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

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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Radiosurgery for large-volume (> 10 cm3) benign meningiomas

Journal of Neurosurgery ◽

10.3171/2009.8.jns09703 ◽

2010 ◽

Vol 112 (5) ◽

pp. 951-956 ◽

Cited By ~ 34

Author(s):

Jonathan M. Bledsoe ◽

Michael J. Link ◽

Scott L. Stafford ◽

Paul J. Park ◽

Bruce E. Pollock

Keyword(s):

Skull Base ◽

Large Volume ◽

Tumor Control ◽

Skull Base Tumors ◽

Who Grade ◽

Average Tumor Volume ◽

The Mean ◽

Skull Base Meningiomas ◽

Supratentorial Tumors

Object Stereotactic radiosurgery (SRS) has proven to be a safe and effective treatment for many patients with intracranial meningiomas. Nevertheless, the morbidity associated with radiosurgery of larger meningiomas is poorly understood. Methods The authors performed a retrospective review of 116 patients who underwent SRS for meningiomas (WHO Grade I) > 10 cm3 between 1990 and 2007, with a minimum follow-up of 12 months. Patients with atypical or malignant meningiomas and those who received prior radiotherapy were excluded. The average tumor volume was 17.5 cm3 (range 10.1–48.6 cm3); the average tumor margin dose was 15.1 Gy (range 12–18 Gy); and the mean follow-up duration was 70.1 months (range 12–199 months). Results Tumor control was 99% at 3 years and 92% at 7 years after radiosurgery. Thirty complications after radiosurgery were noted in 27 patients (23%), including 7 cases of seizures, 6 cases of hemiparesis, 5 cases of trigeminal injury, 4 cases of headaches, 3 cases of diplopia, 2 cases each of cerebral infarction and ataxia, and 1 case of hearing loss. Patients with supratentorial tumors experienced a higher complication rate compared with patients with skull base tumors (44% compared with 18%) (hazard ratio 2.9, 95% CI 1.3–6.7, p = 0.01). Conclusions The morbidity associated with SRS for patients with benign meningiomas > 10 cm3 is greater for supratentorial tumors compared with skull base tumors. Whereas radiosurgery is relatively safe for patients with large-volume skull base meningiomas, resection should remain the primary disease management for the majority of patients with large-volume supratentorial meningiomas.

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Slower growth of skull base meningiomas compared with non–skull base meningiomas based on volumetric and biological studies

Journal of Neurosurgery ◽

10.3171/2011.11.jns11999 ◽

2012 ◽

Vol 116 (3) ◽

pp. 574-580 ◽

Cited By ~ 57

Author(s):

Naoya Hashimoto ◽

Carter S. Rabo ◽

Yoshiko Okita ◽

Manabu Kinoshita ◽

Naoki Kagawa ◽

...

Keyword(s):

Natural History ◽

Skull Base ◽

Biological Behavior ◽

Skull Base Tumor ◽

Skull Base Tumors ◽

Biological Studies ◽

History Of ◽

Skull Base Meningiomas ◽

Mib 1

Object The precise natural history of incidentally discovered meningiomas (IDMs) remains unknown. It has been reported that for symptomatic meningiomas, tumor location can be used to predict growth. As to whether the same is true for IDMs has not been reported. This study aims to answer this question and provide biological evidence for this assumption by extending the study to involve symptomatic cases. Methods A total of 113 IDMs were analyzed by fine volumetry. A comparison of growth rates and patterns between skull base and non–skull base IDMs was made. Subsequently, materials obtained from 210 patients with symptomatic meningiomas who were treated in the authors' hospital during the same period were included for a biological comparison between skull base and non–skull base tumors using the MIB-1 index. Results The 110 patients with IDMs included 93 females and 17 males, with a mean follow-up period of 46.9 months. There were 38 skull base (34%) and 75 non–skull base (66%) meningiomas. Forty-two (37%) did not exhibit growth of more than 15% of the volume, whereas 71 (63%) showed growth. Only 15 (39.5%) of 38 skull base meningiomas showed growth, whereas 56 (74.7%) of 75 non–skull base meningiomas showed growth (p = 0.0004). In the 71 IDMs (15 skull base and 56 non–skull base), there was no statistical difference between the 2 groups in terms of mean age, sex, follow-up period, or initial tumor volume. However, the percentage of growth (p = 0.002) was significantly lower and the doubling time (p = 0.008) was significantly higher in the skull base than in the non–skull base tumor group. In subsequently analyzed materials from 94 skull base and 116 non–skull base symptomatic meningiomas, the mean MIB-1 index for skull base tumors was markedly low (2.09%), compared with that for non–skull base tumors (2.74%; p = 0.013). Conclusions Skull base IDMs tend not to grow, which is different from non–skull base tumors. Even when IDMs grow, the rate of growth is significantly lower than that of non–skull base tumors. The same conclusion with regard to biological behavior was confirmed in symptomatic cases based on MIB-1 index analyses. The authors' findings may impact the understanding of the natural history of IDMs, as well as strategies for management and treatment of IDMs and symptomatic meningiomas.

