Surgically Resected Skull Base Meningiomas Demonstrate a Divergent Postoperative Recurrence Pattern Compared with Superficial Meningiomas

Mansouri, Alireza; Klironomos, George; Taslimi, Shervin; Kilian, Alexandra; Khan, Osaama H.; Gentili, Fred; Zadeh, Gelareh

doi:10.1055/s-0035-1546561

Cited by 2 publications

(5 citation statements)

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“…In contrast, skull base tumors were associated with a lower proliferation index ( p = 0.001) and were less likely to recur with long-term follow-up in a comparison of 129 skull base meningiomas to 269 nonskull base meningiomas. 15 Similarly, in a study of 113 incidentally discovered meningiomas, skull base meningiomas were less likely to exhibit growth ( p <0.001) and had a longer doubling time ( p = 0.008) and lower mean MIB-1 index ( p = 0.013) than nonskull base meningiomas. Future studies with detailed biological analyses are needed to uncover the relationship between the extent of resection, RTV, and meningioma genetics as drivers for skull base meningioma progression.…”

Section: Discussionmentioning

confidence: 96%

“…5 11 12 Clinically, however, conflicting evidence exists on the natural history of these tumors. 9 13 14 15 For example, Savardekar et al 13 found that tumor progression rates were higher in 382 skull base meningiomas than in 200 nonskull base meningiomas ( p = 0.006) following resection. Fukushima et al 9 reported skull base location was an independent predictor of tumor retreatment in multivariate analysis ( p = 0.002).…”

Section: Discussionmentioning

confidence: 99%

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Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

Przybylowski

Hendricks

Furey

et al. 2021

J Neurol Surg B Skull Base

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Objective This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas. Study Design This study is a retrospective volumetric analysis. Setting This study was conducted at a single institution. Participants Patients who underwent subtotal resection of a WHO grade I skull base meningioma and postsurgical observation (July 1, 2007–July 1, 2017). Main Outcome Measure The main outcome was radiographic tumor progression. Results Sixty patients with residual skull base meningiomas were analyzed. The median (interquartile range) RTV was 1.3 (5.3) cm3. Tumor progression occurred in 23 patients (38.3%) at a mean duration of 28.6 months postsurgery. The 1-, 3-, and 5-year actuarial progression-free survival (PFS) rates were 98.3, 58.6, and 48.7%, respectively. The Cox multivariate analysis identified increasing RTV (p = 0.01) and history of more than 1 previous surgery (p = 0.03) as independent predictors of tumor progression. In a Kaplan–Meier analysis for PFS, the RTV threshold of 3 cm3 maximized log-rank testing significance between groups of patients dichotomized at 0.5 cm3 thresholds (p < 0.01). The 3-year actuarial PFS rates for meningiomas with RTV ≤3 cm3 and >3 cm3 were 76.2 and 32.1%, respectively. When RTV >3 cm3 was entered as a covariate in the Cox model, it was the only factor independently associated with tumor progression (p < 0.01). Conclusion RTV was associated with tumor progression after subtotal resection of WHO grade I skull base meningioma in this cohort. An RTV threshold of 3 cm3 was identified that minimized progression of the residual tumor when gross total resection was not safe or feasible.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

Przybylowski

Hendricks

Furey

et al. 2021

J Neurol Surg B Skull Base

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“…2 3 6 In a large retrospective study by Mansouri et al of 398 meningiomas, 11.6% of skull base tumors were grade 2 and 23.4% of non–skull base tumors were grade 2. 13 However, these numbers are recorded prior to the change in histological classification and therefore likely to be higher if following the 2016 WHO grading system. A second large retrospective study by Meling et al analyzed 1,148 meningioma patients in total (49% of which were skull base); only 4% of the skull base cohort was reported as grade 2 histology, compared with 6% of the non–skull base cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Within the skull base, they are reported to be smaller and less aggressive in histological nature. 12 13 14 MIB-1 labeling index (indicating higher rates of cell proliferation) has been noted to be significantly higher within non–skull base meningiomas compared with skull base meningiomas, 12 13 and progesterone receptor expression (indicating less aggressive lower grade tumors) has been noted to be significantly higher within medial skull base meningiomas. 14…”

Section: Introductionmentioning

confidence: 97%

“…Meningioma recurrence may consequently be less likely within the skull base; however, these patients are reported to present at a younger age and given the close association of skull base tumors with critical neurovascular structures, gross total resection (GTR) is not always achievable. 13 14 Therefore, skull base surgery for grade 2 meningiomas poses enhanced challenges. We aimed to review all de novo skull base meningioma cases over a 6-year period within a single unit to analyze presentation and outcome, based on the WHO 2016 criteria.…”

Section: Introductionmentioning

confidence: 99%

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De Novo Skull Base Atypical Meningioma: Incidence and Outcome

James

Makwana

Hayhurst

2022

J Neurol Surg B Skull Base

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Aim: Atypical meningiomas are uncommon in skull base practice and present a management challenge. We aimed to review all de novo atypical skull base meningioma within a single unit to analyse presentation and outcome. Methods: A retrospective review of all patients undergoing surgery for intracranial meningioma identified consecutive cases of de novo atypical skull base meningioma. Electronic case records were analysed for patient demographics, tumour location and size, extent of resection and outcome. Tumour grading is based on the 2016 WHO criteria. Results: 18 patients with de novo atypical skull base meningiomas were identified. The most common tumour location was sphenoid wing in 10 patients (56%). Gross total resection (GTR) was achieved in 13 patients (72%) and subtotal resection (STR) in 5 patients (28%). There was no tumour recurrence recorded in patients who had undergone GTR. Patients with tumours >6cm were more likely to undergo a STR as opposed to a GTR (p=<0.01). Patients who had undergone a STR were more likely have post-operative tumour progression and be referred for radiotherapy (p=0.02 and p=<0.01 respectively). On multiple regression analysis tumour size is the only significant factor correlating with overall survival (p=0.048). Conclusion: The incidence of de novo atypical skull base meningioma is higher in our series than currently published data. Tumour size was a significant indicator for patient outcome and extent of resection. Those undergoing a STR were more likely to have tumour recurrence. Multicentre studies of skull base meningiomas with associated molecular genetics are needed to guide management.

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Surgically Resected Skull Base Meningiomas Demonstrate a Divergent Postoperative Recurrence Pattern Compared with Superficial Meningiomas

Cited by 2 publications

References 0 publications

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

De Novo Skull Base Atypical Meningioma: Incidence and Outcome

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