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Volumetric growth rate of incidental asymptomatic meningiomas: a single-center prospective cohort study

  • Original Article - Neurosurgery general
  • Published:
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Abstract

Background

Decision about treatment of incidentally found intracranial meningiomas is controversial and conditioned by the growth potential of these tumors. We aimed to evaluate the growth rate of a cohort of incidentally found asymptomatic meningiomas and to analyze their natural course and the need for eventual treatment.

Methods

A total of 193 patients harboring intracranial meningiomas (85 with 109 incidental and 108 with 112 symptomatic) were included between 2015 and 2019. In the prospective cohort of incidental meningiomas, we measured size at diagnosis, volumetric growth rate (by segmentation software), appearance of symptoms, and need for surgery or radiotherapy. Progression-free survival and risk factors for growth were assessed with Kaplan-Meier survival and Cox regression analyses.

Results

Among incidental meningiomas, 94/109 (86.2%) remained untreated during a median follow-up of 49.3 months. Tumor growth was observed in 91 (83.5%) and > 15% growth in 40 (36.7%). Neurological symptoms developed in 1 patient (1.2%). Volume increased an average of 0.51 cm3/year (95% CI, 0.20–0.82). Nine patients were operated (9.2%) and 4 underwent radiotherapy (4.7%). Treatment-related complication rates of incidental and symptomatic meningiomas were 0% and 35.4%, respectively. Persistent neurological defects occurred in 46 (40.7%) of symptomatic versus 2 (2.3%) of incidental meningiomas. Among covariates, only brain edema resulted in an increased risk of significant tumor growth in the female subgroup (Cox regression HR 2.96, 95% CI 1.02–8.61, p = 0.046). Size at diagnosis was significantly greater in the symptomatic meningioma group (37.33 cm3 versus 4.74 cm3, p < 0.001).

Conclusions

Overall, 86% of incidentally found meningiomas remained untreated over the first 4 years of follow-up. The majority grew within the 20% range, yet very few developed symptoms. Treatment-related morbidity was absent in the incidental meningioma group.

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Availability of data and material

Complete datasets are available from the corresponding author on reasonable request.

Abbreviations

CT:

Computerized tomography

MRI:

Magnetic resonance imaging

WHO:

World Health Organization

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Acknowledgements

To Javier Sánchez for his assistance with the segmentation software.

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Authors and Affiliations

  1. Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain

    Pedro David Delgado-López, Antonio Montalvo-Afonso, Javier Martín-Alonso, Vicente Martín-Velasco, José Manuel Castilla-Díez, Ana María Galacho-Harriero, Sara Ortega-Cubero, Antonio Sánchez-Rodríguez & Antonio Rodríguez-Salazar

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  1. Pedro David Delgado-López
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  2. Antonio Montalvo-Afonso
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  3. Javier Martín-Alonso
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  4. Vicente Martín-Velasco
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  5. José Manuel Castilla-Díez
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  6. Ana María Galacho-Harriero
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  7. Sara Ortega-Cubero
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  8. Antonio Sánchez-Rodríguez
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  9. Antonio Rodríguez-Salazar
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Pedro Delgado, Antonio Montalvo, and Antonio Sánchez. The first draft was written by Pedro Delgado and all authors revised and commented on previous versions of the manuscript. All authors read, reviewed, and approved the final version of the manuscript.

Corresponding author

Correspondence to Pedro David Delgado-López.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study received local institutional ethics board committee approval (Ethics approval number, CEIC ref #: 2035).

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Informed consent was obtained from all individual participants in the study.

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The authors declare no competing interests.

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Delgado-López, P.D., Montalvo-Afonso, A., Martín-Alonso, J. et al. Volumetric growth rate of incidental asymptomatic meningiomas: a single-center prospective cohort study. Acta Neurochir 163, 1665–1675 (2021). https://doi.org/10.1007/s00701-021-04815-1

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  • DOI: https://doi.org/10.1007/s00701-021-04815-1

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