The recurrence of intracranial meningiomas after surgical treatment

Abstract

A study of 114 surgically treated patients with intracranial meningiomas was carried out to evaluate factors influencing recurrence. The data of the initial surgery extended over a 24-year period from January, 1956, to December, 1979. The patients ranged in age from 1 1/2 years to 82 years. Seventy-one (62.3%) were females and 43 (37.7%) were males. The surgical procedure was graded according to Simpson's classification from 1 to 5 (Grade 1 = complete excision, Grade 5 = simple decompression). In this series, 33 procedures (28.9%) were Grade 1, 55 (48.2%) were Grade 2, seven (6.1%) were Grade 3, 18 (15.8%) were Grade 4, and one (0.9%) was Grade 5. There were eight (7%) postoperative deaths. Approximately 60% of the tumors were located in the sphenoid wing (23.7%), convexity (21.1%), and parasagittally (14.9%). Histological diagnosis in 96% of the patients was transitional (42.1%), syncytial (34.2%), and fibroblastic (20.2%) meningiomas. Eight (7%) patients received postoperative radiotherapy. There was evidence of recurrence in 22 patients (19.3%). Twenty-one underwent a second surgical procedure. Using survival analysis, it was determined that 80% of the patients were free of recurrence 5 years after the initial surgery, and approximately 50% showed no recurrence 20 years after the initial surgery. Only the grade of the initial surgery had a statistically significant influence on recurrence. Sex of patients, site and histology of the tumor, and postoperative radiotherapy had no statistically significant influence on recurrence. Angioblastic and malignant meningiomas were rare (only four cases), and recurred relatively quickly.

Hyperdiploidy defines a distinct cytogenetic entity of meningiomas

“…In 1979, Zü lch stated that it is not the histological grading which is most crucial for the rate of recurrence of meningiomas, but primarily the completeness of extirpation [26]. There is consensus in the literature that radical surgical extirpation is strongly correlated with a favorable prognosis [9,27]. Over 80 years ago, Cushing [28] reported on the frequency and behavior of meningiomas at different intracranial locations.…”

“…Hyperdiploidy, on the other hand, has long been known to be found in rare instances of meningiomas [2,7,8]. Beyond these anecdotal reports of karyotypes, hyperdiploidy in meningiomas has been demonstrated so far mainly through FISH with probes for single chromosomes, such as # 6, 7, 10, 17, 20, 22, and X [9][10][11]. While gains of chromosome 22 have been shown to be associated with aggressive clinical features of meningiomas [12,13], no conclusive data is at hand so far on the overall pattern of chromosome gains in hyperdiploid meningiomas.…”

Meningiomas and hormonal receptors: immunohistochemical study in typical and non-typical tumors

“…It can be surgically removed in most cases and surgery has been the only available treatment. However, some tumors are inoperable because of the poor clinical condition of very old patients or due to invasion of bone and/or blood vessels [20][21][22] . They may also show atypical or anaplastic features 13,22,25 .…”

Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases

“…[2,6,12,[14][15][16]23,24,39,41] Moreover, the prognostic influence of radical surgery on outcome has not been discussed as thoroughly for atypical and malignant meningiomas [2,5,16,24,30,34,39] as for benign meningiomas. [1,14,25,27,31,33] The radicality of surgical excision, in turn, depends mainly on the meningioma site and was graded objectively by Simpson [33] in his well-known paper, in which he pointed out that total removal was sometimes only subjectively assessed by the surgeon and that this gave rise to reports of a 9% recurrence rate after so-called "complete excision" of benign meningiomas. This percentage can reasonably be expected to be higher for anaplastic meningiomas.…”