Surgical strategies for intracranial meningioma in the molecular era

Abstract

Introduction Surgical resection has long been the treatment of choice for meningiomas and is considered curative in many cases. Indeed, the extent of resection (EOR) remains a significant factor in determining disease recurrence and outcome optimization for patients undergoing surgery. Although the Simpson Grading Scale continues to be widely accepted as the measure of EOR and is used to predict symptomatic recurrence, its utility is under increasing scrutiny. The influence of surgery in the definitive management of meningioma is being re-appraised considering the rapid evolution of our understanding of the biology of meningioma. Discussion Although historically considered “benign” lesions, meningioma natural history can vary greatly, behaving with unexpectedly high recurrence rates and growth which do not always behave in accordance with their WHO grade. Histologically confirmed WHO grade 1 tumors may demonstrate unexpected recurrence, malignant transformation, and aggressive behavior, underscoring the molecular complexity and heterogeneity. Conclusion As our understanding of the clinical predictive power of genomic and epigenomic factors matures, we here discuss the importance of surgical decision-making paradigms in the context of our rapidly evolving understanding of these molecular features.

An Uncommon Coexistence of Dural and Intraventricular Meningiomas

“…The treatment of choice for meningiomas is surgical resection, and, in this case, both tumors were successfully removed [ 14 ]. However, because of the atypical nature of the meningiomas and the potential for residual tumor cells, the patient was referred to a higher medical center for further management, and we were unable to follow up with the patient.…”

Risk factors on surgical compliance and its impact on survival outcomes in meningioma patients: a SEER-based retrospective propensity-score matched analysis

“…The decision for surgery requires a detailed assessment of the severity of the patient’s symptoms, the rate of disease progression, the location of the meningioma, the likelihood of successful tumor resection, the extent of resection, and the potential benefits of the surgery. After thorough communication with the patients and their families, the doctor should make the final treatment decision [ 20 ]. Surgical noncompliance is a severe treatment deficit influenced by various factors, and we hypothesized that demographic and clinical pathologic characteristics influence it.…”

Interdisciplinary Therapeutic Approaches to Atypical and Malignant Meningiomas

“…However, radical removal of the tumor is not always without sacrifices [13][14][15]. The location of the tumor [16,17] and the age of the patient [18] play major roles. The extent of resection will usually be determined before surgery according to the radiological findings and the general health condition of the patient [17,19].…”

“…The location of the tumor [16,17] and the age of the patient [18] play major roles. The extent of resection will usually be determined before surgery according to the radiological findings and the general health condition of the patient [17,19]. In 1957, Simpson demonstrated a classification system for meningioma resection [20], dividing patients into five categories according to the type of resection (Table 2), giving the classification a prognostic role regarding recurrence.…”

“…In 1957, Simpson demonstrated a classification system for meningioma resection [20], dividing patients into five categories according to the type of resection (Table 2), giving the classification a prognostic role regarding recurrence. However, not everybody currently agrees with the prognostic value of the Simpson grading [8,9,17,[21][22][23]. Predominantly, because of the available adjuvant radiotherapies, surgeons are increasingly opting for an incomplete resection of the tumor to prevent intraoperative complications and postoperative morbidity.…”