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Meningioma Surgery and Functional Outcome

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (23 July 2023) | Viewed by 24249

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Special Issue Editor

Prof. Dr. Torstein R. Meling

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Guest Editor

1. Head of Department, Department of Neurosurgery, The National Hospital of Denmark, Copenhagen, Denmark
2. Istituto Nazionale Neurologico "C.Besta", 20133 Milan, Italy
Interests: meningioma; AVM; aneurysm; skull base; vascular neurosurgery; craniofacial malignancy; brain stem cavernoma

Special Issue Information

Dear Colleagues,

Intracranial meningiomas account for 25–35% of all primary tumors of the central nervous system in clinical practice and, over the past few decades, their diagnosis incidence has been increasing due to an ageing population and widespread use of MRI.

The primary treatment of meningiomas that are symptomatic or show growth on serial imaging is surgical resection, even at advanced ages, where the goal of surgery is maximal safe resection, aiming for a gross total resection. In stark contrast to outcome parameters such as extent of resection, complications, overall survival and progression-free survival, there is a paucity with respect to data on long-term functional outcomes of meningioma patients.

There is a growing interest in health-related quality of life (HrQoL) and functional disability (FD) in meningioma patients. The standard indicators of QoL relate to environment, education, leisure time as well as physical and mental health. Consequently, HrQoL is increasingly considered as a crucial element in the evaluation of treatment outcomes, wherefore systematic, standardized and uniform assessments must be advocated.

Our aim is to focus on the important topic of functional outcomes after surgery for meningiomas, not only with respect to long-term assessment of HrQoL and FD, but also neurological deficits and neurocognitive deficits. This Special Issue will include articles on the following topics:

HrQoL after meningioma surgery;
Functional disability after meningioma surgery;
Return to work after meningioma surgery;
Neurological deficits after meningioma surgery;
Neurocognitive deficits after meningioma surgery;
Patient-reported outcomes measures (PROMS) after meningioma surgery.

Prof. Torstein R. Meling
Guest Editor

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Keywords

meningioma
neurosurgery
quality of life
functional disability
return-to-work
neurological deficits
neuropsychology
outcome

Published Papers (14 papers)

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13 pages, 3218 KiB

Open AccessArticle

Predictors of Neurological Worsening after Resection of Spinal Meningiomas

by Dragan Jankovic, Darius Kalasauskas, Ahmed Othman, Marc A. Brockmann, Clemens J. Sommer, Florian Ringel and Naureen Keric

Cancers 2023, 15(22), 5408; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15225408 - 14 Nov 2023

Cited by 1 | Viewed by 831

Abstract

Background: Due to the slow-growing nature of spinal meningiomas, they are mostly asymptomatic for a long time, and become symptomatic after the compression of the spinal cord or nerve roots. The aim of this study was to identify predictors for a poor clinical outcome after the surgical resection of spinal meningiomas and thereby to allow a preoperative identification of high-risk spinal meningiomas. Methods: Data acquisition was conducted as a single-center retrospective analysis. From 1 January 2004 to 31 December 2019, 121 patients who underwent surgical resection of a spinal meningioma were reviewed. Clinical and radiological data (such as tumor size, location, occupation ratio of the spinal canal, and the degree of spinal cord compression) were assessed. The functional clinical findings of the patients were recorded using the Karnofsky Performance Score, modified McCormick scale, and Frankel scale preoperatively, at discharge, and 3–6 months after surgery. Results: The mean patient age was 66 ± 13 years. A total of 104 (86%) patients were female and 17 (14%) were male. The thoracic spine (68%) was the most common location, followed by the cervical (29%) and lumbar (3%) spine. Preoperatively, 11.7% of patients were categorized as McCormick 1, 35.8% as 2, 39.2% as 3, 11.7% as 4, and 1.7% as 5. The neurological function of the patients with a functional deficit prior to surgery improved in 46% of the patients, remained unchanged in 52%, and worsened in 2% at discharge. At early follow-up, the proportions were 54%, 28%, and 5%, respectively. Preoperative Frankel scale was a significant predictor of a postoperative deterioration. Patients with Frankel score A to C preoperatively had a 9.2 times higher chance of clinical deterioration postoperatively (OR = 9.16). We found that the Frankel scale weakly correlated with the degree of spinal cord compression. In this study, other radiological parameters, such as the degree of cord compression and spinal canal occupation ratio, did not show a significant effect on the outcome. Conclusions: Surgery of intraspinal meningiomas can be considered safe. Neurological function improves in a large proportion of patients after surgery. However, a relevant preoperative deficit according to the Frankel scale (grade A–C) was a significant predictor of a postoperative neurological deterioration. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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21 pages, 2892 KiB

