Skull Base 2007; 17(3): 157-171
DOI: 10.1055/s-2007-970554
ORIGINAL ARTICLE

Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Predicting the Probability of Meningioma Recurrence in the Preoperative and Early Postoperative Period: A Multivariate Analysis in the Midterm Follow-Up

Faruk İldan1 , Tahsin Erman1 , A. İskender Göçer1 , Metin Tuna1 , Hüseyin Bağdatoğlu1 , Erdal Çetinalp1 , Refik Burgut2
  • 1Department of Neurosurgery, Çukurova University, School of Medicine, Adana, Turkey
  • 2Department of Biostatistics, Çukurova University, School of Medicine, Adana, Turkey
Further Information

Publication History

Publication Date:
23 March 2007 (online)

ABSTRACT

We reviewed the clinical, radiological, surgical, and histopathological features of patients with meningiomas to identify factors that can predict tumor recurrence after “microscopic total removal,” to improve preoperative surgical planning, and to help determine the need for close radiological observation at shorter intervals or the need for radiotherapy as an adjuvant treatment in the early postoperative period. Clinical data, magnetic resonance imaging studies, angiographic data, operative reports, and histopathological findings were examined retrospectively in 137 patients with a meningioma treated microsurgically and with no evidence of residual tumor on postoperative MR images. Based on univariate analysis, tumor size, a mushroom shape, proximity to major sinuses, edema, osteolysis, cortical penetration, signal intensity on T2-weighted MRIs, pial-cortical arterial supply, presence of a brain-tumor interface in surgery, Simpson's criteria, and histopathological classification were significant predictors for recurrence. However, age, gender, location of tumor, dural tail, calcification, signal intensity on T1-weighted images, and histopathologic subtypes in the benign group were not significant predictors. By Cox regression analysis the most important variables related to the time to recurrence were mushroom shape, osteolysis, dural tail, and proximity to major sinuses. Aggressive surgical therapy with wider dural removal should be considered in the presence of the preoperative predictors of a recurrence. Close radiological observation at shorter intervals or radiotherapy should be considered as adjuvant therapy in high-risk patients based on surgical findings predicting recurrence related to the brain-tumor interface, Simpson's criteria, and histopathological findings in the early postoperative period.

