The Sovereignty of Primary Cranial Tumors - Meningiomas: Vetting the Cardinal Epidemiological Features

Abstract

Introduction: Cranial meningiomas considered one of most frequently encountered primary intracranial tumors in our daily neurosurgical practice, represent about 36% of brain neoplasms. Aim: In this cohort analysis, we investigated epidemiological features of brain meningiomas diagnosed at a single institution. Special highlighting has been dedicated to demographic features, foretelling radiological signs, and concomitant factors predictive of tumor atypia. Material and Methods: This retrospective analysis was conducted by revising all medical registries of patients aged ≥18 years, with a diagnosis of brain meningioma treated at King Hussein Medical Center, patients were retrieved from the electronic hospital database during a 12-year period (2004 to 2015). Preoperative radiology reports were examined to confirm tumor site and size based on largest measured dimension. Level of resection was based on surgical operative reports and post-operative radiological imaging. Results: A total of 665-patients operated for intracranial meningiomas were analyzed out of total 2047-patients operated for intracranial neoplasm during the same period. Demographic analysis showed; female to male ratio 2.4:1. Mean age 49.6-years. Average follow-up of 8.7 years. Tumor locations were classified as parasagittal (39.55%), convexity (27.52%), tentorial/ falx (6.17%), intraventricular (2.04%). Mean tumor size was 3,86 cm and tumor size was >4.5cm in (28. 07%) of cases. In this study we achieved gross total resection in (73.1%) of cases, subtotal resection in (22.6%). The majority of patients evolved favorably with respect to their neurological examination post-operatively, though a neurological deficit persisted in 64-cases and 16-cases developed a new neurological deficit. Ninety five cases developed recurrence during the observation period. Surgical mortality was reported in 11-cases in the immediate post-operative period and in 42-cases further cases during the observation period related to other causes. Conclusion: Neurosurgery faces a large number of intracranial meningioma patients in daily practice. Because of its “benign” nature; the variability in management strategy, Neurosurgery is more and more challenged with the concern of intracranial meningioma treatment in the daily practice. Because of its “benign” nature; the variability in management strategy, research regarding the meningioma etiology and epidemiology has lagged behind that for more malignant intracranial neoplasms. These risk factors piloted a revitalization in the study of meningiomas.

Review of Treatment Options for Smaller Benign Cranial Meningiomas: Observation, Stereotactic Radiosurgery, and Rarely, Open Surgery

“…More females than males develop cranial meningiomas, with ratios varying from 1.08:1 to 2.4:1 to 3:1 [Table 2]. [3,6,10] The average age for all patients undergoing cranial surgery for meningiomas ranged from 49.6 – 64 years of age; males were typically in their fifties (average age 57.6), while females were usually in their late fifties/early sixties (average age 59.5) [Table 2]. [3,6,10]…”

“…Cranial meningiomas occur in multiple locations [Tables 1, 2]. [3,4,6,9,10] Colombo et al . (2009) performed…”

“…[9] Rami et al , (2018), found that 665 meningiomas (36% out of 2047 with cranial lesions) originated in the; parasagittal (39.55%), convexity (27.52%), tentorial/falx (6.17%), and intraventricular (2.04%) locations [Table 2]. [10] When Champeaux et al . (2019) evaluated the French database (Programme de Medicalization des Systèmes d’Information (PMSI)) that included 25,737 surgically managed meningiomas (2008-2016: equivalent to 4.5/100, 000 persons/year), the majority were located on the convexity or in the middle fossa/skull base [Table 2].…”

“…In two respective series (2012 and 2018), 21.2%-27.5% of 739 meningiomas were convexity lesions [Table 2]. [6,10] In Kondziolka et al . (2009), convexity meningiomas were located in the; frontal (80 patients), parietal (24 patients), temporal (12 patients), and occipital (9 patients) regions [Table 1].…”

“…(2018) series was > 4.5 cm in 28.07% of 665 cranial meningiomas [Table 2]. [10] The average recurrent size of cranial meningiomas was 3.6 ± 0.4 cm in Alvernia et al . 2011 study, an average of 86 mos.…”