Open AccessArticle

Impact of Shape Irregularity in Medial Sphenoid Wing Meningiomas on Postoperative Cranial Nerve Functioning, Proliferation, and Progression-Free Survival

by Johannes Wach, Johannes Naegeli, Martin Vychopen, Clemens Seidel, Alonso Barrantes-Freer, Ronny Grunert, Erdem Güresir and Felix Arlt

Cancers 2023, 15(12), 3096; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15123096 - 07 Jun 2023

Cited by 1 | Viewed by 1017

Abstract

Medial sphenoid wing meningiomas (MSWM) are surgically challenging skull base tumors. Irregular tumor shapes are thought to be linked to histopathology. The present study aims to investigate the impact of tumor shape on postoperative functioning, progression-free survival, and neuropathology. This monocentric study included 74 patients who underwent surgery for primary sporadic MSWM (WHO grades 1 and 2) between 2010 and 2021. Furthermore, a systematic review of the literature regarding meningioma shape and the MIB-1 index was performed. Irregular MSWM shapes were identified in 31 patients (41.9%). Multivariable analysis revealed that irregular shape was associated with postoperative cranial nerve deficits (OR: 5.75, 95% CI: 1.15–28.63, p = 0.033). In multivariable Cox regression analysis, irregular MSWM shape was independently associated with tumor progression (HR:8.0, 95% CI: 1.04–62.10, p = 0.046). Multivariable regression analysis showed that irregular shape is independently associated with an increased MIB-1 index (OR: 7.59, 95% CI: 2.04–28.25, p = 0.003). A systematic review of the literature and pooled data analysis, including the present study, showed that irregularly shaped meningiomas had an increase of 1.98 (95% CI: 1.38–2.59, p < 0.001) in the MIB-1 index. Irregular MSWM shape is independently associated with an increased risk of postoperative cranial nerve deficits and a shortened time to tumor progression. Irregular MSWM shapes might be caused by highly proliferative tumors. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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21 pages, 2165 KiB

Open AccessArticle

Long-Term Follow-Up, Treatment Strategies, Functional Outcome, and Health-Related Quality of Life after Surgery for WHO Grade 2 and 3 Intracranial Meningiomas

by Jenny Pettersson-Segerlind, Alexander Fletcher-Sandersjöö, Ann-Christin von Vogelsang, Oscar Persson, Lars Kihlström Burenstam Linder, Petter Förander, Tiit Mathiesen, Erik Edström and Adrian Elmi-Terander

Cancers 2022, 14(20), 5038; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14205038 - 14 Oct 2022

Cited by 4 | Viewed by 1459

Abstract

Progression-free survival (PFS) and overall survival (OS) for WHO grade 2 and 3 intracranial meningiomas are poorly described, and long-term results and data evaluating the routine use of supplementary fractionated radiotherapy (RT) or stereotactic radiosurgery (SRS) has been inconclusive. The aim of this study was to determine the long-term PFS and OS at a center that does not employ routine adjuvant RT. For this purpose, a retrospective population-based cohort study was conducted of all WHO grade 2 and 3 meningiomas surgically treated between 2005 and 2013. The cohort was uniformly defined according to the WHO 2007 criteria to allow comparisons to previously published reports. Patient records were reviewed, and patients were then prospectively contacted for structured quality-of-life assessments. In total, 51 consecutive patients were included, of whom 43 were WHO grade 2 and 8 were grade 3. A Simpson grade 1–2 resection was achieved in 62%. The median PFS was 31 months for grade 2 tumors, and 3.4 months for grade 3. The median OS was 13 years for grade 2, and 1.4 years for grade 3. The MIB-1-index was significantly associated with an increased risk for recurrence (p = 0.018, OR 1.12). The median PFS was significantly shorter for high-risk tumors compared to the low-risk group (10 vs. 46 months; p = 0.018). The surviving meningioma patients showed HRQoL measures comparable to that of the general population, with the exception of significantly more anxiety and depression. All patients who worked before surgery returned to work after their treatment. In conclusion, we confirm dismal prognoses in patients with grade 2 and 3 meningiomas, with tumor-related deaths resulting in severely reduced OS. However, the cohort was heterogenous, and a large subgroup of both grade 2 and 3 meningiomas was alive at 10 years follow-up, suggesting that a cure is possible. In addition, fractionated radiotherapy and chemotherapy had little benefit when introduced for recurrent and progressive diseases. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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15 pages, 968 KiB

