Konar SK, Missios S, Guthikonda B. Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma. J Neurosurg 2016; 126:201-211. [PMID: 27058201 DOI: 10.3171/2016.1.jns151842] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The clinical significance of the Simpson system for grading the extent of meningioma resection and its role as a predictor of the recurrence of World Health Organization (WHO) Grade I meningiomas have been questioned in the past, echoing changes in meningioma surgery over the years. The authors reviewed their experience in resecting WHO Grade I meningiomas and assessed the association between extent of resection, as evaluated using the Simpson classification, and recurrence-free survival (RFS) of patients after meningioma surgery. METHODS Clinical and radiological information for patients with WHO Grade I meningiomas who had undergone resective surgery over the past 20 years was retrospectively reviewed. Simpson and Shinshu grading scales were used to evaluate the extent of resection. Statistical analysis was conducted using Kaplan-Meier curves and Cox proportional-hazards regression. RESULTS Four hundred fifty-eight patients were eligible for analysis. Overall tumor recurrence rates for Simpson resection Grades I, II, III, and IV were 5%, 22%, 31%, and 35%, respectively. After Cox regression analysis, Simpson Grade I (extensive resection) was revealed as a significant predictor of RFS (p = 0.003). Patients undergoing Simpson Grade I and II resections showed significant improvement in RFS compared with patients undergoing Grade III and IV resections (p = 0.005). Extent of resection had a significant effect on recurrence rates for both skull base (p = 0.047) and convexity (p = 0.012) meningiomas. Female sex and a Karnofsky Performance Scale score > 70 were also identified as independent predictors of RFS after resection of WHO Grade I meningioma. CONCLUSIONS In this patient cohort, a significant association was noted between extent of resection and rates of tumor recurrence. In the authors' experience the Simpson grading system maintains its relevance and prognostic value and can serve an important role for patient education. Even though complete tumor resection is the goal, surgery should be tailored to each patient according to the risks and surgical morbidity.
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Affiliation(s)
- Anil Nanda
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Shyamal C Bir
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Tanmoy K Maiti
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Subhas K Konar
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Symeon Missios
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
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Hwang WL, Marciscano AE, Niemierko A, Kim DW, Stemmer-Rachamimov AO, Curry WT, Barker FG, Martuza RL, Loeffler JS, Oh KS, Shih HA, Larvie M. Imaging and extent of surgical resection predict risk of meningioma recurrence better than WHO histopathological grade. Neuro Oncol 2015; 18:863-72. [PMID: 26597949 DOI: 10.1093/neuonc/nov285] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/20/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Risk stratification of meningiomas by histopathological grade alone does not reliably predict which patients will progress/recur after treatment. We sought to determine whether preoperative imaging and clinical characteristics could predict histopathological grade and/or improve prognostication of progression/recurrence (P/R). METHODS We retrospectively reviewed preoperative MR and CT imaging features of 144 patients divided into low-grade (2007 WHO grade I; n = 118) and high-grade (2007 WHO grades II/III; n = 26) groups that underwent surgery between 2002 and 2013 (median follow-up of 49 months). RESULTS Multivariate analysis demonstrated that the risk factors most strongly associated with high-grade histopathology were male sex, low apparent diffusion coefficient (ADC), absent calcification, and high peritumoral edema. Remarkably, multivariate Cox proportional hazards analysis demonstrated that, in combination with extent of resection, ADC outperformed WHO histopathological grade for predicting which patients will suffer P/R after initial treatment. Stratification of patients into 3 risk groups based on non-Simpson grade I resection and low ADC as risk factors correlated with the likelihood of P/R (P < .001). The high-risk group (2 risk factors; n = 39) had a 45% cumulative incidence of P/R, whereas the low-risk group (0 risk factors; n = 31) had no P/R events at 5 years after treatment. Independent of histopathological grade, high-risk patients who received adjuvant radiotherapy had a lower 5-year crude rate of P/R than those without (17% vs 59%; P = .04). CONCLUSIONS Patients with non-Simpson grade I resection and low ADC meningiomas are at significantly increased risk of P/R and may benefit from adjuvant radiotherapy and/or additional surgery.
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Affiliation(s)
- William L Hwang
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Ariel E Marciscano
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Andrzej Niemierko
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Daniel W Kim
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Anat O Stemmer-Rachamimov
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - William T Curry
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Fred G Barker
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Robert L Martuza
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Jay S Loeffler
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Kevin S Oh
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Helen A Shih
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
| | - Mykol Larvie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.)
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Kim CH, Chung CK, Lee SH, Jahng TA, Hyun SJ, Kim KJ, Yoon SH, Kim ES, Eoh W, Kim HJ, Kim KT, Sung JK, Choi Y. Long-term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades. Eur Spine J 2016; 25:4025-32. [PMID: 26542390 DOI: 10.1007/s00586-015-4306-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Simpson grade II removal (coagulation of the dural attachment after gross total removal) of spinal meningioma is considered an acceptable alternative, but increased recurrence after more than 10 years has been reported. More attention must be paid to the long-term surgical outcomes after Simpson grade II removal. METHODS A retrospective review was performed for 20 patients (M:F = 5:15; age, 59 ± 9 years) with Simpson grade II removal (mean follow-up period, 12.9 years; range 10.0-17.5). Magnetic resonance (MR) imaging was conducted in 17 patients at 88 ± 52 months (range 12-157). During the same period, Simpson grade I removal (removal of the dural origin) was performed in 21 patients (follow-up, 89 ± 87 months; range 9-316). Radiological recurrence was defined as a visible tumor on a follow-up MR image, and clinical tumor recurrence was defined as the recurrence of symptoms. RESULTS At the final follow-up, neurological symptoms had improved in 16/20 patients and remained stable in 4/20. A recurrent tumor was detected in one patient due to increased back pain at 92 months postoperative, but the symptom was stable without surgery until the last follow-up (124 months). The radiological and clinical recurrence-free survival periods were 150 ± 7 months (95 % CI 136-163) and 204 ± 6 months (95 % CI 193-215), respectively. There was no recurrence after Simpson grade I removal, whereas neurological deterioration occurred in two patients after surgery. CONCLUSIONS Simpson grade II removal may be an alternative option if the risk of complications with Simpson grade I removal is expected to be high.
