Recurrence of Cranial Base Meningiomas

Abstract

The findings emphasized the necessity to plan the management of patients with cranial base meningiomas according to a 10- to 20-year perspective. Patients must be followed to evaluate the treatment results and to detect recurrences. Nonradical surgery must be viewed as a temporizing or palliative measure; a continued search for means of radical tumor treatment is warranted in these often surgically difficult tumors.

Long-Term Experience of Gamma Knife Radiosurgery for Benign Skull Base Meningiomas

“…5 13 35 38 39 At 10 years, recurrence free rates range from 10% to 33% following radical resection, while tumour progression counts for 55-75% after partial meningioma removal. 13 35 39 As microsurgery alone still leaves us with a substantial recurrence or residual rate, considerable morbidity, and occasional mortality, less invasive alternative strategies have to be considered for the therapeutic management of basal meningiomas. 2 4 6 10 14 16-20 24 29 In elderly or medically infirm patients particularly, it must be considered whether the meningioma will be likely to cause serious problems in the natural course of the remaining years and if the risks of surgery will exceed the potential benefits offered.…”

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

“…They are still reported to have the worst neurological functional outcome hindering postoperative quality of life (next to petroclival meningiomas) with highest recurrence rate (2,8,18), partly because of their intricate and intimate relationship with cavernous sinus (CS), arteries of anterior circulation, and optic pathways. As radiosurgery plays an increasing important role in benign tumors, there is much controversy about the indications for aggressive resection of MSWM 1,5,13,20 .…”

“…It was known that the more aggressive radical resection is achieved, the higher incidence of morbidity and or even mortality would be led to. However, tumor recurrence, which correlates with the extent of resection, is the greatest threat in long-term outcomes (5,18,27). Therefore, it still puzzles neurosurgeons about how to balance the immediate risk of morbidity or even mortality and long-term risk of tumor recurrence.…”

Radiosurgical Treatment of Intracranial Meningiomas: Update 2011

“…(6,20,22,56,72,83,86) However, recent reports have emphasized the extremely high chances to maintain adequate LTC rates -without increasing side effects-by treating larger meningiomas with either fractionated schedules or reduced dosages (3,13,18,19,22,24,31,32). b. the controversial or disappointing results obtained in atypic and anaplastic lesions (17,25,27,30,51,73), sometimes characterized by intra-or extraneuraxis metastatization (17) or by enhanced growth after radiosurgery (6,14,42); c. the still pronounced morbidity rate of this technique on sensory nerves (6,14,77). d. finally, potential problems with undue hotspots on strategic vessels within the dosimetry area (1,15).…”