Twelve-year experience of pineal region meningiomas: Long-term outcomes of maximal safe resection

Abstract

Purpose The purpose of this research was to summarize the clinical and prognostic features of penial region meningiomas, evaluate treatment strategies and long-term prognoses, and improve the management of penial region meningiomas. Methods We retrospectively studied the data of 37 patients who received surgical resection for penial region meningiomas at West China Hospital of Sichuan University from 2009 to 2021. Adjuvant gamma knife radiosurgery (GKRS) was conducted according to the extent of resection (EOR). Progression-free survival (PFS), Karnofsky performance status (KPS) scores and recovery of neurological function were adopted to assess a comprehensive management strategy for penial region meningiomas. Results The most common symptom was intracranial hypertension associated with obstructive hydrocephalus (75.7%). The Poppen approach (40.5%) and Krause approach (29.7%) were performed in most cases. Gross total resection (GTR) was achieved in 27 patients (73.0%) and the remaining patients were treated with subtotal resection (STR) combined with postoperative GKRS. With a mean follow-up period of 87.0 months, the progression rate was 10%, the 5-year PFS rate was 92.9%, and the ΔKPS was 15.3. Multivariate analysis revealed that the STR+GKRS and Krause approach were beneficial to the recovery of quality of life of patients. Conclusion Pineal region meningiomas are sporadic but challenging. It is necessary to select the most appropriate surgical approach, EOR, and hydrocephalus treatment strategy for patients with pineal region meningiomas. Maximal safe resection to protect neurovascular function combined with postoperative GKRS can significantly improve the quality of life of patients.