Clinical Outcomes Following Re-Operations for Intracranial Meningioma

Abstract

The outcomes following re-operation for meningioma are poorly described. The aim of this study was to identify risk factors for a performance status outcome following a second operation for a recurrent meningioma. A retrospective, comparative cohort study was conducted. The primary outcome measure was World Health Organization performance. Secondary outcomes were complications, and overall and progression free survival (OS and PFS respectively). Baseline clinical characteristics, tumor details, and operation details were collected. Multivariable binary logistic regression was used to identify risk factors for performance status outcome following a second operation. Between 1988 and 2018, 712 patients had surgery for intracranial meningiomas, 56 (7.9%) of which underwent a second operation for recurrence. Fifteen patients (26.8%) had worsened performance status after the second operation compared to three (5.4%) after the primary procedure (p = 0.002). An increased number of post-operative complications following the second operation was associated with a poorer performance status following that procedure (odds ratio 2.2 [95% CI 1.1–4.6]). The second operation complication rates were higher than after the first surgery (46.4%, n = 26 versus 32.1%, n = 18, p = 0.069). The median OS was 312.0 months (95% CI 257.8–366.2). The median PFS following the first operation was 35.0 months (95% CI 28.9–41.1). Following the second operation, the median PFS was 68.0 months (95% CI 49.1–86.9). The patients undergoing a second operation for meningioma had higher rates of post-operative complications, which is associated with poorer clinical outcomes. The decisions surrounding second operations must be balanced against the surgical risks and should take patient goals into consideration.

Recurrence of Resected Skull Base Meningiomas during Long-term Follow-up: Incidence and Predisposing Factors

“…These findings support those of Richardson et al, who reported a diminution in functional status in patients with recurrent intracranial meningiomas, irrespective of location or treatment modality. 40 Moreover, Magill et al demonstrated considerably higher rates of postoperative complications in patients receiving reoperation for recurrent SBM. 22 It has been argued that as patient age increases from first surgery, brain resilience and plasticity decrease, resulting in decreased functional status in these patients.…”

Management of Recurrent Meningiomas: State of the Art and Perspectives

“…N = 41 articles met the inclusion criteria and N = 16 articles failed to assess management of meningioma recurrence. Finally, N = 24 articles were included in our review [ 22 , 29 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 ] ( Flowchart 1 ). The articles were distributed as follows: studies on chemotherapy (N = 14); RT, PT, and SRS (N = 6); BNCT (N = 2); and surgery (N = 3).…”

“…Richardson et al [ 53 ] investigated the outcomes of N = 56 patients who had re-operation for meningioma recurrence. The median time to re-operation after initial surgery was 35 months (95% CI 28.9–41.1), while it was 68 months (95% CI 49.1–86.9) after re-operation.…”

“…Lemée et al [ 29 ] and Richardson et al [ 53 ] have shown that PFS after re-surgery is far longer than after non-surgical adjuvant therapies. Certainly, this may be regarded as an argument in favor of surgery for recurring meningiomas, as it is shown by the cohort of recurring SBMs described by Magill et al [ 52 ].…”

Volumetric Growth and Growth Curve Analysis of Residual Intracranial Meningioma

“…Owing to the relatively indolent nature of most meningioma, ‘active monitoring’ of the residual tumor was used for most patients, and this approach is supported by the finding that very few patients had clinical progression associated with radiological growth. 28,29 Elevated Ki-67 index has previously been noted to predict time to recurrence in a prospective cohort of surgically treated meningioma consisting of both GTR and STR cases 30 ; however, this was only available for 20 patients within our study, likely representing a highly selected population. Radiation-induced meningiomas have been noted to display increased volumetric growth rates, in comparison with sporadic meningiomas, hence why they were not included in our study.…”