Open AccessArticle

Surgical Treatment of Spinal Meningiomas in the Elderly (≥75 Years): Which Factors Affect the Neurological Outcome? An International Multicentric Study of 72 Cases

by Gabriele Capo, Alessandro Moiraghi, Valentina Baro, Nadim Tahhan, Alberto Delaidelli, Andrea Saladino, Luca Paun, Francesco DiMeco, Luca Denaro, Torstein Ragnar Meling, Enrico Tessitore and Cédric Yves Barrey

Cancers 2022, 14(19), 4790; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14194790 - 30 Sep 2022

Cited by 4 | Viewed by 1109

Abstract

(1) Background: With the increasing life expectancy in the Western world, an increasing number of old patients presents with spinal meningioma. Considering the benign nature of these tumors, the functional outcome remains of great importance, since more people reach old age in general conditions of well-being and satisfactory autonomy. (2) Methods: We conducted an international multicenter retrospective study to investigate demographic, clinical and radiological data in a population of elderly patients (≥75 years of age) undergoing surgery for SM from January 2000 to December 2020 in four European referral centers. The aim was to identify prognostic and predictive factors for a good postoperative functional outcome. (3) Results: 72 patients were included in the study. Complete tumor resection (Simpson I or II) was achieved in 67 (95.7%) cases. Intraoperative complications were reported in 7 (9.9%) patients while postoperative complications were found in 12 (16.7%). An excellent general postoperative status (McCormick I and II) was achieved in 65.3%. Overall, surgical resection had a good impact on patients’ functional outcome (86.1% either showing an improvement or maintaining a good preoperative status). Uni- and multivariate analyses found that both age and preoperative modified McCormick independently correlated with relative outcome (coeff = −0.058, p = 0.0251; coeff = 0.597, p < 0.0001) and with postoperative status (coeff = 0.058, p = 0.02507; coeff = 0.402, p = 0.00027), respectively. (4) Conclusions: Age and preoperative modified McCormick were found to be independent prognostic factors. Nevertheless, advanced age (≥75), per se, did not seem to contraindicate surgery, even in those with severe preoperative neurological deficits. The functional results sustain the need for surgical resection of SM in the elderly. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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16 pages, 1885 KiB

Open AccessArticle

Functional Outcome in Spinal Meningioma Surgery and Use of Intraoperative Neurophysiological Monitoring

by Christopher Marvin Jesse, Pablo Alvarez Abut, Jonathan Wermelinger, Andreas Raabe, Ralph T. Schär and Kathleen Seidel

Cancers 2022, 14(16), 3989; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14163989 - 18 Aug 2022

Cited by 10 | Viewed by 1584

Abstract

Data on intraoperative neurophysiological monitoring (IOM) during spinal meningioma (SM) surgery are scarce. The aim of this study was to assess the role of IOM and its impact on post-operative functional outcome. Eighty-six consecutive surgically treated SM patients were included. We assessed pre and post-operative Modified McCormick Scale (mMCS), radiological and histopathological data and IOM findings. Degree of cord compression was associated with preoperative mMCS and existence of motor or sensory deficits (p < 0.001). IOM was used in 51 (59.3%) patients (IOM-group). Median pre and post-operative mMCS was II and I, respectively (p < 0.001). Fifty-seven (66.3%) patients showed an improvement of at least one grade in the mMCS one year after surgery. In the IOM group, only one patient had worsened neurological status, and this was correctly predicted by alterations in evoked potentials. Analysis of both groups found no significantly better neurological outcome in the IOM group, but IOM led to changes in surgical strategy in complex cases. Resection of SM is safe and leads to improved neurological outcome in most cases. Both complication and tumor recurrence rates were low. We recommend the use of IOM in surgically challenging cases, such as completely ossified or large ventrolateral SM. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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16 pages, 963 KiB

