Lessons from surgical outcome for intracranial meningioma involving major venous sinus

Abstract

Intracranial meningiomas involving the major venous sinus (MVS) pose several complication risks upon performing radical resection. Some surgeons consider MVS invasion a contraindication for a complete resection of meningioma, and others suggest total resection followed by venous reconstruction. The aim of the study was to analyze our surgical results and discuss management strategy for intracranial meningiomas involving the MVS. Between 1993 and 2011, 107 patients with intracranial meningiomas involving MVS underwent surgery in our institution. Clinicoradiological features including pathological features and operative findings were retrospectively analyzed. Median follow-up duration was 60.2 months (range, 6.2–218.2 months). Distributions of tumor cases according to the involved sinus were as follows: 86% parasagittal, 10.3% tentorial, and 3.7% peritorcular. Simpson Grade I/II removal was achieved in 93 of 107 patients (87%). Partially or totally occluded MVS by their meningiomas (Sindou classification IV and V) was found in 39 patients (36%). Progression rate was 12% (13/107) and progression-free survival rates were 89%, 86%, and 80% at 5, 7, and 10 years, respectively. Sindou classification (IV/V) and Karnofsky performance status (KPS) score 6 month after the surgery (KPS < 90) were predictive factors for progression in our study (P = 0.044 and P = 0.001, respectively). The resection degree did not reach statistical significance (P = 0.484). Interestingly, there was no progression in patients that underwent radiation therapy or gamma knife radiosurgery for residual tumor. There were no perioperative deaths. Complication rate was 21% with brain swelling being the most common complication. There was no predictive factor for occurrence of postoperative complication in this study. In conclusion, complete tumor resection with sinus reconstruction did not significantly prevent tumor recurrence in intracranial meningioma involving MVS. Considering the complications from this procedure as it has possibly related with reduced postoperative KPS score, the tumor should be removed as much as possible while leaving remnant portion with significant invasion of sinus or drainage vein. Following radiation therapy or gamma knife radiosurgery for a remnant or recurred meningioma might then be justified.

Prognostic factors of microsurgical treatment of intracranial meningiomas – A multivariate analysis

“…Their results showed an increase in the health-related QOL score from 73.9 to 84.9, which means that there is a significant improvement in their QOL and, thus, a favorable outcome. Further studies by Kalkanis et al and other authors support this attitude, while also observing QOL improvement after meningioma surgery [ 1 , 17 – 19 ]. When regarding the relationship of the Karnofsky indices to each other, binary logistic regression indicated a negative association between K1 and Kd, which was confirmed by Spearman’s correlation.…”

“…Markovic et al investigated the influence of peritumoral edema on the prognosis of morbidity and postoperative complications referring to 78 patients with supratentorial meningiomas treated surgically[ 37 ]. They determined that the outcome was significantly better in cases without than in patients with peritumoral edema, but there is no clear consensus in the literature [ 1 , 27 ]. This study, however, identified a connection between the occurrence of peritumoral edema or mass effects and an improved Kd score.…”

“…Meningioma is the most common primary brain tumor and constitutes approximately 20–30% of all intracranial neoplasm [ 1 – 3 , 4 ]. The incidence of meningioma amounts to 2.3–7:100,000 people, and between 80 and 85% of these intracranial tumors are regarded as histologically benign (WHO I)[ 5 – 7 ].…”

Predictors of early progression of surgically treated atypical meningiomas

“…Furthermore, while Simpson grade 1 resection would be desirable if recurrence was the only consideration, in real life, there are many other important considerations, not least widely published morbidity related to radical resection of meningiomas invading venous sinuses. [ 45 , 46 ] Indeed some authors propose that use of stereotactic radiosurgery following incomplete resection of parasagittal meningiomas reduces recurrence rates to those seen with Simpson grade 1 resections. [ 47 ] While we have notinvestgated this directly our data does not support pursuing radical resection in parafalcine/parasagittal meningiomas at the expense of morbidity.…”

Comprehensive treatment of patients with parasagittal meningiomas

“…Moon-Soo Han и соавт. [19] проанализировали результаты лечения 107 пациентов с ПСМ и выявили существенную зависимость вероятности рецидива от степени инвазии ВСС менингиомой. При этом радикальность операции по шкале Симпсона, гистологический тип, размер опухоли и перитуморозный отек статистически значимого влияния на вероятность рецидива не оказывали.…”