Risk of Developing Postoperative Deficits Based on Tumor Location after Surgical Resection of an Intracranial Meningioma

Ehresman, Jeff; Garzón-Muvdi, Tomás; Rogers, Davis; Lim, Michael; Gallia, Gary L.; Weingart, Jon; Brem, Henry; Bettegowda, Chetan; Chaichana, Kaisorn L.

doi:10.1055/s-0038-1667066

Cited by 15 publications

(15 citation statements)

References 39 publications

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“…In addition, we also confirmed that tumor located in the skull base was an independent risk factor for long-term non-independent status in our population. Previous studies suggested that brain tumors located in the cerebellopontine angle and anterior clinoidal might affect postoperative functional status and QoL, perhaps because they were always adjacent to important nerves and vessels (26). Besides, Hischam Bassiouni et al reported that approximately one-third of patients with meningioma involved visual nerve could achieve improved functional outcomes after excision, but the majority remained unchangeable and even worsened (35).…”

Section: Discussionmentioning

confidence: 99%

“…Until now, few studies have investigated independent risk factors of postoperative longterm QoL, also including long-term independence in meningioma patients. Unsurprisingly, several independent risk factors that have previously been associated with functional deficits, recurrence, and death in meningioma patients, including poor performance before operation and on discharge, advanced age, large tumor diameter and high risk of grade and biological behavior were also found to increase the elderly meningioma patients' susceptibilities to longterm non-independent status (9,10,26,27,29). In addition, we also confirmed that tumor located in the skull base was an independent risk factor for long-term non-independent status in our population.…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Comparison Of Clinical Featuresmentioning

confidence: 99%

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

Huang

Zhang

et al. 2021

Front. Oncol.

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BackgroundMaintenance of postoperative long-term independence has value for older adults who undergo surgical procedures. However, independence has barely caught attention for the elderly with meningiomas. Preventing postoperative long-term independence decline in this population necessitates the identification of the factors related to this outcome and minimizing their implications. Therefore, we assessed the independence evolution and identified potential determinants and population.Materials and MethodsFrom 2010 to 2016, elderly meningioma patients (≥65 years old) undergoing operation at Beijing Tiantan Hospital were included in our study. The primary outcome was 3-year (i.e., long-term) postoperative independence measured by Karnofsky performance scale (KPS) score. We used univariate and multivariate analyses to determine the risk factors for postoperative long-term independence, and nomogram was established.ResultsA total of 470 patients were included eligibly. The distribution in each KPS was significantly different before and 3 years after resection (P < 0.001). Especially in patients with preoperative KPS 80 and 70, only 17.5 and 17.3% of the patients kept the same KPS after 3 years, and the remaining patients experienced significant polarization. The most common remaining symptom cluster correlated with postoperative long-term independence included fatigue (R = −0.795), memory impairment (R = −0.512), motor dysfunction (R = −0.636) and communication deficits (R = −0.501). Independent risk factors for postoperative long-term non-independence included: advanced age (70–74 vs. 65–69 OR: 2.631; 95% CI: 1.545–4.481 and ≥75 vs. 65–69 OR: 3.833; 95% CI: 1.667–8.812), recurrent meningioma (OR: 7.791; 95% CI: 3.202–18.954), location in the skull base (OR: 2.683; 95% CI: 1.383–5.205), tumor maximal diameter >6 cm (OR: 3.089; 95% CI: 1.471–6.488), nerves involved (OR: 3.144; 95% CI: 1.585–6.235), high risk of WHO grade and biological behavior (OR: 2.294; 95% CI: 1.193–4.408), recurrence during follow-up (OR: 10.296; 95% CI: 3.253–32.585), lower preoperative KPS (OR: 0.964; 95% CI: 0.938–0.991) and decreased KPS on discharge (OR: 0.967; 95% CI: 0.951–0.984) (P < 0.05). The discrimination and calibration of the nomogram revealed good predictive ability (C-index: 0.810).ConclusionElderly meningioma patients might present significant polarization trend in maintaining long-term independence after surgery. Our findings will be helpful for guiding surgical management for the elderly with meningioma and provide proposals for early functional rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Comparison Of Clinical Featuresmentioning

confidence: 99%

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

Huang

Zhang

et al. 2021

Front. Oncol.

