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Published on: January 17, 2018
Morbidity in 201 patients with small sized meningioma treated by microsurgery
M Reinert1, M Babey, J Curschmann
1Department of Neurosurgery, Inselspital Bern, University of Bern, Bern, Switzerland. michael.reinert@neurochirugie-bern.ch
Background:
The management of patients with small, often asymptomatic meningiomas is controversial and includes observation, microsurgery (MS) and stereotactic radiosurgery (SRS). The purpose of this retrospective study was to analyze the morbidity and the extent of removal after MS for small (< or =3 cm) intracranial meningiomas and compare these results to those of SRS reported in the literature.
Methods:
All patients with an intracranial meningioma with a maximum diameter up to 3 cm operated on in our institution over a 10 year period (1992-2002) were included in the study and retrospectively analyzed. Patients were grouped into asymptomatic and symptomatic and according to tumor location as: group I (cranial vault, parasagittal, lateral sphenoid), group II (falx, frontobasal, medial sphenoid, parasellar and tentorial), group III (cavernous sinus, petroclival, petrosal, CPA and foramen magnum).
Findings:
There were a total of 201 patients, of whom 102 were asymptomatic and 99 were symptomatic. The overall risk of permanent neurological morbidity was 4.9% in asymptomatic and 23.2% in symptomatic patients. The combined risk in asymptomatic and symptomatic patients was 5.4% in group I, 11.5% in group II, and 39.9% in group III lesions. Radical removal was achieved in all patients in group I, in 93.7% of group II, and 80% of group III lesions. There was no disease related mortality.
Conclusions:
MS provides excellent efficacy and morbidity results in groups I and II meningiomas, especially in asymptomatic patients and might therefore be considered the first choice of treatment for these patients. The results of MS in group III were worse than those of SRS reported in the literature.
Insights
Microsurgery offers excellent outcomes for small intracranial meningiomas in groups I and II, particularly for asymptomatic patients. However, results for group III meningiomas were less favorable compared to stereotactic radiosurgery.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Management of small intracranial meningiomas (< or =3 cm) is debated, with options including observation, microsurgery (MS), and stereotactic radiosurgery (SRS).
- This study retrospectively analyzes microsurgery outcomes for small meningiomas.
Purpose of the Study:
- To evaluate the morbidity and extent of tumor removal following microsurgery for small intracranial meningiomas.
- To compare microsurgery results with existing literature data on stereotactic radiosurgery for similar tumors.
Main Methods:
- Retrospective analysis of 201 patients with intracranial meningiomas (<=3 cm) treated between 1992 and 2002.
- Patients were categorized as asymptomatic or symptomatic and by tumor location into three groups (I, II, III).
Main Results:
- Overall permanent neurological morbidity was 4.9% in asymptomatic and 23.2% in symptomatic patients.
- Radical tumor removal was achieved in 100% of group I, 93.7% of group II, and 80% of group III lesions.
- Morbidity varied by location: 5.4% (Group I), 11.5% (Group II), and 39.9% (Group III).
Conclusions:
- Microsurgery demonstrates high efficacy and acceptable morbidity for treating small meningiomas in groups I and II, especially in asymptomatic individuals.
- Microsurgery is a potential first-line treatment for specific small meningiomas.
- Outcomes for group III meningiomas treated with microsurgery were inferior to those reported for stereotactic radiosurgery.
