Topographic Distribution of Intracranial Meningioma’s Recurrences: Localized Versus Diffuse-Multicentric

Abstract

Meningiomas recur with a rate of 10–32% at ten years. Several features influence the risk of recurrence. Our aim is to define the pathological and surgical features at risk of diffuse-multicentric versus local-peripheral recurrence. Thirty-three cases of multicentric-diffuse recurrence of intracranial meningiomas were retrospectively analyzed and compared with 50 cases who experienced local-peripheral recurrence. The analyzed factors included age and sex, tumor location and shape, brain-tumor interface, entity of resection, WHO grade, Ki67 MIB1, progesterone receptor (PR) expression, number of reoperations, progression of WHO grade, and outcome. The multicentric-diffuse recurrences were mainly related to flat-shaped and Ki67 Li greater than 4% features at first surgery. Among patients with multicentric-diffuse recurrences, 25 underwent one to three reoperations; among them, 17 are alive with local tumor control or slow progression 2 to 25 years after the initial surgery versus only 2 out of 8 who did not undergo surgery. We conclude that flat-shaped meningiomas and those with Ki67 Li greater than 4% are at higher risk to recur in multicentric-diffuse pattern. Even multiple reoperations over a period of several years may obtain rather long survivals in selected patients with prevalent intradural not anaplastic tumors and not too extensive dural infiltration.

Topographic Patterns of Intracranial Meningioma Recurrences—Systematic Review with Clinical Implication

“…Maiuri et al [ 17 , 44 ] classified intracranial meningioma recurrences, according to their appearance on contrast-enhanced magnetic resonance imaging and surgical description, into four types: Type 1, “local”, confined to the previous dural site; Type 2, “peripheral”, in the surrounding dura (within 1 cm), contiguous to the previous site; Type 3, “multicentric”, with multiple nodules both at the dural site and distant (>1 cm) from it, with seemly normal interposed dura mater; and Type 4, “diffuse”, with multiple nodules with interposed dural infiltration, or diffuse extradural infiltration; in addition, the authors further grouped these types into “local–peripheral” and “multicentric–diffuse”.…”

“…Maiuri et al [ 17 , 44 ], retrospectively analyzed data from 83 cases of intracranial WHO grade 1 and 2 meningioma recurrences, including 50 cases of “local–peripheral” recurrences and 33 cases of “multicentric–diffuse” recurrences, with the aim of defining the pathological and surgical risk factors correlated with both topographic patterns of recurrences. From the analysis of many demographic (sex and age), neuroradiological (tumor location and shape, brain–tumor interface), pathological (WHO grade, Ki67-MIB1, progesterone receptor expression), and surgical (entity of resection, number of reoperation) factors and time to recurrence and outcome, at initial diagnosis and at recurrence, revealed that the flat shape and values of Ki67 Li ≥ 4% were significantly associated with a higher risk of recurrence in multicentric–diffuse form.…”

“…Maiuri et al [17,44] classified intracranial meningioma recurrences, according to their appearance on contrast-enhanced magnetic resonance imaging and surgical description, into four types: Type 1, "local", confined to the previous dural site; Type 2, "peripheral", in the surrounding dura (within 1 cm), contiguous to the previous site; Type 3, "multicentric", with multiple nodules both at the dural site and distant (>1 cm) from it, with seemly normal interposed dura mater; and Type 4, "diffuse", with multiple nodules Nakasu et al [41] classified meningioma recurrences into three types according their topographic pattern: "local recurrence", at the same localization as the initial tumor; "peripheral recurrence", in the dura adjacent to the site of tumor attachment, which was removed or coagulated; "distant recurrence", ≥4 cm away from the original tumor.…”

“…Maiuri et al [17,44], retrospectively analyzed data from 83 cases of intracranial WHO grade 1 and 2 meningioma recurrences, including 50 cases of "local-peripheral" recurrences and 33 cases of "multicentric-diffuse" recurrences, with the aim of defining the pathological and surgical risk factors correlated with both topographic patterns of recurrences. From the analysis of many demographic (sex and age), neuroradiological (tumor location and shape, brain-tumor interface), pathological (WHO grade, Ki67-MIB1, progesterone receptor expression), and surgical (entity of resection, number of reoperation) factors and time to recurrence and outcome, at initial diagnosis and at recurrence, revealed Obiri-Yeboah et al [42] defined recurrence as any radiographic progression and identified the following 3 zones of recurrence on T1-weighted volumetric contrast-enhanced magnetic resonance imaging: (1) "central growth", observed inside the area of the previously resected tumor and more than 1 cm inside the original tumor margin; (2) "marginal growth", observed within 1 cm (inside or outside) of the original tumor margin; and (3) "remote growth", observed >1 cm outside the original tumor margin.…”

“…Maiuri et al [17,44], retrospectively analyzed data from 83 cases of intracranial WHO grade 1 and 2 meningioma recurrences, including 50 cases of "local-peripheral" recurrences and 33 cases of "multicentric-diffuse" recurrences, with the aim of defining the pathological and surgical risk factors correlated with both topographic patterns of recurrences.…”