The evolution of cranial meningioma surgery—a single-center 25-year experience

Sicking, Johanna; Voß, Kira Marie; Spille, Dorothee Cäcilia; Schipmann, Stephanie; Holling, Markus; Paulus, Werner; Heß, Katharina; Steinbicker, Andrea U.; Stummer, Walter; Grauer, Oliver; Wölfer, Johannes; Brokinkel, Benjamin

doi:10.1007/s00701-018-3617-6

Cited by 28 publications

(24 citation statements)

References 38 publications

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“…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 .…”

Section: Discussionsupporting

confidence: 94%

“…The postoperative infection rate described in our cohort is lower than in previous published series (2.3% vs. 6-12%) 23,30 and lower than the 16% rate reported in a series of recurrent meningiomas 10 . However, as superficial wound infections were often treated at local hospitals or in private practice, we considered in our study only postoperative infections requiring reoperations.…”

Section: Discussioncontrasting

confidence: 80%

“…The rate of postoperative neurological worsening was lower in our cohort compared to the literature for the first surgery (3.9% vs. 10-14%) 23,26 . 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%).…”

Section: Discussioncontrasting

confidence: 69%

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Benefits of re-do surgery for recurrent intracranial meningiomas

Lemée

Corniola

Meling

2020

Sci Rep

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Meningiomas are the most common intracranial extra-axial tumor. While the literature is abundant on the therapeutic management of meningioma recurrence after the initial surgery, the natural history of repeated recurrences is poorly described, as well as and their respective management. A partly retrospective, partly prospective review was conducted in a Norwegian cohort of 1469 consecutive cases of meningioma surgically treated, totaling 11 414 patient-years of follow-up. 114 recurrences (7.7%) were treated surgically with a risk a surgical retreatment of 1% per patient-year of follow-up. 36 patients were operated on 3 times or more. The time-to-retreatment (TTR) decreased significantly and steadily between surgeries, from 4.3 ± 4 years after the first surgery to 2.4 ± 2.9 years after the third surgery. The primary driver for recurrence was the WHO grade (OR 7.13 [4.40;11.55], p < 0.001 for the first recurrence and OR 4.13 [1.49;12.15], p 0.008 for the second), the second predictive factor being a skull base location (OR 2.76 [1.95;3.99] p < 0.001 and OR 0.24 [0.09;0.65], p0.006 respectively). The rates of postoperative hematomas and infections were not influenced by the number of surgeries, whereas the rate of postoperative neurological worsening increased from 3.9% to 16.6% and 13.9%, respectively, after the first, second, and third surgeries. We observed that the TTR decreased significantly between surgeries in patients requiring repeated resections, indicating that surgical treatment of recurrences does not reset the clock but is indeed a "race against time". This should be considered when assessing the benefit-to-risk ratio of patients undergoing repeated surgeries for a recurrent meningioma. Meningiomas are the most frequent intracranial extra-cerebral tumors 1,2. They are classified according to the World Health Organization (WHO) in histopathological grades from I to III 3. The therapeutic management is primarily surgical, aimed at a complete resection of the tumor with its dural tail 4 , followed by a clinico-radiological follow-up 5,6. This "intervention-first" paradigm allows for high rates of disease-control 6,7. However, the majority of meningiomas show slow growth, making their therapeutic management similar to a chronic disease with a lengthy clinico-radiological follow-up 8,9. Should the tumor recur, the treatment is surgical whenever possible, according to the patient's functional status and Karnofsky Performance Scale (KPS). Stereotactic or conventional radiation therapies are privileged otherwise. Therefore, early recognition of recurrence and its management is of paramount importance for neurosurgeons. While the literature is abundant on the therapeutic management of meningioma recurrence after the initial surgery, the natural history of repeated recurrences and their therapeutic management is poorly described. Furthermore, there is little information regarding the interval between surgeries (or any treatment) and successive recurrences. Such information would be useful to assess the benefit-...

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Section: Discussionsupporting

confidence: 94%

Section: Discussioncontrasting

confidence: 80%

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Benefits of re-do surgery for recurrent intracranial meningiomas

Lemée

Corniola

Meling

2020

Sci Rep

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“…Only a quarter of patients undergoing active monitoring demonstrate radiological or clinical progression requiring intervention. Since most incidental meningiomas are histologically benign and the risk of treatment-related morbidity from surgery or radiosurgery is similar to those reported for symptomatic meningiomas [ 34 – 37 ], a policy of active monitoring seems justified. Meningioma progression and subsequent treatment intervention in the vast majority of cases occurs within 5 years of diagnosis.…”