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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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A comparison of World Health Organization tumor grades at recurrence in patients with non–skull base and skull base meningiomas

Journal of Neurosurgery ◽

10.3171/2009.9.jns09617 ◽

2010 ◽

Vol 112 (5) ◽

pp. 925-933 ◽

Cited By ~ 57

Author(s):

Susan L. McGovern ◽

Kenneth D. Aldape ◽

Mark F. Munsell ◽

Anita Mahajan ◽

Franco DeMonte ◽

...

Keyword(s):

Skull Base ◽

Labeling Index ◽

World Health ◽

Skull Base Tumors ◽

Who Grade ◽

Grade Ii ◽

Health Organization ◽

Skull Base Meningiomas ◽

Mib 1

Object Despite a favorable outcome for most patients with WHO Grade I meningiomas, a subset of these patients will have recurrent or progressive disease that advances to a higher grade and requires increasingly aggressive therapy. The goal of this study was to identify clinical characteristics associated with the recurrence of benign meningiomas and their acceleration to atypical and malignant histological types. Methods Records of 216 patients with WHO Grade I, II, or III meningioma that were initially treated between 1965 and 2001 were retrospectively reviewed. Median follow-up was 7.2 years. Results Patients with non–skull base cranial meningiomas (82 of 105 [78%]) were more likely to have undergone a gross-total resection than patients with skull base meningiomas (32 of 78 [41%]; p < 0.001). Consequently, patients with Grade I non–skull base cranial meningiomas had better 5-year recurrence-free survival (69%) than patients with Grade I skull base meningiomas (56%) or Grade II or III tumors at any site (50%; p = 0.005). Unexpectedly, patients with non–skull base tumors who experienced a recurrence (8 of 22 [36%]) were more likely than patients with skull base tumors (1 of 19 [5%]) to have a higher grade tumor at recurrence (p = 0.024). Furthermore, the median MIB-1 labeling index of Grade I non–skull base cranial meningiomas (2.60%) was significantly higher than that of Grade I skull base tumors (1.35%; p = 0.016). Conclusions Cranial meningiomas that occur outside of the skull base are more likely to have a higher MIB-1 labeling index and recur with a higher grade than those within the skull base, suggesting that non–skull base cranial tumors may have a more aggressive biology than skull base tumors.

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High Efficacy of Fractionated Stereotactic Radiotherapy of Large Base-of-Skull Meningiomas: Long-Term Results

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.15.3547 ◽

2001 ◽

Vol 19 (15) ◽

pp. 3547-3553 ◽

Cited By ~ 197

Author(s):

Juergen Debus ◽

Martina Wuendrich ◽

Andrea Pirzkall ◽

Angelika Hoess ◽

Wolfgang Schlegel ◽

...

