Indications and outcome in surgically treated asymptomatic meningiomas: a single-center case-control study

Abstract

Background Many meningiomas are detected incidentally and remain asymptomatic until intervention. The goal of this study was to describe the management and outcome in this group of surgically treated asymptomatic meningiomas. Methods From 2004 to 2017, 45 patients with asymptomatic meningioma were surgically treated at Sahlgrenska University Hospital, and their medical records and imaging data were analyzed. The asymptomatic cases were matched with symptomatic ones with respect to age at diagnosis, location, WHO (World Health Organization) grade, and Simpson grade. Results Time from diagnosis to surgery differed between the asymptomatic and symptomatic patients (8.6 vs. 1.3 months; p < 0.001). Of symptomatic patients, 32.6% still used anti-epileptic drugs > 1 year after surgery, compared with 7.7% of the asymptomatic (p = 0.003). Thirty-day complication rate was significantly higher among the asymptomatic cases (35.6% vs. 24.4%; 0.001), as well as the proportion of older asymptomatic individuals (> 70 years) experiencing postoperative complication compared with symptomatic patients of the same age group. Conclusion As expected, asymptomatic cases had smaller tumors and waited longer for surgery. Surprisingly, complication rate was significantly higher among asymptomatic cases compared with their symptomatic control. Taken into account that many asymptomatic tumors are removed surgically due to patient's wish, one might suggest a more restrictive approach, especially in the elderly.

Nation-wide Brain Tumor Registry-based Study of Intracranial Meningioma in Japan: Analysis of Surgery-related Risks

“…10) Although diverse classifications of complications exist in the literature, the overall incidence of surgical complications of asymptomatic meningiomas ranges from 9.4 to 35.6%. 11,28,29) Considering the low mortality and morbidity rate shown in this study, surgery is an important treatment option for asymptomatic meningiomas. Based on these results, we would like to emphasize that it is difficult to completely avoid vascular complications, even for asymptomatic meningiomas.…”

“…The rationale to determine the need for surgery for asymptomatic meningiomas is another unsolved clinical issue. Current evidence for the treatment of asymptomatic meningiomas is Level IV or V and the grade of recommendation remains at Grade C. 10 , 11 , 28 , 29) Therefore, the treatment strategy for asymptomatic meningiomas must be formulated by integrating data on the natural history and surgical risks. 10) Although diverse classifications of complications exist in the literature, the overall incidence of surgical complications of asymptomatic meningiomas ranges from 9.4 to 35.6%.…”

Stereotactic radiosurgery for treating meningiomas eligible for complete resection

“…However, data analyzing surgical management specifically for small tumors are not available to date. In particular, a large-scale data analysis reported a 30-day-readmission rate for patients after meningioma resection of 10.9% [ 21 ]. Furthermore, a recent register-based study from Sweden analyzed sick-leave periods after resection of meningiomas, revealing an unexpectedly high rate of 42.7% of patients not returning to full time occupation two years after surgery [ 22 ].…”

Clinical condition of 120 patients alive at 3 years after poor-grade aneurysmal subarachnoid hemorrhage

“…For visual estimation and browsing, one representative slice of each of the 120 primary CT scans (ICH; IVH; hydrocephalus) and the interventions (extraventricular drainage; sIA occlusion; ICH evacuation; decompressive craniectomy; shunt) were compiled together, according to the mRS (0 to 5) at 3 years (Fig. 3 ) (see also 45 asymptomatic meningiomas by Näslund et al in 2020 in Acta Neurochirurgica [ 35 ]). Furthermore, the interventions and the presence or absence of ICH were cross-tabulated into 12 groups (Table 3 ).…”