Section: Discussionmentioning

confidence: 95%

Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes

et al. 2019

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Background Incidental discovery accounts for 30% of newly-diagnosed intracranial meningiomas. There is no consensus on their optimal management. This review aimed to evaluate the outcomes of different management strategies for these tumors. Methods Using established systematic review methods, six databases were scanned up to September 2017. Pooled event proportions were estimated using a random effects model. Meta-regression of prognostic factors was performed using individual patient data. Results Twenty studies (2130 patients) were included. Initial management strategies at diagnosis were: surgery (27.3%), stereotactic radiosurgery (22.0%) and active monitoring (50.7%) with a weighted mean follow-up of 49.5 months (SD = 29.3). The definition of meningioma growth and monitoring regimens varied widely impeding relevant meta-analysis. The pooled risk of symptom development in patients actively monitored was 8.1% (95% CI 2.7–16.1). Associated factors were peritumoral edema (OR 8.72 [95% CI 0.35–14.90]) and meningioma diameter ≥ 3 cm (OR 34.90 [95% CI 5.17–160.40]). The pooled proportion of intervention after a duration of active monitoring was 24.8% (95% CI 7.5–48.0). Weighted mean time-to-intervention was 24.8 months (SD = 18.2). The pooled risks of morbidity following surgery and radiosurgery, accounting for cross-over, were 11.8% (95% CI 3.7–23.5) and 32.0% (95% CI 10.6–70.5) respectively. The pooled proportion of operated meningioma being WHO grade I was 94.0% (95% CI 88.2–97.9). Conclusion The management of incidental meningioma varies widely. Most patients who clinically or radiologically progressed did so within 5 years of diagnosis. Intervention at diagnosis may lead to unnecessary overtreatment. Prospective data is needed to develop a risk calculator to better inform management strategies. Electronic supplementary material The online version of this article (10.1007/s11060-019-03104-3) contains supplementary material, which is available to authorized users.

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“…Clinical data, radiological imaging, and histopathological diagnosis of all patients who underwent surgery for intracranial grade I meningioma in our department between 1991 and 2015 were reviewed as described previously [ 56 , 57 , 58 , 59 , 60 , 61 ]. Data included patient sex and age at the time of surgery; the extent of resection, classified as gross total resection (GTR, Simpson grades I–II) and subtotal resection (STR, Simpson grades III–V) [ 62 ].…”

Section: Methodsmentioning

confidence: 99%

Occurrence of Fibrotic Tumor Vessels in Grade I Meningiomas Is Strongly Associated with Vessel Density, Expression of VEGF, PlGF, IGFBP-3 and Tumor Recurrence

Heß

Spille

Adeli

et al. 2020

Cancers

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Angiogenesis is a key feature during oncogenesis and remains a potential target of antiangiogenic therapy. While commonly described in high-grade lesions, vascularization and its correlation with prognosis in grade I meningiomas is largely unexplored. In the histological classification, not only the number but also the composition of blood vessels seems to be important. Therefore, tumor vessel density and fibrosis were correlated with clinical and imaging variables and prognosis in 295 patients with intracranial grade I meningioma. Expression of pro-angiogenic proteins within the meningiomas was investigated by proteome analyses and further validated by immunohistochemical staining. Fibrotic tumor vessels (FTV) were detected in 48% of all tumors and strongly correlated with vessel density, but not with the histopathological tumor subtype. Occurrence of FTV was correlated with a 2-fold increased risk of recurrence in both univariate and multivariate analyses. Explorative proteome analyses revealed upregulation of VEGF (vascular endothelial growth factor), PlGF (placental growth factor), and IGFBP-3 (insulin-like growth factor-binding protein-3) in tumors displaying FTV. Immunohistochemical analyses confirmed strong correlations between tumor vessel fibrosis and expression of VEGF, PlGF, and IGFBP-3. Presence of FTV was strongly associated with disruption of the arachnoid layer on preoperative MRI in univariate and multivariate analyses. In summary, the occurrence of fibrotic tumor vessels in grade I meningiomas is strongly associated with vessel density, disruption of the arachnoid layer, expression of VEGF, PlGF, IGFBP-3 and tumor recurrence.

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The evolution of cranial meningioma surgery—a single-center 25-year experience

Abstract: Preoperative diagnosis and surgery of meningiomas have been substantially evolved. Although early neurological outcome has improved, long-term prognosis remains unchanged.

Cited by 28 publications

References 38 publications

Benefits of re-do surgery for recurrent intracranial meningiomas

Benefits of re-do surgery for recurrent intracranial meningiomas

Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes

Occurrence of Fibrotic Tumor Vessels in Grade I Meningiomas Is Strongly Associated with Vessel Density, Expression of VEGF, PlGF, IGFBP-3 and Tumor Recurrence

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