Surgical outcomes after reoperation for recurrent skull base meningiomas

Abstract

OBJECTIVE Skull base meningiomas are surgically challenging tumors due to the intricate skull base anatomy and the proximity of cranial nerves and critical cerebral vasculature. Many studies have reported outcomes after primary resection of skull base meningiomas; however, little is known about outcomes after reoperation for recurrent skull base meningiomas. Since reoperation is one treatment option for patients with recurrent meningioma, the authors sought to define the risk profile for reoperation of skull base meningiomas. METHODS A retrospective review of 2120 patients who underwent resection of meningiomas between 1985 and 2016 was conducted. Clinical information was extracted from the medical records, radiology data, and pathology data. All records of patients with recurrent skull base meningiomas were reviewed. Demographic data, presenting symptoms, surgical management, outcomes, and complications data were collected. Kaplan-Meier analysis was used to evaluate survival after reoperation. Logistic regression was used to evaluate for risk factors associated with complications. RESULTS Seventy-eight patients underwent 100 reoperations for recurrent skull base meningiomas. Seventeen patients had 2 reoperations, 3 had 3 reoperations, and 2 had 4 or more reoperations. The median age at diagnosis was 52 years, and 64% of patients were female. The median follow-up was 8.5 years. Presenting symptoms included cranial neuropathy, headache, seizure, proptosis, and weakness. The median time from initial resection to first reoperation was 4.4 years and 4.1 years from first to second reoperation. Seventy-two percent of tumors were WHO grade I, 22% were WHO grade II, and 6% were WHO grade III. The sphenoid wing was the most common location (31%), followed by cerebellopontine angle (14%), cavernous sinus (13%), olfactory groove (12%), tuberculum sellae (12%), and middle fossa floor (5%). Forty-four (54%) tumors were ≥ 3 cm in maximum diameter at the time of the first reoperation. In 100 reoperations, 60 complications occurred in 30 cases. Twenty of the 60 complications required surgical intervention (33%). Complications included hydrocephalus (12), CSF leak/pseudomeningocele (11), wound infection (9), postoperative hematoma (4), venous infarction (1), and pneumocephalus (1). Postoperative neurological deficits included new or worsened cranial nerve deficits (10) and hemiparesis (3). There were no perioperative deaths in this series. On multivariate analysis, posterior fossa location was significantly associated with complications (OR 3.45, p = 0.0472). The 1-, 2-, 5-, and 10-year overall survival rates according to Kaplan-Meier analysis after the first reoperation were 94%, 92%, 88%, and 76%, respectively. The median survival after the first reoperation was 17 years. CONCLUSIONS Recurrent skull base meningiomas are surgically challenging tumors, and reoperation is associated with high morbidity and complication rates. Despite these cautionary data, repeat resection of recurrent skull base meningiomas in appropriately selec...

Benefits of re-do surgery for recurrent intracranial meningiomas

“…The rate of postoperative hematomas was not increased after re-operations. This is in concordance with previous reports [23][24][25][26][27][28] . However, meningiomas have a higher risk of postoperative infection when compared to other intracranial tumors 29,30 .…”

“…In contrast, the rate after the second and third surgery in our cohort was higher than the series reported in the literature (23.8% vs. 14%). This main be explained by the high proportion of skull-base meningiomas in our cohort (up to 50%), since these meningiomas represents an increased surgical challenge and an increased risk of postoperative morbidity in case of surgical re-treatment at the site of a previous surgery 10,28 .…”

Surgical outcomes after reoperation for recurrent non–skull base meningiomas

“…In our series of 78 patients undergoing 100 reoperations for recurrent skull base meningiomas, 30% of patients experienced at least 1 complication and onethird of the complications required additional surgery. 14 One potential factor influencing this could be the inherent biology of the tumors. Recurrent non-skull base tumors were more often grade II (51% vs 22%) or grade III (27% vs 6%) compared to recurrent skull base meningiomas.…”

Second Free Flap Surgery for Skull Base Tumors: Case Report and Literature Review

“…Numerous studies 1 5 have described skull base tumors invading the paranasal sinuses. Recurrence of such tumors is common 4,5 , and radiation therapy or additional surgery is often required. Prevention of cerebrospinal fluid (CSF) leakage and meningitis is important 2,6,7 during skull base tumor removal, because skull base surgeries require removal of the dura and release of the paranasal sinuses.…”

“…The temporal, facial, or cervical artery is often used as a donor vessel for the flap 9 . However, the tumor often recurs after reconstructive surgery, and surgical treatment in such cases is difficult 2,4,10,11 .…”