Open AccessArticle

A Frailty-Adjusted Stratification Score to Predict Surgical Risk, Post-Operative, Long-Term Functional Outcome, and Quality of Life after Surgery in Intracranial Meningiomas

by Leonardo Tariciotti, Giorgio Fiore, Sara Carapella, Luigi Gianmaria Remore, Luigi Schisano, Stefano Borsa, Mauro Pluderi, Marco Canevelli, Giovanni Marfia, Manuela Caroli, Marco Locatelli and Giulio Bertani

Cancers 2022, 14(13), 3065; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14133065 - 22 Jun 2022

Cited by 6 | Viewed by 1617

Abstract

Object: To investigate those parameters affecting early and follow-up functional outcomes in patients undergoing resection of meningiomas and to design a dedicated predictive score, the Milan Bio(metric)-Surgical Score (MBSS) is hereby presented. Methods: Patients undergoing transcranial surgery for intracranial meningiomas were included. The most significant parameters in the regression analyses were implemented in a patient stratification score and were validated by testing its classification consistency with a clinical–radiological grading scale (CRGS), Milan complexity scale (MCS), and Charlson Comorbidity Index (CCI) scores. Results: The ASA score, Frailty index, skull base and posterior cranial fossa locations, a diameter of >25 mm, and the absence of a brain–tumour interface were predictive of early post-operative deterioration and were collected in MBSS Part A (AUC: 0.965; 95%C.I. 0.890–1.022), while the frailty index, posterior cranial fossa location, a diameter of >25 mm, a edema/tumour volume index of >2, dural sinus invasion, DWI hyperintensity, and the absence of a brain–tumour interface were predictive of a long-term unfavourable outcome and were collected in MBSS Part B (AUC: 0.877; 95%C.I. 0.811–0.942). The score was consistent with CRGS, MCS, and CCI. Conclusion: Patients’ multi-domain evaluation and the implementation of frailty indexes might help predict the perioperative complexity of cases; the functional, clinical, and neurological early outcomes; survival; and overall QoL after surgery. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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14 pages, 1284 KiB

Open AccessArticle

by Jenny Pettersson-Segerlind, Ann-Christin von Vogelsang, Alexander Fletcher-Sandersjöö, Charles Tatter, Tiit Mathiesen, Erik Edström and Adrian Elmi-Terander

Cancers 2021, 13(24), 6371; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13246371 - 19 Dec 2021

Cited by 13 | Viewed by 2183

Abstract

Spinal meningiomas are the most common primary spinal intradural tumor. This study aimed to assess Health-related quality of life (HRQoL) and the frequency of return to work in patients surgically treated for spinal meningiomas, in comparison to the general population. Variables were collected from patient charts, EQ-5D-3L, and study specific questionnaires. Patients who had been operated between 2005–2017 were identified in a previous study and those alive in 2020 (104 of 129) were asked to participate. Eighty-four patients (80.8%) with a mean follow-up of 8.7 years, responded and were included. Data was compared to the Stockholm Public Health Survey 2006, a cross-sectional survey of a representative sample of the general population. Analysis for potential non-response bias showed no significant differences. Women in the meningioma sample scored more problems than men with regards to mobility (p = 0.048). There were no significant differences concerning EQ-5D_index (p = 0.325) or EQ_VAS (p = 0.116). The correlation between follow-up time and EQ-5D_index was low (r = 0.167). When comparing HRQoL to the general population sample, no significant differences were found within the EQ-5D-3L dimensions, EQ-5D_index or EQVAS. Those who postoperatively scored 3–5 on mMCs scored significantly more problems in the EQ-5D-3L dimension mobility (p = 0.023). Before surgery, 41 (48.8%) of the spinal meningioma patients were working and after surgery all returned to work, the majority within three months. Seventy-eight (96%) of the patients would accept surgery for the same diagnosis if asked today. We conclude that surgery for spinal meningiomas is associated with good long-term HRQoL and a high frequency of return to work. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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14 pages, 2279 KiB

