Incidence of surgery after gamma knife radiosurgery for parasagittaland parafalcine meningiomas is higher than meningiomas in other locations: A 10-year institutional analysis and review of the literature

Abstract

Background: Parasagittal and Parafalcine Meningiomas (PSPF) have a higher rate of recurrence, increased risk of postoperative morbidities, and less favorable outcomes after stereotactic radiosurgery compared to other ocations. Herein, we try to find factors associated with treatment failure after radiosurgery in patients with PSPF meningiomas. Methods: We retrospectively reviewed records of 104 patients with 130 Gamma Knife® Radiosurgery (GKRS) treatments for individual meningiomas at a single institution. 38 were PSPF compared to 92 in non-PSPF locations. Results: The PSPF group showed a significantly higher rate of surgical intervention after radiosurgery compared to the non-PSPF group (18.4% vs 4.4, p = 0.008 in univariate analysis). The relative risk for a PSPF tumor requiring surgery after GKRS was 4.24, with an odds ratio of 4.97 (95% CI: [1.32-13.63], p = 0.015). The average tumor size between the PSPF group and the non-PSPF group was 3.53 cm3 and 2.28 cm3, respectively; this difference was statistically significant (p = 0.035) on univariant analysis, but not multivariate (p = 0.125). In the whole sample, for tumors >5 cm3, the relative risk ratio for needing surgery after GKRS was 6.23 with an odds ratio of 8.32 (95% CI: [2.25-30.67], p = 0.0015). Both PSPF and non-PSPF meningiomas were similar in gender, follow-up length, prior surgical intervention, and WHO grades. Conclusion: Meningiomas’ outcome and response to radiosurgery depend on their location. We have two possible explanations. First, PSPF tumors are located near sensitive cerebral cortex areas. Second, the tumor’s mutational profile affects meningiomas’ location and prognosis.

Factors Influencing Long-Term Outcomes of Single-Session Gamma Knife Radiosurgery in Large-Volume Meningiomas >10 cc

“…This is not a novel observation; estimates of 5-year PFS among these tumours post-GKRS range between 55% and 90%, [7,21,22] with our analysis of 64% 5-year PFS demonstrating similarly modest results. Parasagittal and falcine meningiomas have been associated with higher rate of hospitalization and need for surgical intervention post-GKRS, hypothesized to result from the proximity of such tumours to eloquent cortical regions leading to a lower threshold for treatment-related symptoms and a propensity for falcine meningiomas to harbour more aggressive genetic profiles [23]. Damen et al have demonstrated that loss of 1p36 is significantly associated with regrowth of WHO Grade 1 meningiomas after radiosurgery; however, they did not stratify their cohort based on clinical features, volume, or location.…”

Non-coding RNAs as Genetic Biomarkers for the Diagnosis, Prognosis, Radiosensitivity, and Histopathologic Grade of Meningioma

“…The mainstay treatment of meningiomas is microsurgical resection. The meningioma prognosis depends on tumor grade, location, and patient's age [1][2][3][4]. Chemotherapy and hormonal treatment have bad results in treating meningioma, despite meningiomas' expression of hormonal receptors; subsequently, patients having recurrence after surgical resection and radiotherapy have very limited options for treatment [2,[5][6][7][8].…”

“…The meningioma prognosis depends on tumor grade, location, and patient's age [1][2][3][4]. Chemotherapy and hormonal treatment have bad results in treating meningioma, despite meningiomas' expression of hormonal receptors; subsequently, patients having recurrence after surgical resection and radiotherapy have very limited options for treatment [2,[5][6][7][8]. As a result, searching for other potential therapies for meningioma should be encouraged by studying the role of non-coding RNAs on tumor differentiation, growth, and proliferation.…”

“…These features include small cells with a high nuclear: cytoplasmic ratio, prominent nucleoli, spontaneous necrosis, loss of whorling or fascicular architecture, and hypercellularity [10]. Less than 20% of meningioma cases are considered WHO-II or WHO-III and have aggressive behavior, high recurrence rate, and higher morbidity and mortality rates [2,4,[9][10][11].…”