Surgically resected skull base meningiomas demonstrate a divergent postoperative recurrence pattern compared with non–skull base meningiomas

Abstract

M eningioMas are the second most common primary intracranial tumors in adults. 32 These tumors tend to exhibit a slow growth rate and minimal invasion of the brain parenchyma; therefore, they are typically considered benign. The optimal management of meningiomas is complete resection of the tumor along with the associated dura and bone, traditionally recognized as a Simpson Grade I resection. 30 However, this goal cannot always be achieved safely. This is particularly true for meningiomas in regions that are associated with critical neurovascular structures, typically in the skull base. Also, it has been suggested that even upon achieving an apparent abbreviatioNs CI = confidence interval; EOR = extent of resection; GTR = gross-total resection; IQR = interquartile range; NF2 = neurofibromatosis Type 2; OR = odds ratio; PR = progesterone receptor; STR = subtotal resection. obJective The objective of this study was to identify the natural history and clinical predictors of postoperative recurrence of skull base and non-skull base meningiomas. methods The authors performed a retrospective hospital-based study of all patients with meningioma referred to their institution from September 1993 to January 2014. The cohort constituted both patients with a first-time presentation and those with evidence of recurrence. Kaplan-Meier curves were constructed for analysis of recurrence and differences were assessed using the log-rank test. Cox proportional hazard regression was used to identify potential predictors of recurrence. results Overall, 398 intracranial meningiomas were reviewed, including 269 (68%) non-skull base and 129 (32%) skull base meningiomas (median follow-up 30.2 months, interquartile range [IQR] 8.5-76 months). The 10-year recurrence-free survival rates for patients with gross-total resection (GTR) and subtotal resection (STR) were 90% and 43%, respectively. Skull base tumors were associated with a lower proliferation index (0.041 vs 0.062, p = 0.001), higher likelihood of WHO Grade I (85.3% vs 69.1%, p = 0.003), and younger patient age (55.2 vs 58.3 years, p = 0.01). Meningiomas in all locations demonstrated an average recurrence rate of 30% at 100 months of follow-up. Subsequently, the recurrence of skull base meningiomas plateaued whereas non-skull base lesions had an 80% recurrence rate at 230 months follow-up (p = 0.02). On univariate analysis, a prior history of recurrence (p < 0.001), initial WHO grade following resection (p < 0.001), and the inability to obtain GTR (p < 0.001) were predictors of future recurrence. On multivariate analysis a prior history of recurrence (p = 0.02) and an STR (p < 0.01) were independent predictors of a recurrence. Assessing only patients with primary presentations, STR and WHO Grades II and III were independent predictors of recurrence (p < 0.001 for both). coNclusioNs Patients with skull base meningiomas present at a younger age and have less aggressive lesions overall. Extent of resection is a key predictor of recurrence and long-term follow-up of meningiomas is nec...

The outcome of patients with surgically treated meningioma in England: 1999–2013. A cancer registry data analysis

“…Skull base meningioma are less common, have a higher recurrence rate and worse progression free survival, but are more likely to be grade I, have a slower growth rate, and reports suggest a comparable net survival rate. 16,19,20 Overall survival outcomes for surgically treated patients are getting better. This improving trend, in light of greater subspecialisation within surgical practice in the UK, may be used to further support the role of the specialty tumour surgeon.…”

“Skull base meningiomas have a distinct immune landscape.”

“…We further investigated the immune landscape of meningiomas by combining leukocyte cell fraction with cytokine expression profile in a network-based analysis. M1 macrophages, known The more aggressive grade II and grade III meningiomas are less prevalent in the skull base compared to convexity 7,26 . When comparing to meningiomas of the convexity, only immune processes showed significant upregulation in meningiomas of the skull base which was maintained after correcting for histological grade.…”

Meningiomas’ Management: An Update of the Literature

“…En plaque meningiomas, with a flat extension in the subdural space, may also be difficult to resect completely. However, according to a recent study, patients with skull base meningiomas present at a younger age and lesions have often a more indolent behavior [54]. More aggressive meningiomas may present with associated brain invasion, venous sinuses invasion or less defined limits, thus rendering the complete resection more challenging.…”