Predictors of Severe Complications in Intracranial Meningioma Surgery: A Population-Based Multicenter Study

Bártek, Jiří; Sjåvik, Kristin; Förander, Petter; Solheim, Ole; Gulati, Sasha; Weber, Clemens; Ingebrigtsen, Tor; Jakola, Asgeir Store

doi:10.1016/j.wneu.2015.01.022

Cited by 56 publications

(38 citation statements)

References 32 publications

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“…17,21 The univariate association of increased postdischarge seizure occurrence in males may be due to gender differences in tumor characteristics. Male gender has been associated with more aggressive disease in anaplastic meningioma, 24 greater incidence of severe complication in intracranial meningioma surgery, 25 and in our study, higher grade tumors.…”

Section: Discussionsupporting

confidence: 64%

Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

et al. 2017

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BACKGROUND Risk factors for pre- and postoperative seizures in supratentorial meningiomas are understudied compared to other brain tumors. OBJECTIVE To report seizure frequency and identify factors associated with pre- and postoperative seizures in a large single-center population study of patients undergoing resection of supratentorial meningioma. METHODS Retrospective chart review of 1033 subjects undergoing resection of supratentorial meningioma at the author’s institution (1991–2014). Multivariate regression was used to identify variables significantly associated with pre- and postoperative seizures. RESULTS Preoperative seizures occurred in 234 (22.7%) subjects. At 5 years postoperative, probability of seizure freedom was 89.9% among subjects without preoperative seizures and 62.2% with preoperative seizures. Multivariate analysis identified the following predictors of preoperative seizures: presence of ≥1 cm peritumoral edema (odds ratio [OR]: 4.45, 2.55–8.50), nonskull base tumor location (OR: 2.13, 1.26–3.67), greater age (OR per unit increase: 1.03, 1.01–1.05), while presenting symptom of headache (OR: 0.50, 0.29–0.84) or cranial nerve deficit (OR: 0.36, 0.17–0.71) decreased odds of preoperative seizures. Postoperative seizures after discharge were associated with preoperative seizures (OR: 5.70, 2.57–13.13), in-hospital seizure (OR: 4.31, 1.28–13.67), and among patients without preoperative seizure, occurrence of medical or surgical complications (OR 3.39, 1.09–9.48). Perioperative anti-epileptic drug use was not associated with decreased incidence of postoperative seizures. CONCLUSIONS Nonskull base supratentorial meningiomas with surrounding edema have the highest risk for preoperative seizure. Long-term follow-up showing persistent seizures in meningioma patients with preoperative seizures raises the possibility that these patients may benefit from electrocorticographic mapping of adjacent cortex and resection of noneloquent, epileptically active cortex.

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Section: Discussionsupporting

confidence: 64%

Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

et al. 2017

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“…Twelve papers 3,6,17,25–33) defined elderly as people aged over 70 years and included a total of 3,131 patients; 53.8% of whom were females (this category included the above-mentioned Veterans Affairs’ Surgical Quality Improvement Program database study). Only three papers 31–33) were published after 2010 and three studies 17,31,32) were prospective.…”

Section: Introductionmentioning

confidence: 99%

“…Only three papers 31–33) were published after 2010 and three studies 17,31,32) were prospective. Ten papers 3,6,26–33) included some patients with surgically removed meningioma as a part of all age or other treatments. The mean skull base-related location rate was 49.9%, and two studies focused only on skull base 29) or cerebellopontine angle lesions.…”

Section: Introductionmentioning

confidence: 99%

Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

Ikawa

Kinoshita

Takeda

et al. 2017

Neurol. Med. Chir.(Tokyo)

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The Japanese population features the highest rate of elderly individuals worldwide. Moreover, Japan has the highest number of computed tomography/magnetic resonance imaging devices in the world, which has led to an increase in the incidental detection of meningioma in healthy elderly patients. Many previous papers have discussed the risks and indications for surgery in this patient population, but available information remains insufficient, and the definition of “elderly” has not been standardized. This review tried to clarify the published evidence and challenges associated with elderly meningioma based on a search of the PubMed database using the terms “meningioma,” “elderly,” and “surgery” for English-language clinical studies and collected related papers published from 2000 to 2016. Twenty-four papers were reviewed and classified by definition of elderly age: over 60, 65, 70, and 80 years old. Six of seven papers that defined the elderly cutoff as over 65 years old were published after 2010, which suggested the consensus definition. Four preoperative grading scoring systems were described and associated with mortality. The 1-year and 5-year mortality rates ranged from 0% to 16.7% and from 7% to 27%, which were comparable with unselected cohorts. Review of risk factor analysis emphasized the importance of considering the preoperative status, presence of comorbidities, and optimum surgical timing during patient selection. Careful choice of patients can also lead to better quality of life. A prospective randomized study considering patient frailty should address the causes and prevention of complications.

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“…In addition to WHO Grade I pathology and asymptomatic status, our inclusion criteria also included age of 60 or above at time of operation. Increasing age has been repeatedly associated with increased perioperative morbidity and mortality [8][9][10][11]. Accordingly, we thought that the screening for an asymptomatic tumor in this patient population in particular might be of even lower utility due to increased hesitancy to surgically intervene.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, we focused on elderly patients, in whom any reoperation for resection of an asymptomatic recurrence or new tumor is known to be associated with significant morbidity and mortality [8][9][10][11]. We aim to show that under the current practice these patients undergo a significant amount of unnecessary postoperative imaging surveillance.…”

Section: Introductionmentioning

confidence: 99%

Short-term postoperative surveillance imaging may be unnecessary in elderly patients with resected WHO Grade I meningiomas

Nayeri

Prablek

Brinson

et al. 2016

Journal of Clinical Neuroscience

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Predictors of Severe Complications in Intracranial Meningioma Surgery: A Population-Based Multicenter Study

Cited by 56 publications

References 32 publications

Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

Review of Current Evidence Regarding Surgery in Elderly Patients with Meningioma

Short-term postoperative surveillance imaging may be unnecessary in elderly patients with resected WHO Grade I meningiomas

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