Risk profile associated with convexity meningioma resection in the modern neurosurgical era

Abstract

Object. Although meningiomas are commonly found along the supratentorial convexity, the risk profile associated with this subset of lesions in the modern neurosurgical era is unknown.Methods. The authors retrospectively reviewed the clinical course of patients with supratentorial convexity meningiomas treated during the past 10 years. All patients had undergone MR imaging within 72 hours after surgery and at least 1 year of clinical follow-up. Patients with multiple meningiomas, hemangiopericytomas, malignant meningiomas, or tumor-prone syndromes were excluded from analysis.Results. Between 1997 and 2007, 141 consecutive patients (median age 48 years, range 18-95 years) underwent resection of a supratentorial convexity meningioma. The most common signs or symptoms at presentation were headache (48%), seizures (34%), and weakness (21%). The mean tumor volume was 146.3 cm 3 (range 1-512 cm 3). There were no intraoperative complications or deaths. Medical or neurosurgical morbidity was noted in the postoperative course of 14 patients, equating to a 10% overall complication rate. Postoperative surgical complications included hematoma requiring evacuation, CSF leakage, and operative site infection. Medical complications included pulmonary embolus and deep vein thrombosis requiring treatment. A Simpson Grade 0 or 1 resection was achieved in 122 patients (87%). One hundred six tumors (75%) were WHO Grade I, whereas 35 (25%) were WHO Grade II. The median clinical follow-up was 2.9 years (range 1-10 years), and the median radiographic follow-up was 3.7 years (range 1-10 years). Six patients (4%) had radiographic evidence of tumor recurrence, with 3 (2%) undergoing repeat resection.Conclusions. With the conservative recommendations for surgery for asymptomatic meningiomas and the advent of radiosurgery during the past 10 years, microsurgically treated convexity meningiomas are now typically large in size. Nevertheless, the patient's clinical course following microsurgical removal of these lesions is expected to be uncomplicated. The authors' findings provide a defined risk profile associated with the resection of supratentorial convexity meningiomas in the modern neurosurgical era.

Modern surgical outcomes following surgery for sphenoid wing meningiomas

“…Radiosurgery, and a growing propensity for observation of smaller me ningiomas, has inherently altered the profile of tumors undergoing resection at our center and others, because they are likely to be bigger and more aggressive that those operated on in the past. 16 Importantly, medialthird sphenoid wing meningio mas are most notable for their proximity to the ipsilateral optic nerve and optic apparatus, which is the symptom prompting the diagnostic imaging study in more than two-thirds of these cases. Optic canal invasion and CS involvement are frequent features of these tumors, and are more common than with lateral parasylvian tumors.…”

Outcome and survival following primary and repeat surgery for World Health Organization Grade III meningiomas

“…Additionally, it seems that aggressive removal of malignant meningiomas is associated with greater risk of neurological morbidity, regardless of extent of resection, than in lower-grade meningiomas (Table 5). 19 Furthermore, many of our worst complications with these cases occurred in patients who underwent GTR. Although there is little doubt of the desirability of GTR in cases in which there is a clear plane between the tumor and normal brain, nerves, or vessels, often such a plane does not exist with these tumors.…”

Descriptive Epidemiology of World Health Organization Grades II and III Intracranial Meningiomas in the United States

“…Prior studies have demonstrated an increased risk of higher grade meningiomas in the convexity location. 5,8,9,36,37 Fifth, the current study is limited to the population of the United States, which limits the ability to generalize the results to other countries that may have significantly different genetic and environmental factors. Sixth, we must acknowledge limitations in the collection of race and ethnicity data.…”