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da Silva CE, Peixoto de Freitas PE. Recurrence of Skull Base Meningiomas: The Role of Aggressive Removal in Surgical Treatment. J Neurol Surg B Skull Base 2015; 77:219-25. [PMID: 27175316 DOI: 10.1055/s-0035-1566251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 09/19/2015] [Indexed: 10/22/2022] Open
Abstract
Objectives The recurrence of meningiomas is a crucial aspect that must be considered during the planning of treatment strategy. The Simpson grade classification is the most relevant surgical aspect to predict the recurrence of meningiomas. We report on a series of patients with recurrent skull base meningiomas who were treated with the goal of radical removal. Design A retrospective study. Setting Hospital Ernesto Dornelles, Porto Alegre, Brazil. Participants Patients with recurrent skull base meningiomas. Main Outcomes Measures The goal of obtaining aggressive resection (i.e., Simpson grades I and II). Results The average age was 54 years, the mean follow-up period was 52.1 months, and Simpson grades I and II were obtained in 82%. The overall mortality was 5.8%. Transient cranial nerve deficits occurred in 11.7%; the definitive morbidity was also 5.8%. A second recurrence occurred in 5.8%. Conclusions Radical removal of recurrent skull base meningiomas is achievable and should be considered an option with a good outcome and an acceptable morbidity. The common surgical finding that was responsible for recurrence in this study was incomplete removal during the first surgery. We recommend extensive dura and bone removal in the surgical treatment of such recurrent lesions.
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Affiliation(s)
- Carlos Eduardo da Silva
- Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre/RS, Brazil
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Abstract
Background: The large and giant skull base meningiomas are challenging lesions, and the involvement of crucial neurovascular structures needs the surgical removal as the primordial treatment. The authors report on a series of patients with large and giant skull base meningiomas who were treated with the goal of radical removal. Methods: A retrospective study including 49 patients with large and giant skull base meningiomas was carried out. Tumors presenting 3 cm or larger were included. Results: The meningiomas in the sample included the following types: 10 olfactory groove, 8 sphenoorbital, 8 petroclival, 8 tentorial, 4 clinoidal, 4 cavernous sinus, 3 temporal floor, 2 tuberculum sellae and 2 foramen magnum. The average age was 53 years, the mean follow-up period was 52 months, Simpson Grades I and II were obtained in 75.5%. The overall mortality was 5%. Transient cranial nerve deficits occurred in 32% with definite cranial nerve lesion in 18%. Cerebrospinal fluid leak occurred in 14%. Conclusions: The surgical treatment is a mandatory option for large and giant skull base meningiomas. The radical removal is achievable and should be considered an alternative with a good outcome and an acceptable morbidity for such challenge lesions.
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Affiliation(s)
- Carlos Eduardo da Silva
- Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, RS 90160-093, Brazil
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30
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Przybylowski CJ, Raper DMS, Starke RM, Xu Z, Liu KC, Sheehan JP. Stereotactic radiosurgery of meningiomas following resection: predictors of progression. J Clin Neurosci 2014; 22:161-5. [PMID: 25439747 DOI: 10.1016/j.jocn.2014.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
Residual or recurrent meningiomas after initial surgical resection are commonly treated with stereotactic radiosurgery (SRS), but progression of these tumors following radiosurgery is difficult to predict. We performed a retrospective review of 60 consecutive patients who underwent resection and subsequent Gamma Knife (Elekta AB, Stockholm, Sweden) radiosurgery for residual or recurrent meningiomas at our institution from 2001-2012. Patients were subdivided by Simpson resection grade and World Health Organization (WHO) grade. Cox multivariate regression and Kaplan-Meier analyses were performed to assess risk of tumor progression. There were 45 men (75%) and 15 women (25%) with a median age of 56.8 years (range 26.5-82 years). The median follow-up period was 34.9 months (range 6-108.4 months). Simpson grade 1-3 resection was achieved in 17 patients (28.3%) and grade 4 resection in 43 patients (71.7%). Thirty-four tumors (56.7%) were WHO grade 1, and 22 (36.7%) were WHO grade 2-3. Time from resection to SRS was significantly shorter in patients with Simpson grade 4 resection compared to grade 1-3 resection (p<0.01), but did not differ by WHO grade (p=0.17). Post-SRS complications occurred in five patients (8.3%). Overall, 19 patients (31.7%) experienced progression at a median of 15.3 months (range 1.2-61.4 months). Maximum tumor diameter >2.5 cm at the time of SRS (p=0.02) and increasing WHO grade (p<0.01) were predictive of progression in multivariate analysis. Simpson resection grade did not affect progression-free survival (p=0.90). The mortality rate over the study period was 8.3%. SRS offers effective tumor control for residual or recurrent meningiomas following resection, especially for small benign tumors.
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Affiliation(s)
- Colin J Przybylowski
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Daniel M S Raper
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Zhiyuan Xu
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22903, USA; Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA, USA.
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