Keyword(s):

Skull Base ◽

Stereotactic Radiotherapy ◽

Fractionated Stereotactic Radiotherapy ◽

World Health ◽

Long Term Results ◽

Subtotal Resection ◽

Who Grade ◽

Skull Base Meningiomas

PURPOSE: Large skull-base meningiomas are difficult to treat due to their proximity or adherence to critical structures. We analyzed the long-term results of patients with skull-base meningiomas treated by a new approach with high-precision fractionated stereotactic radiotherapy. PATIENTS AND METHODS: One hundred eighty-nine patients with benign meningiomas were treated with conformal fractionated stereotactic radiotherapy between 1985 and 1998. Patients were undergoing a course of radiotherapy either as primary treatment, following subtotal resection, or for recurrent disease. The median target volume was 52.5 mL (range, 5.2 to 370 mL). The mean radiation dose was 56.8 Gy (± 4.4 Gy). Follow-up examinations, including magnetic resonance imaging, were performed at 6-month intervals thereafter. RESULTS: The median follow-up period was 35 months (range, 3 months to 12 years). Overall actuarial survival for patients with World Health Organization (WHO) grade I meningiomas was 97% after 5 years and 96% after 10 years. Local tumor failure was observed in three of 180 patients with WHO grade I tumors and was significantly higher in two of nine patients with WHO grade II tumors. A volume reduction of more than 50% was observed in 26 patients (14%). Preexisting cranial nerve symptoms resolved completely in 28% of the patients. Clinically significant treatment-induced toxicity was seen in 1.6% of the patients. No treatment-related deaths occurred. CONCLUSION: The results of this study demonstrate that fractionated stereotactic radiotherapy is safe and effective in the therapy of subtotally resected or unresectable meningiomas. The overall morbidity and incidence subacute and late side effects of this conformal radiotherapy approach were low.

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Pediatric Skull Base Meningiomas

Journal of Child Neurology ◽

10.1177/0883073816664669 ◽

2016 ◽

Vol 31 (14) ◽

pp. 1523-1527 ◽

Cited By ~ 3

Author(s):

Zhicen Li ◽

Hao Li ◽

Shuo Wang ◽

Jizong Zhao ◽

Yong Cao

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Skull Base ◽

Study Group ◽

Overall Survival Rate ◽

Initial Operation ◽

Who Grade ◽

Entire Cohort ◽

Skull Base Meningiomas

The purpose of this study is to investigate the clinical, pathological, and prognostic characteristics of pediatric skull base meningiomas. A retrospective analysis of 44 pediatric skull base patients younger than 18 years who underwent surgery at Beijing Tiantan Hospital was performed. The study group included 20 males and 24 females. Multiple lesions were seen in 8 patients. WHO grade I was found in 28 patients and higher grade was seen in 16 patients. Recurrence or progression occurred in 10 patients after the initial operation. The overall survival rate in the follow-up period for the entire cohort was 89.7%. The authors found no sex predominance in pediatric skull base meningiomas. In addition, this lesion was more often seen in their second decades. In contrast to skull base meningiomas in adult patients, pediatric skull base meningiomas had a higher incidence of nonbenign histopathological variants and a higher rate of recurrence.

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Gamma Knife radiosurgery of large skull base meningiomas

Journal of Neurosurgery ◽

10.3171/2014.10.jns14198 ◽

2015 ◽

Vol 122 (2) ◽

pp. 363-372 ◽

Cited By ~ 34

Author(s):

Robert M. Starke ◽

Colin J. Przybylowski ◽

Mukherjee Sugoto ◽

Francis Fezeu ◽

Ahmed J. Awad ◽

...

Keyword(s):

