Extent of Resection in Meningioma: Predictive Factors and Clinical Implications

Abstract

Meningiomas present as intracranial extra-axial lesions with dural attachment, which are primarily managed surgically. The extent of resection (EOR) may vary depending on patient- and tumor-related factors. The aim of this study is to identify preoperative predictive factors of EOR and to propose an estimation of the predicted gross total resection (GTR) based of patient- and tumor-characteristics. 1469 patients from a retrospectively (1990 to 2002) and prospectively managed (2003 to 2010) databank of Oslo University Hospital, Norway, totalling 11,414 patient-years of follow-up were included. Patients had a mean age at surgery of 64 ± 20.1 years with a female-to-male ratio was 2.4:1 and a mean KPS of 81.2 ± 12.1. Skull-base meningiomas represented 47% of all cases. WHO grades were I in 92.3%, II in 5.2%, and III in 2.2%. Bone infiltration was described in 18.7% of cases. 39.3% of patients had Simpson I resection, 34.3% had Simpson II, 5.4% had Simpson III, 20.6% had Simpson IV, and 0.5% had Simpson V. The risk factors for incomplete resection were: symptomatic presentation (OR 0.56 [0.43–0.72]), skull-base location (OR 0.79 [0.70–0.88]), and bone invasion (OR 0.85 [0.73–0.99]). Using a recursive partitioning analysis, we propose a classification-tree for the prediction of GTR rate based on preoperatively determinable patient- and tumor characteristics. The identification of preoperative predictors of poor GTR rate may aid clinicians managing meningioma patients. In selected cases were the predicted GTR rate is low, staged treatment with surgical debulking followed by adjuvant therapy may be favored in order to minimize postoperative morbidity and mortality.

Resection of Olfactory Groove Meningiomas Through Unilateral vs. Bilateral Approaches: A Systematic Review and Meta-Analysis

“…In conjunction with the fact that both pooled GTR rates are very high, the contribution of tumor volume to GTR may be less vital. Indeed significant risk factors for subtotal meningioma resection were found to be symptomatic presentation and bone invasion, but not tumor volume (33). In the authors' experience, size has never been a limiting or deciding factor in the type of approach, and even extremely large tumors can be safely resected via a simple unilateral pterional approach (Figures 4, 5).…”

The Preferred Locations of Meningioma According to Different Biological Characteristics Based on Voxel-Wise Analysis

“…Although skull-base clusters also significantly indicated grade I lesions, they were identified as the most frequent occurrence in subtotal resection. It has been well-documented that skull-base meningioma was a risk factor for incomplete resection ( 24 ). Moreover, the p value heatmap suggested the skull-base lesions presented a significant inclination to recur.…”

Benefits of re-do surgery for recurrent intracranial meningiomas

“…A total of 1469 consecutive patients were identified from a database (retro-and prospective inclusions from 1990 to 2002 and from 2003 to 2010, respectively). The characteristics of the cohort have been described in previously published reports 17,19,[31][32][33] .…”