Recurrence Rate and Outcome Analysis of Skull Base Meningiomas after Surgical 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 necessary, especially for non–skull base tumors. In skull base meningiomas, recurrence risk plateaus approximately 100 months after surgery, suggesting that for this specific cohort, follow-up after 100 months can be less frequent.

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Surgical resection of pediatric skull base meningiomas

Child s Nervous System ◽

10.1007/s00381-012-1906-6 ◽

2012 ◽

Vol 29 (1) ◽

pp. 83-87 ◽

Cited By ~ 12

Author(s):

Jan-Karl Burkhardt ◽

Marian C. Neidert ◽

Michael A. Grotzer ◽

Niklaus Krayenbühl ◽

Oliver Bozinov

Keyword(s):

Skull Base ◽

Surgical Resection ◽

Skull Base Meningiomas

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Surgical Resection of Pediatric Skull Base Meningiomas

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0032-1316261 ◽

2012 ◽

Vol 73 (S 03) ◽

Author(s):

J.-K. Burkhardt ◽

N. Krayenbühl ◽

R.-L. Bernays ◽

M. Grotzer ◽

O. Bozinov

Keyword(s):

Skull Base ◽

Surgical Resection ◽

Skull Base Meningiomas

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Skull Base Meningiomas: Is Surgical Resection Enough? Outcome Evaluation and Prognostic Factors Analysis in a Single-Center Cohort

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1739204 ◽

2021 ◽

Author(s):

Federico Pessina ◽

Pierina Navarria ◽

Zefferino Rossini ◽

Elena Clerici ◽

Maurizio Fornari ◽

...

Keyword(s):

Prognostic Factors ◽

Skull Base ◽

Surgical Resection ◽

Brain Magnetic Resonance Imaging ◽

Outcome Evaluation ◽

High Recurrence Rate ◽

Subtotal Resection ◽

Adjuvant Radiation ◽

Karnofsky Performance Score ◽

Skull Base Meningiomas

Abstract Background Surgical resection represents the mainstay of treatment in skull base meningiomas (SBMs). Considering the high recurrence rate reported, an adjuvant radiation therapy (RT) treatment should be considered. The aim of this study was to evaluate the progression-free survival (PFS), overall survival (OS), and prognostic factors conditioning outcome. Methods Patients receiving surgical resection for grade I SBMs were included. The extent of resection (EOR) was dichotomized as gross total resection (GTR) and subtotal resection (STR). RT was administered only in patients receiving STR. Clinical outcome was evaluated by brain magnetic resonance imaging (MRI) performed every 6 months for the first year and yearly thereafter. Results From January 2000 to December 2015, 123 patients were treated. The majority were females (70.7%), with a Karnofsky Performance Score (KPS) ≥80 (95%), and symptoms at diagnosis (91%). GTR was performed in 30% of cases and STR in 70%. RT was performed in 18 (20.9%) patients at diagnosis and in 29 (33.7%) patients at progression. Improvement or stability of neurologic status was obtained in 78.9% of patients. The median follow-up time was 91 months (range: 40–230 months). Local recurrence occurred in 34 (27.6%) patients at a median time of 45 months (range: 6–214 months). The median, 2-, 5-, and 10-year PFS were 193 months, 89.3, 81.8, and 72.5%, respectively. On univariate and multivariate analyses, factors impacting on PFS were EOR, tumor location, neurologic postoperative status, and adjuvant RT in STR. Conclusions A safe surgical resection followed by RT adjuvant treatment could represent the better choice to obtain local control maintaining neurologic integrity. Our data underlined the value of adjuvant RT in incompletely resected meningiomas.