Tumor Progression ◽

Skull Base ◽

Stereotactic Radiosurgery ◽

Tumor Volume ◽

Gamma Knife Radiosurgery ◽

Neurological Function ◽

Tumor Control ◽

History Of ◽

Skull Base Meningiomas

OBJECT Stereotactic radiosurgery (SRS) has become a common treatment modality for intracranial meningiomas. Skull base meningiomas greater than 8 cm3 in volume have been found to have worse outcomes following SRS. When symptomatic, patients with these tumors are often initially treated with resection. For tumors located in close proximity to eloquent structures or in patients unwilling or unable to undergo a resection, SRS may be an acceptable therapeutic approach. In this study, the authors review the SRS outcomes of skull base meningiomas greater than 8 cm3 in volume, which corresponds to a lesion with an approximate diameter of 2.5 cm. METHODS The authors reviewed the data in a prospectively compiled database documenting the outcomes of 469 patients with skull base meningiomas treated with single-session Gamma Knife radiosurgery (GKRS). Seventy-five patients had tumors greater than 8 cm3 in volume, which was defined as a large tumor. All patients had a minimum follow-up of 6 months, but patients were included if they had a complication at any time point. Thirty patients were treated with upfront GKRS, and 45 were treated following microsurgery. Patient and tumor characteristics were assessed to determine predictors of new or worsening neurological function and tumor progression following GKRS. RESULTS After a mean follow-up of 6.5 years (range 0.5–21 years), the tumor volume was unchanged in 37 patients (49%), decreased in 26 patients (35%), and increased in 12 patients (16%). Actuarial rates of progression-free survival at 3, 5, and 10 years were 90.3%, 88.6%, and 77.2%, respectively. Four patients had new or worsened edema following GKRS, but preexisting edema decreased in 3 patients. In Cox multivariable analysis, covariates associated with tumor progression were 1) presentation with any cranial nerve (CN) deficit from III to VI (hazard ratio [HR] 3.78, 95% CI 1.91–7.45; p < 0.001), history of radiotherapy (HR 12.06, 95% CI 2.04–71.27; p = 0.006), and tumor volume greater than 14 cm3 (HR 6.86, 95% CI 0.88–53.36; p = 0.066). In those patients with detailed clinical follow-up (n = 64), neurological function was unchanged in 37 patients (58%), improved in 16 patients (25%), and deteriorated in 11 patients (17%). In multivariate analysis, the factors predictive of new or worsening neurological function were history of surgery (OR 3.00, 95% CI 1.13–7.95; p = 0.027), presentation with any CN deficit from III to VI (OR 3.94, 95% CI 1.49–10.24; p = 0.007), and decreasing maximal dose (OR 0.76, 95% CI 0.63–0.93; p = 0.007). Tumor progression was present in 64% of patients with new or worsening neurological decline. CONCLUSIONS Stereotactic radiosurgery affords a reasonable rate of tumor control for large skull base meningiomas and does so with a low incidence of neurological deficits. Those with a tumor less than 14 cm3 in volume and without presenting CN deficit from III to VI were more likely to have effective tumor control.

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Predictors of Survival in Subtotally Resected WHO Grade I Skull Base Meningiomas

Cancers ◽

10.3390/cancers13061451 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1451

Author(s):

Michele Da Broi ◽

Paola Borrelli ◽

Torstein R. Meling

Keyword(s):

Skull Base ◽

Clinical Outcomes ◽

Karnofsky Performance Status ◽

Performance Status ◽

Multivariable Analysis ◽

Advanced Age ◽

Final Visit ◽

Subtotal Resection ◽

Who Grade ◽

Skull Base Meningiomas

Background: Although gross total resection (GTR) is the goal in meningioma surgery, this can sometimes be difficult to achieve in skull base meningiomas. We analyzed clinical outcomes and predictors of survival for subtotally resected benign meningiomas. Methods: A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between 1990–2010 were investigated. Results: Median age was 57.7 [IQR 18.8] years, median preoperative Karnofsky performance status (KPS) was 80.0 [IQR 20.0], 75 patients (35.4%) had posterior fossa meningioma. After a median follow-up of 6.2 [IQR 7.9] years, retreatment (either radiotherapy or repeated surgery) rate was 16% at 1-year, 27% at 3-years, 34% at 5-years, and 38% at 10-years. Ten patients (4.7%) died perioperatively, 9 (3.5%) had postoperative hematomas, and 2 (0.8%) had postoperative infections. Neurological outcome at final visit was improved/stable in 122 patients (70%). Multivariable analysis identified advanced age and preoperative KPS < 70 as negative predictors for overall survival (OS). Patients who underwent retreatment had no significant reduction of OS. Conclusions: Advanced age and preoperative KPS were independent predictors of OS. Retreatments did not prolong nor shorten the OS. Clinical outcomes in STR skull base meningiomas were generally worse compared to cohorts with high rates of GTR.