Open AccessArticle

Clinical Outcomes Following Re-Operations for Intracranial Meningioma

by George E. Richardson, Conor S. Gillespie, Mohammad A. Mustafa, Basel A. Taweel, Ali Bakhsh, Siddhant Kumar, Sumirat M. Keshwara, Tamara Ali, Bethan John, Andrew R. Brodbelt, Emmanuel Chavredakis, Samantha J. Mills, Chloë May, Christopher P. Millward, Abdurrahman I. Islim and Michael D. Jenkinson

Cancers 2021, 13(19), 4792; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13194792 - 24 Sep 2021

Cited by 8 | Viewed by 2184

Abstract

The outcomes following re-operation for meningioma are poorly described. The aim of this study was to identify risk factors for a performance status outcome following a second operation for a recurrent meningioma. A retrospective, comparative cohort study was conducted. The primary outcome measure was World Health Organization performance. Secondary outcomes were complications, and overall and progression free survival (OS and PFS respectively). Baseline clinical characteristics, tumor details, and operation details were collected. Multivariable binary logistic regression was used to identify risk factors for performance status outcome following a second operation. Between 1988 and 2018, 712 patients had surgery for intracranial meningiomas, 56 (7.9%) of which underwent a second operation for recurrence. Fifteen patients (26.8%) had worsened performance status after the second operation compared to three (5.4%) after the primary procedure (p = 0.002). An increased number of post-operative complications following the second operation was associated with a poorer performance status following that procedure (odds ratio 2.2 [95% CI 1.1–4.6]). The second operation complication rates were higher than after the first surgery (46.4%, n = 26 versus 32.1%, n = 18, p = 0.069). The median OS was 312.0 months (95% CI 257.8–366.2). The median PFS following the first operation was 35.0 months (95% CI 28.9–41.1). Following the second operation, the median PFS was 68.0 months (95% CI 49.1–86.9). The patients undergoing a second operation for meningioma had higher rates of post-operative complications, which is associated with poorer clinical outcomes. The decisions surrounding second operations must be balanced against the surgical risks and should take patient goals into consideration. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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13 pages, 4033 KiB

Open AccessArticle

Spinal Meningiomas: Influence of Cord Compression and Radiological Features on Preoperative Functional Status and Outcome

by Valentina Baro, Alessandro Moiraghi, Valentina Carlucci, Luca Paun, Mariagiulia Anglani, Mario Ermani, Andrea Saladino, Franco Chioffi, Domenico d’Avella, Andrea Landi, Andrea Bartoli, Francesco DiMeco, Karl Schaller, Luca Denaro and Enrico Tessitore

Cancers 2021, 13(16), 4183; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13164183 - 20 Aug 2021

Cited by 9 | Viewed by 2346

Abstract

Background: Radiological parameters predicting the postoperative neurological outcome after resection of a spinal meningioma (SM) are poorly studied, with controversial results. Methods: Observational multicenter cohort (2011–2018) of adult patients undergoing surgery for resection of SM. Tumor-canal volume ratio (TCR), the areas related to the cord and tumor occupancy at maximum compression, the presence of dural tail, calcifications, signs of myelopathy, and postoperative cord expansion were compared with the modified McCormick scale (mMCS) preoperative and at follow-up. Results: In the cohort (n = 90 patients), cord and tumor occupancy as well as cord compression and tumor volume showed a correlation with preoperative mMCS (p < 0.05, R −0.23; p < 0.001, R 0.35; p < 0.005, R −0.29; p < 0.001, R 0.42). Cord occupancy had a strong correlation with cord compression (p < 0.001, R 0.72). Tumor occupancy and TCR were correlated with relative outcome at follow-up (p < 0.005 R 0.3; p < 0.005 R 0.29). No correlation was found between cord re-expansion and clinical outcome at follow-up. Finally, a correlation was shown between preoperative signs of cord myelopathy and mMCS (p < 0.05 R 0.21) at follow-up. Conclusions: Larger tumors showed lower preoperative functional status and a worse clinical outcome. Moreover, preoperative T2 cord signal changes are correlated with a poorer outcome. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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11 pages, 2175 KiB