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The role of radical microsurgical resection in multimodal treatment for skull base meningioma

Journal of Neurosurgery ◽

10.3171/2010.2.jns091118 ◽

2010 ◽

Vol 113 (5) ◽

pp. 1072-1078 ◽

Cited By ~ 44

Author(s):

Tsutomu Ichinose ◽

Takeo Goto ◽

Kenichi Ishibashi ◽

Toshihiro Takami ◽

Kenji Ohata

Keyword(s):

Skull Base ◽

Recurrence Rate ◽

Combined Treatment ◽

Tumor Resection ◽

Tumor Location ◽

Karnofsky Performance Scale ◽

Skull Base Meningioma ◽

The Mean ◽

Skull Base Meningiomas ◽

Recurrence Group

Object Because resection followed by timely stereotactic radiosurgery (SRS) is becoming a standard strategy for skull base meningiomas, the role of initial surgical tumor reduction in this combined treatment should be clarified. Methods This study examined 161 patients with benign skull base meningiomas surgically treated at Osaka City University between January 1985 and December 2005. The mean follow-up period was 95.3 months. Patients were categorized into 3 groups based on the operative period and into 4 groups based on tumor location. Maximal resection was performed as first therapy throughout all periods. In the early period (1985–1994), in the absence of SRS, total excision of the tumor was intentionally performed for surgical cure of the disease. In the mid and late periods (1995–2000 and 2001–2005), small parts of the tumor invading critical neurovascular structures were left untouched to obtain good functional results. Residual tumors with high proliferation potential (Ki 67 index > 4%) or with progressive tendencies were treated with SRS. The extent of initial tumor resection, recurrence rate, Karnofsky Performance Scale score, and complication rate were investigated in each group. Results The mean tumor equivalent diameter of residual tumors was 3.67 mm in the no-recurrence group and 11.7 mm in the recurrence group. The mean tumor resection rate (TRR) was 98.5% in the no-recurrence group and 90.1% in the recurrence group. A significant relationship was seen between postoperative tumor size, TRR, and recurrence rate (p < 0.001), but the recurrence rate showed no significant relationship with any other factors such as operative period (p = 0.48), tumor location (p = 0.76), or preoperative tumor size (p = 0.067). The mean TRR was maintained throughout all operative periods, but the complication rate was lowest and postoperative Karnofsky Performance Scale score was best in the late period (p < 0.001 each). Late-period results were as follows: mean TRR, 97.9%; mortality rate, 0%; and severe morbidity rate, 0%. Stereotactic radiosurgery procedures were added in 27 cases (16.8%) across all periods. Throughout all follow-up periods, 158 tumors were satisfactorily controlled by maximal possible excision alone or in combination with adequate SRS. Conclusions The combination of maximal possible resection and additional SRS improves functional outcomes in patients with skull base meningioma. A TRR greater than 97% in volume can be achieved with satisfactory functional preservation and will lead to excellent tumor control in combined treatment of skull base meningioma.

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Recurrence pattern of surgically-resected skull base versus superficial meningiomas, signs of divergent pattern

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.102 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S18-S18

Author(s):

S Taslimi ◽

G Klironomos ◽

A Mansouri ◽

A kilian ◽

F Gentili ◽

...

Keyword(s):

Skull Base ◽

Recurrence Rate ◽

Multivariable Analysis ◽

Recurrence Pattern ◽

Total Resection ◽

Who Grade ◽

Skull Base Meningiomas ◽

First Time ◽

Time Diagnosis

Background: To identify differences in the recurrence pattern of surgically-resected skull base meningiomas compared with superficial intra-cranial meningiomas Methods: A retrospective hospital-based study of all patients referred to our institution from 1990 to 2014 for surgical resection of meningiomas was conducted (both primary and recurrent cases). Survival analysis was performed using IBM SPSS v22.0. Results: Overal, 398 intra-cranial meningiomas –129 (32%) skull base - were reviewed. Skull base tumors had a lower MIB-1 index (p = 0.001) and were more likely to be WHO I (p = 0.003). Meningiomas in all locations demonstrated a recurrence rate of 30% at 100 months of follow-up. Afterwards, the recurrence of skull base meningiomas plateaued (longest follow-up: 250 months) whereas superficial lesions had a recurrence rate of 80% at 230 months (p = 0.02). In multivariable analysis, patients with a first-time diagnosis (p = 0.02), those with WHO I or II tumors (p= 0.02 and 0.05), and those with a total resection (p < 0.01) were less likely to experience a recurrence. Conclusions: Skull base meningiomas are less aggressive than superficial lesions and may not need to be followed beyond 100 months. The WHO grade, complete resection, and prior recurrence are predictive factors of recurrence.

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