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Short diameter may be a useful simple indicator of the tumor response in skull base meningiomas after conventionally fractionated stereotactic radiotherapy

European Radiology ◽

10.1007/s00330-021-07707-1 ◽

2021 ◽

Author(s):

Keiichi Takehana ◽

Daisuke Nakamura ◽

Alshaymaa Abdelghaffar ◽

Megumi Uto ◽

Tomohiro Katagiri ◽

...

Keyword(s):

Skull Base ◽

Stereotactic Radiotherapy ◽

Tumor Volume ◽

Tumor Response ◽

Fractionated Stereotactic Radiotherapy ◽

Skull Base Meningioma ◽

Skull Base Meningiomas ◽

Simple Indicator ◽

Conventionally Fractionated

Abstract Objectives The purpose of this study was to assess the radiological change patterns in skull base meningiomas after conventionally fractionated stereotactic radiotherapy (CFSRT) to determine a simple and valid method to assess the tumor response. Materials and methods Forty-one patients with a benign skull base meningioma treated by CFSRT from March 2007 to August 2015 were retrospectively evaluated. We measured tumor volume (TV), long-axis diameter (LD), and short-axis diameter (SD) on both pre-treatment images and follow-up images of 1, 3, and 5 years after CFSRT, respectively. The paired t test was used to detect differences in the LD and SD change rates. Spearman’s correlation coefficients were calculated to evaluate relationships between the TV and the diameters changes. Results The number of available follow-up MRIs that was performed at 1, 3, and 5 years after the CFSRT was 41 (100%), 34 (83%), and 23 (56%), respectively. The change rates of SD were significantly higher than those of LD at every time point and more strongly correlated with the change rates of tumor volume at 3 and 5 years after CFSRT. Conclusions SD may be useful as a simple indicator of the tumor response for skull base meningioma after CFSRT. Key Points • The change rate in short-axis diameter is a useful and simple indicator of the response of skull base meningioma to conventionally fractionated stereotactic radiotherapy. • Conventionally fractionated stereotactic radiotherapy for skull base meningioma achieved excellent 5-year local control.

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Abstract P011: Heart Failure and the Obesity Paradox Among Participants in the in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap011 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Raegan W Durant ◽

Todd M Brown ◽

Emily B Levitan ◽

Joshua S Richman ◽

Nicole Redmond ◽

...

Keyword(s):

Heart Failure ◽

Health Behaviors ◽

Normal Weight ◽

Community Dwelling ◽

Prior History ◽

Central Adiposity ◽

All Cause Mortality ◽

History Of ◽

Regards Study

Background: Overweight and obese adults living with heart failure (HF) have lower mortality compared to those of normal weight. However, the specific relationships of overall weight status and central adiposity with mortality among those with HF are less well-defined. We examined the relationships among body mass index (BMI), waist circumference (WC) and mortality among patients hospitalized for HF in the REGARDS Study. Methods: REGARDS is a national cohort of US community-dwelling adults aged >45 recruited from 2003 to 2007. We measured all-cause mortality rates among 565 participants hospitalized with HF who were normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), or obese (BMI > 30.0 kg/m 2 ) at baseline. Underweight participants (BMI < 18.5 kg/m 2 ) were excluded. Baseline WC, weight, and height were measured during an in-home exam. Index HF hospitalizations during follow-up were adjudicated by a panel of experts. Vital status was determined using the Social Security Death Index or the National Death Index. Cox proportional models estimated hazard ratios for all-cause mortality following the index HF hospitalization. Models were sequentially adjusted for WC, sociodemographics, HF severity (EF and BNP during HF hospitalization, prior history of HF, prior history of diastolic dysfunction), comorbidities, and health behaviors. Results: Among 565 participants hospitalized for HF, 116 (21%) were normal weight, 209 (37%) overweight, and 240 (42%) obese at baseline. Over a mean follow-up of 2.5 years, 253 deaths occurred. In multivariable analyses, overweight was associated with lower all-cause mortality in all models (Table). Each 1-cm increase in WC was associated with higher risk of all-cause mortality, but the relationship was not statistically significant after health behaviors were added in the final model. . Conclusions: Among adults hospitalized for HF, overweight as assessed by BMI may be associated with lower risk for mortality. However, central adiposity may confer higher risk of mortality.

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