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“…An initial review of the literature describing several large surgical studies of sporadic meningiomas (NF2-associated tumor studies are more rare and usually underpowered) indicated that the mean age at surgery for sporadic cranial meningiomas was between 53.8 and 58.3 y.o. [14][15][16][17] and the mean age at surgery for sporadic spinal meningiomas was between 53.0 and 69.0 y.o. [17][18][19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

Comparative clinical and genomic analysis of neurofibromatosis type 2-associated cranial and spinal meningiomas

Pemov

Dewan

Hansen

et al. 2020

Sci Rep

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Neurofibromatosis type 2 (NF2) is an autosomal dominant Mendelian tumor predisposition disorder caused by germline pathogenic variants in the tumor suppressor NF2. Meningiomas are the second most common neoplasm in NF2, often occurring in multiple intracranial and spinal locations within the same patient. In this prospective longitudinal study, we assessed volumes and growth rates of ten spinal and ten cranial benign meningiomas in seven NF2 patients that concluded with surgical resection and performed whole-exome sequencing and copy-number variant (CNV) analysis of the tumors. Our comparison of the volume and the growth rate of NF2-associated spinal and cranial meningiomas point to the differences in timing of tumor initiation and/or to the differences in tumor progression (e.g., non-linear, saltatory growth) at these two anatomical locations. Genomic investigation of these tumors revealed that somatic inactivation of NF2 is the principal and perhaps the only driver of tumor initiation; and that tumor progression likely occurs via accumulation of CNVs, rather than point mutations. Results of this study contribute to a better understanding of NF2associated meningiomas clinical behavior and their genetic underpinnings. Neurofibromatosis type 2 (NF2) is a rare hereditary neoplasia syndrome, with an estimated incidence of 1:25,000-1:33,000 1,2. Although the hallmark and primary definitive diagnostic criterion of NF2 is the presence of bilateral vestibular schwannomas, meningiomas are the next most frequently identified tumor in these patients 3,4. It is estimated that 45-58% of NF2 patients harbor intracranial meningiomas and 20% have spinal meningiomas 5-7. Meningiomas in NF2 are typically WHO grade 1, slow-growing, benign tumors. When present, meningiomas in NF2 patients are often multiple, which contributes significantly to morbidity and mortality. Although symptoms are primarily due to the direct mass effect of tumor upon adjacent brain and cranial nerves, tumors may also evoke seizures and obstruct venous outflow causing cerebral edema 6. A case series examining 287 cranial meningiomas from NF2 patients confirmed that similar to their sporadic counterparts, the majority of NF2-associated meningiomas (95.8%) were grade 1 by WHO guidelines. Although only 4.2% of total meningiomas were grade 2 or 3, 35% of growing or symptomatic resected meningiomas were grade 2/3. Growth rate was generally slow, although 7.3% of meningiomas examined by MRI analysis displayed an annual volumetric growth rate of 20% or higher 8. The cumulative burden of intracranial meningiomas in NF2 patients results in a 2.51-fold greater risk of mortality when compared to NF2 patients without intracranial meningiomas 9 .

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“…Due to the rarity of this subcategory of SWMs, there are few studies addressing surgical results. There is no consensus in recent studies in regarding the optimal surgical solution, alternating from aggressive to conservative surgical attitudes, especially when dealing with significant skull base and vascular involvement [ 4 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical Strategies and Clinical Outcome of Large to Giant Sphenoid Wing Meningiomas: A Case Series Study

et al. 2020

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Large to giant sphenoid wing meningiomas (SWMs) remain surgically challenging due to frequent vascular encasement and a tendency for tumoral invasion of the cavernous sinus and optic canal. We aimed to study the quality of resection, postoperative clinical evolution, and recurrence rate of large SWMs. This retrospective study enrolled 21 patients who underwent surgery between January 2014 and December 2019 for SWMs > 5 cm in diameter (average 6.3 cm). Tumor association with cerebral edema, extension into the cavernous sinus or optic canal, degree of encasement of the major intracranial arteries, and tumor resection grade were recorded. Cognitive decline was the most common symptom (65% of patients), followed by visual decline (52%). Infiltration of the cavernous sinus and optical canal were identified in five and six patients, respectively. Varying degrees of arterial encasement were seen. Gross total resection was achieved in 67% of patients. Long-term follow-up revealed improvement in 17 patients (81%), deterioration in two patients (9.5%), and one death (4.7%) directly related to the surgical procedure. Seven patients displayed postoperative tumor progression and two required reintervention 3 years post initial surgery. Tumor size, vascular encasement, and skull base invasion mean that, despite technological advancements, surgical results are dependent on surgical strategy and skill. Appropriate microsurgical techniques can adequately solve arterial encasement but tumor progression remains an issue.

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Risk of Developing Postoperative Deficits Based on Tumor Location after Surgical Resection of an Intracranial Meningioma

Cited by 15 publications

References 39 publications

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

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

Comparative clinical and genomic analysis of neurofibromatosis type 2-associated cranial and spinal meningiomas

Surgical Strategies and Clinical Outcome of Large to Giant Sphenoid Wing Meningiomas: A Case Series Study

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