Open AccessArticle

Neuropsychological Outcomes after Surgery for Olfactory Groove Meningiomas

by Paul E. Constanthin, Renato Gondar, Julia Fellrath, Isaline Mottet Wyttenbach, Karima Tizi, Leo Weman, Pia Vayssière, Karl Schaller and Torstein R. Meling

Cancers 2021, 13(11), 2520; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13112520 - 21 May 2021

Cited by 4 | Viewed by 2369

Abstract

Background: In recent years, several studies have reported abnormal pre- and postoperative neuropsychological functioning in patients with meningiomas located in the prefrontal cortex (notably the ventromedial region). In the case of olfactory groove meningiomas, the tumor is in direct contact with the inferior aspect of the prefrontal cortex, a cortical region with crucial roles in decision-making, cognition and memory functions, potentially negatively impacting neuropsychological functions. Materials and Methods: We retrospectively compared pre- and post-operative neuropsychological testing of 17 patients undergoing surgical removal of olfactory groove meningiomas in our institution between January 2013 and December 2018. Neuropsychological results were obtained from the patients’ medical history and normalized as z-scores of their respective cognitive functions. Results: Assessment of cognitive follow-up showed an important heterogeneity among patients. Pre-operative cognitive impairment was observed in most patients, particularly in cognitive flexibility (mean z-score: −1.35). Immediate post-operative cognitive status showed an overall impairment in all domains of cognition, significant for the domains of attention (p = 0.0273) and flexibility (p = 0.0234) and almost significant for the domain of language (p = 0.0547). The late follow-up at one year showed a trend towards general improvement, although attention and flexibility remained impaired. Discussion: Olfactory groove meningiomas impact pre-frontal cortex cognitive functions, particularly in the domain of cognitive flexibility. After an initial postoperative worsening, patients tended to improve in most aspects after one year, aside from cognitive flexibility and attention. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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28 pages, 1105 KiB

Open AccessSystematic Review

by Ali San, Raphia K. Rahman, Praveen Sanmugananthan, Michael D. Dubé, Nicholas Panico, Ogechukwu Ariwodo, Vidur Shah and Randy S. D’Amico

Cancers 2023, 15(19), 4680; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15194680 - 22 Sep 2023

Viewed by 1142

Abstract

Patients with meningiomas may have reduced health-related quality of life (HRQoL) due to postoperative neurological deficits, cognitive dysfunction, and psychosocial burden. Although advances in surgery and radiotherapy have improved progression-free survival rates, there is limited evidence regarding treatment outcomes on HRQoL. This review examines HRQoL outcomes based on tumor location and treatment modality. A systematic search in PubMed yielded 28 studies with 3167 patients. The mean age was 54.27 years and most patients were female (70.8%). Approximately 78% of meningiomas were located in the skull base (10.8% anterior, 23.3% middle, and 39.7% posterior fossae). Treatment modalities included craniotomy (73.6%), radiotherapy (11.4%), and endoscopic endonasal approach (EEA) (4.0%). The Karnofsky Performance Scale (KPS) was the most commonly utilized HRQoL instrument (27%). Preoperative KPS scores > 80 were associated with increased occurrence of postoperative neurological deficits. A significant difference was found between pre- and post-operative KPS scores for anterior/middle skull base meningiomas (SBMs) in comparison to posterior (SBMs) when treated with craniotomy. Post-craniotomy SF-36 scores were lower for posterior SBMs in comparison to those in the anterior and middle fossae. Risk factors for poor neurological outcomes include a high preoperative KPS score and patients with posterior SBMs may experience a greater burden in HRQoL. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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19 pages, 1039 KiB

Open AccessSystematic Review

Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1)

by Victor Gabriel El-Hajj, Jenny Pettersson-Segerlind, Alexander Fletcher-Sandersjöö, Erik Edström and Adrian Elmi-Terander

Cancers 2022, 14(24), 6251; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14246251 - 19 Dec 2022

