Predictors of postoperative motor function in rolandic meningiomas

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Resection of supratentorial meningiomas is generally considered a low-risk procedure, but tumors involving the rolandic cortex present a unique challenge. The rate of motor function deterioration associated with resecting such tumors is not well described in the literature. Thus, the authors sought to report the rates and predictors of postoperative motor deficit following the resection of rolandic meningiomas to assist with patient counseling and surgical decision-making.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>An institution’s pathology database was screened for meningiomas removed between 2000 and 2017, and patients with neuroradiological evidence of rolandic involvement were identified. Parameters screened as potential predictors included patient age, sex, preoperative motor severity, tumor location, tumor origin (falx vs convexity), histological grade, FLAIR signal (T2-weighted MRI), venous involvement (T1-weighted MRI with contrast), intratumoral hemorrhage, embolization, and degree of resection (Simpson grade). Variables of interest included preoperative weakness and postoperative motor decline (novel or worsened permanent deficit). The SPSS univariate and bivariate analysis functions were used, and statistical significance was determined with alpha &lt; 0.05.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>In 89 patients who had undergone resection of convexity (80.9%) or parasagittal (19.1%) rolandic meningiomas, a postoperative motor decline occurred in 24.7%. Of 53 patients (59.6%) with preoperative motor deficits, 60.3% improved, 13.2% were unchanged, and 26.4% worsened following surgery. Among the 36 patients without preoperative deficits, 22.2% developed new weakness. Predictors of preoperative motor deficit included tumor size (41.6 vs 33.2 cm<jats:sup>3</jats:sup>, p = 0.040) and presence of FLAIR signal (69.8% vs 50.0%, p = 0.046). Predictors of postoperative motor decline were preoperative motor deficit (47.2% vs 22.2%, p = 0.017), minor (compared with severe) preoperative weakness (25.6% vs 21.4%, p &lt; 0.001), and preoperative embolization (54.5% vs 20.5%, p = 0.014). Factors that trended toward significance included parafalcine tumor origin (41.2% vs 20.8% convexity, p = 0.08), significant venous involvement (44.4% vs 23.5% none, p = 0.09), and Simpson grade II+ (34.2% vs 17.6% grade I, p = 0.07).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Resection of rolandic area meningiomas carries a high rate of postoperative morbidity and deserves special preoperative planning. Large tumor size, peritumoral edema, preoperative embolization, parafalcine origin, and venous involvement may further increase the risk. Alternative surgical strategies, such as aggressive internal debulking, may prevent motor decline in a subset of high-risk patients.</jats:p></jats:sec>

Surgical management of Rolandic area meningioma in the era of intraoperative neurophysiological monitoring

“…Progressive paresis as an admitting symptom beside disturbing the IOM is considered to be a negative prognostic factor for the motor outcome (47,2 % vs 22,2%, p = 0,017, Ottenhausen et al, 2018) [26]. In our group of patients in one case we had aggravation of the pre-existent deficit and new deficit was observed in 10,52% of the cases.…”

“…Ottenhausen et al, found that a high rate of neurological deficit was associated with parafalcine insertion, large tumoral mass and perilesional oedema. Another negative prognostic factor was found to be the necessity for preoperative embolization and the involvement of the Rolandic drainage vein [26]. From our group of patients in one case it was necessary to perform an endovascular procedure, tumour's location being on the falx cerebri to facilitate the resection.…”

“…The correspondence with the IOM results was in a percentage of 94,2% [28]. With all those tools available, in the literature there is still a controversy about the techniques association and intraoperative necessity of neurophysiological monitoring for all meningioma [25,26,31].…”

“…Other characteristic of those three cases was the fact that it was observed an important venous component involvement, with the Rolandic vein being encased in tumour capsule and the superior sagittal sinus being partially obstructed. In other publication various result of subtotal resection were presented from 26,2% (Ostry et al, 2012) to 1,1% (Ottenhause et a., 2018) [25,26]. Ostry et al, mentioned that in some patients the remanent tumour was not even detected on the postoperative MRI, the estimated volume being of 0,1cm³ and the Simpson IV grade of the case was based on surgeons' report.…”

Postoperative Long-Term Independence Among the Elderly With Meningiomas: Function Evolution, Determinant Identification, and Prediction Model Development

“…The multivariate analysis was performed by Logistic regression model. Potential-risk estimators with P value <0.05 in the univariate Logistic regression analysis or based on clinical importance, scientific knowledge and predictors identified in previously published articles (7,10,(26)(27)(28)(29), among all variables, were tested in the multivariate model. Backward stepwise selection with the Akaike information criterion (AIC) was used to identify variables for the multivariable Logistic regression model and Odd ratios (ORs) were presented with their 95% confidence intervals (CIs).…”