REFERENCES

  • 1 Adegbite A B, Khan M I, Paine K WE, Tan L K. The recurrence of intracranial meningiomas after surgical treatment.  J Neurosurg. 1983;  58 51-56
  • 2 Mirimanoff R O, Dosoretz D E, Linggood R M, Ojemann R G, Martuza R L. Meningioma: analysis of recurrence and progression following neurosurgical resection.  J Neurosurg. 1985;  62 18-24
  • 3 Borovich B, Doron Y. Recurrence of intracranial meningiomas: the role played by regional multicentricity.  J Neurosurg. 1986;  64 58-63
  • 4 Sindou M P, Alaywan M. Most intracranial meningiomas are not cleavable tumors: anatomic-surgical evidence and angiographic predictability.  Neurosurgery. 1998;  42 476-480
  • 5 İldan F, Tuna M, Göçer Aİ et al.. Correlation of the relationships of brain-tumor interfaces, magnetic resonance imaging, and angiographic findings to predict cleavage of meningiomas.  J Neurosurg. 1999;  91 384-390
  • 6 Jääskeläinen J, Haltia M, Laasonen E, Wahlström T, Valtonen S. The growth rate of intracranial meningiomas and its relation to histology: an analysis of 43 patients.  Surg Neurol. 1985;  24 165-172
  • 7 Ide M, Jimbo M, Yamamoto M, Umebara Y, Hagiwara S, Kubo O. Growth rate of intracranial meningioma: tumor doubling time and proliferating cell nuclear antigen staining index.  Neurol Med Chir (Tokyo). 1995;  35 289-293
  • 8 Nakasu S, Nakasu Y, Nakajima M. Potential doubling time and tumor doubling time in meningiomas and neurinomas.  Acta Neurochir (Wien). 1996;  138 763-770
  • 9 May P L, Broome J C, Lawry J, Buxton R A, Battersby R DE. The prediction of recurrence in meningiomas: a flow cytometric study of paraffin-embedded archival material.  J Neurosurg. 1989;  71 347-351
  • 10 New P FJ, Hesselink J R, O'Carroll C P, Kleinman G M. Malignant meningiomas: CT and histological criteria, including a new CT sign.  AJNR Am J Neuroradiol. 1982;  3 267-276
  • 11 Simpson D. The recurrence of intracranial meningiomas after surgical treatment.  J Neurol Neurosurg Psychiatry. 1957;  20 22-39
  • 12 Russell D S, Rubinstein L J. Pathology of Tumours of the Nervous System. Baltimore, MD; Williams & Wilkins 1989: 449-507
  • 13 Quest D O. Meningiomas: an update.  Neurosurgery. 1978;  3 219-225
  • 14 Boldrey E. The meningiomas. In: Minckler J Pathology of the Nervous System. New York, NY; McGraw-Hill 1971: 2125-2144
  • 15 Gupta P K, Sastry Kolluri V R, Das S, Chandra Mouli B A, Narayana Swamy K S, Das B S. Recurrences in meningioma after surgery.  Acta Neurochir (Wien). 1989;  100 104-107
  • 16 Mahmood A, Qureshi N H, Malik G M. Intracranial meningiomas: analysis of recurrence after surgical treatment.  Acta Neurochir (Wien). 1994;  126 53-58
  • 17 Perry A, Stafford S L, Scheithauer B W, Suman V J, Lohse C M. Meningioma grading: an analysis of histologic parameters.  Am J Surg Pathol. 1997;  21 1455-1465
  • 18 Beks J W, de Windt H L. The recurrence of supratentorial meningiomas after surgery.  Acta Neurochir (Wien). 1988;  95 3-5
  • 19 Boker D-K, Meurer H, Gullota F. Recurring intracranial meningiomas: evaluation of some factors predisposing for tumor recurrence.  J Neurosurg Sci. 1985;  29 11-17
  • 20 Jääskeläinen J, Haltia M, Servo A. Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome.  Surg Neurol. 1986;  25 233-242
  • 21 Nakasu S, Nakasu Y, Nakajima M, Matsuda M, Handa J. Preoperative identification of meningiomas that are highly likely to recur.  J Neurosurg. 1999;  90 455-462
  • 22 Jääskeläinen J. Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients-a multivariate analysis.  Surg Neurol. 1986;  26 461-469
  • 23 Bitzer M, Wöckel L, Morgalla M et al.. Peritumoral brain edema in intracranial meningiomas: influence of tumor size, location and histology.  Acta Neurochir (Wien). 1997;  139 1136-1142
  • 24 Ide M, Jimbo M, Kubo O, Yamamoto M, Takeyama E, Imanaga H. Peritumoral brain edema and cortical damage by meningioma.  Acta Neurochir Suppl (Wien). 1994;  60 369-372
  • 25 Palma L, Celli P, Franco C, Cervoni L, Cantore G. Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases.  J Neurosurg. 1997;  86 793-800
  • 26 Alvarez F, Roda J M, Perez Romero M, Morales C, Sarmiento M A, Blazquez M G. Malignant and atypical meningiomas: a reappraisal of clinical, histological, and computed tomographic features.  Neurosurgery. 1987;  20 688-694
  • 27 Kallio M, Sankila R, Hakulinen T, Jääskeläinen J. Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma.  Neurosurgery. 1992;  31 2-12
  • 28 Olmsted W W, McGee T P. Prognosis in meningioma through evaluation of skull bone patterns.  Radiology. 1977;  123 375-377
  • 29 Younis G, Sawaya R. Intracranial osteolytic malignant meningiomas appearing as extracranial soft-tissue masses.  Neurosurgery. 1992;  30 932-935
  • 30 Nakau H, Miyazawa T, Tamai S et al.. Pathologic significance of meningeal enhancement (“flare sign”) of meningiomas on MRI.  Surg Neurol. 1997;  48 584-591
  • 31 Tokumaru A, O'uchi T, Eguchi T et al.. Prominent meningeal enhancement adjacent to meningioma on Gd-DTPA-enhanced MR images: histopathologic correlation.  Radiology. 1990;  175 431-433
  • 32 Chen T C, Zee C S, Miller C A et al.. Magnetic resonance imaging and pathological correlates of meningiomas.  Neurosurgery. 1992;  31 1015-1022
  • 33 Zee C S, Chin T, Segall H D, Destian S, Ahmadi J. Magnetic resonance imaging of meningiomas.  Semin Ultrasound CT MR. 1992;  13 154-169
  • 34 Elster A D, Challa V R, Gilbert T H, Richardson D N, Contento J C. Meningiomas: MR and histopathologic features.  Radiology. 1989;  170 857-862
  • 35 Bitzer M, Wöckel L, Luft A R et al.. The importance of pial blood supply to the development of peritumoral brain edema in meningiomas.  J Neurosurg. 1997;  87 368-373
  • 36 Tamiya T, Ono Y, Matsumoto K, Ohmoto T. Peritumoral brain edema in intracranial meningiomas: effects of radiological and histological factors.  Neurosurgery. 2001;  49 1046-1052
  • 37 Christensen D, Laursen H, Klinken L. Prediction of recurrence in meningiomas after surgical treatment: a quantitative approach.  Acta Neuropathol (Berl). 1983;  61 130-134
  • 38 Marks S M, Whitwell H L, Lye R H. Recurrence of meningiomas after operation.  Surg Neurol. 1986;  25 436-440
  • 39 Salmon I, Kiss R, Levivier M et al.. Characterization of nuclear DNA content, proliferation index, and nuclear size in a series of 181 meningiomas, including benign primary, recurrent, and malignant tumors.  Am J Surg Pathol. 1993;  17 239-247
  • 40 Younis G A, Sawaya R, De Monte F, Hess K R, Albrecht S, Bruner J M. Aggressive meningeal tumors: review of a series.  J Neurosurg. 1995;  82 17-27
  • 41 Demaerel P, Wilms G, Lammens M et al.. Intracranial meningiomas: correlation between MR imaging and histology in fifty patients.  J Comput Assist Tomogr. 1991;  15 45-51

Faruk İldanM.D. 

Department of Neurosurgery, Çukurova University, School of Medicine

Balcalı-Adana, 01330, Turkey

Email: fildanm@superonline.com

    >