Recurrence of intracranial meningiomas: the role played by regional multicentricity

Abstract

Globular single meningiomas are generally regarded as benign tumors that can be completely removed. Nevertheless, after a total macroscopic resection including the insertion zone (Grade 1 operation according to Simpson's classification), the incidence of recurrence ranged from 9% to 14% at the 5-year follow-up review. The authors have shown that single meningiomas represent only the visible predominant growth in the midst of a wide neoplastic field in the dura mater. Regional multiplicity in meningiomas would thus seem to be the rule. With this in mind, the authors propose to divide recurrences after Grade 1 operations into true local and false regional. A local recurrence is defined as a regrowth within the limits of the previous dural flap. Regional recurrence is when new growth develops outside the previous craniotomy site; this should not be considered as a recurrence but as a new primary site. These regional recurrences might explain some unexpected late tumor growth occurring after a Grade 1 operation. Five illustrative cases in which regional recurrence was detected by computerized tomography are presented. The authors also propose to add a supplementary grade to Simpson's surgical grading: Grade 0. This operation would entail a wide resection of the dura around the attachment zone of the meningioma. The authors hope that with a Grade 0 operation the incidence of recurrence might be reduced.

Meningeal hemangiopericytomas and hemangiopericytoma/solitary fibrous tumors of extracranial soft tissues: a comparison

“…It is possible that high recurrence rate of meningeal HPC is also linked to incomplete resection of the lesion, as stated by the surgeons in three cases of the present series. It is pertinent to remember that meningiomas (WHO grade II) may recur despite their low grade because of incomplete resection [30].…”

Meningioma in the pediatric population

“…The goal of treatment is total resection. In an effort to prevent recurrence, the dural resection is widened until negative margins are obtained [18]. As in adults, recurrence and death are more likely with skull base lesions, incomplete resections, and malignant histopathology [4,9].…”

Can Excision of Meningiomas Be Limited to Resection of Tumor and Radiologically Abnormal Dura Mater? Neuronavigation-Guided Biopsies of Dural Tail and Seemingly Normal Dura Mater, with a Review of the Literature

“…Most surgeons aim for complete resection of the meningioma including dural attachment and, if feasible, a rim of 1 cm of surrounding normal dura mater (2). Some authors suggest that this rim of normal dura mater should be 2e4 cm (4,15). In previous dural tail studies, the surgeon intraoperatively marked by sight what was judged to be the dural tail and resected this for histologic examination.…”