Aim: Atypical meningiomas are uncommon in skull base practice and present a management challenge. We aimed to review all de novo atypical skull base meningioma within a single unit to analyse presentation and outcome.
Methods: A retrospective review of all patients undergoing surgery for intracranial meningioma identified consecutive cases of de novo atypical skull base meningioma. Electronic case records were analysed for patient demographics, tumour location and size, extent of resection and outcome. Tumour grading is based on the 2016 WHO criteria.
Results: 18 patients with de novo atypical skull base meningiomas were identified. The most common tumour location was sphenoid wing in 10 patients (56%). Gross total resection (GTR) was achieved in 13 patients (72%) and subtotal resection (STR) in 5 patients (28%). There was no tumour recurrence recorded in patients who had undergone GTR. Patients with tumours >6cm were more likely to undergo a STR as opposed to a GTR (p=<0.01). Patients who had undergone a STR were more likely have post-operative tumour progression and be referred for radiotherapy (p=0.02 and p=<0.01 respectively). On multiple regression analysis tumour size is the only significant factor correlating with overall survival (p=0.048).
Conclusion: The incidence of de novo atypical skull base meningioma is higher in our series than currently published data. Tumour size was a significant indicator for patient outcome and extent of resection. Those undergoing a STR were more likely to have tumour recurrence. Multicentre studies of skull base meningiomas with associated molecular genetics are needed to guide management.
Objectives30 day readmission rate is a widely adopted marker of quality and performance of acute care, but validity is not well demonstrated. We analysed readmission data following cranial meningioma surgery to assess risk factors for readmission.DesignRetrospective cohort study.SubjectsAll adult patients who underwent cranial meningioma resection from January 2015 to December 2017 in a single institution.MethodsUsing Welsh Clinical Portal electronic data to identify readmission within and beyond 30 days to both the index hospital and regional hospitals. Causes of readmission were recorded.Results160 patients were included (76% female, median age 58). 28 cases were emergency admissions, median length of initial admission 7 days. 26% had seizures at presentation. Total readmission rate was 13.5% (median age 54.5, pre-operative seizure rate 40.1%, median length of readmission 9 days). 13 (59%) patients presented within 30 days and 9 (41%)>30 days. Readmission causes were seizure, neurological deficit, thromboembolic, infection, CSF, bleeding and social. Causes after 30 days were the same except social or neurological deficit.ConclusionsReadmission rates are not associated with age, admission route or initial length of stay. Those who have had seizures are more likely to be readmitted. 41% of readmissions presented outside of the 30 day post-operative time. 30 day readmission rates may not be the most suitable method to demonstrate neurosurgical unit performance in meningioma surgery.
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