Cited by 10 | Viewed by 1481

Abstract

Background: Spinal meningiomas are the most common primary intradural spinal tumors. Although they are a separate entity, a large portion of the knowledge on spinal meningiomas is based on findings in intracranial meningiomas. Therefore, a comprehensive review of all the literature on spinal meningiomas was performed. Methods: Electronic databases were searched for all studies on spinal meningiomas dating from 2000 and onward. Findings of matching studies were pooled to strengthen the current body of evidence. Results: A total of 104 studies were included. The majority of patients were female (72.83%), elderly (peak decade: seventh), and had a world health organization (WHO) grade 1 tumor (95.7%). Interestingly, the minority of pediatric patients had a male overrepresentation (62.0% vs. 27.17%) and higher-grade tumors (33.3% vs. 4.3%). Sensory and motor dysfunction and pain were the most common presenting symptoms. Despite a handful of studies reporting promising findings associated with the use of non-surgical treatment options, the literature still suffers from contradictory results and limitations of study designs. Conclusions: Elderly females with WHO grade 1 tumors constituted the stereotypical type of patient. Compared to surgical alternatives, the evidence for the use of non-surgical treatments is still relatively weak. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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26 pages, 2567 KiB

Open AccessSystematic Review

Current Knowledge on Spinal Meningiomas—Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2)

by Victor Gabriel El-Hajj, Jenny Pettersson-Segerlind, Alexander Fletcher-Sandersjöö, Erik Edström and Adrian Elmi-Terander

Cancers 2022, 14(24), 6221; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14246221 - 16 Dec 2022

Cited by 8 | Viewed by 1338

Abstract

Background: Most of the knowledge on spinal meningiomas is extrapolated from their intracranial counterparts, even though they are considered separate entities. This review aimed to systematically summarize studies covering different aspects of spinal meningiomas and their management. Methods: Databases were searched for all studies concerning spinal meningiomas dating from 2000 and onwards. When possible, a meta-analysis was performed. Results: Neurological outcomes of surgery were consistently favorable across studies, with a complication rate of 7.9% and 78.9% of the patients demonstrating good postoperative neurological function (McCormick score 1–2). The most relevant predictors of unfavorable outcomes were poor preoperative status, longer time from diagnosis to surgery, and surgery of recurrent tumors. The recurrence rate after surgery was estimated at 6%. Meta-analysis and/or survival analysis revealed that higher WHO grade (p < 0.001), higher Simpson grade (p < 0.001), ventral tumor location (p = 0.02), and male sex (p = 0.014) were all associated with higher odds of recurrence. However, the meta-analysis did not show any difference between Simpson grade 1 and grade 2 with respect to the odds of recurrence (p = 0.94). Surgery provided immediate and durable health-related quality-of-life improvement, as well as a high frequency of return to work. Conclusion: Spinal meningioma surgery is a relatively safe procedure with a low risk of tumor recurrence and high likelihood of favorable postoperative outcomes. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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14 pages, 711 KiB

Open AccessSystematic Review

Management of Recurrent Meningiomas: State of the Art and Perspectives

by Marco Vincenzo Corniola and Torstein R. Meling

Cancers 2022, 14(16), 3995; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14163995 - 18 Aug 2022

Cited by 3 | Viewed by 1553

Abstract

Background: While meningiomas often recur over time, the natural history of repeated recurrences and their management are not well described. Should recurrence occur, repeat surgery and/or use of adjuvant therapeutic options may be necessary. Here, we summarize current practice when it comes to meningioma recurrence after initial surgical management. Methods: A total of N = 89 articles were screened. N = 41 articles met the inclusion criteria and N = 16 articles failed to assess management of meningioma recurrence. Finally, N = 24 articles were included in our review. Results: The articles were distributed as follows: studies on chemotherapy (N = 14), radiotherapy, protontherapy, and stereotaxic radiosurgery (N = 6), boron-neutron capture therapy (N = 2) and surgery (N = 3). No study seems to provide serious alternatives to surgery in terms of progression-free and overall survival. Recurrence can occur long after the initial surgery and also affects WHO grade 1 meningiomas, even after initial gross total resection at first surgery, emphasizing the need for a long-term and comprehensive follow-up. Conclusions: Surgery still seems to be the state-of-the-art management when it comes to meningioma recurrence, since none of the non-surgical alternatives show promising results in terms of progression-free and overall survival. Full article

(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)

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