Pre-operative factors affecting resectability of giant intracranial meningiomas

Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas > or =5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability.

Sixty-seven patients undergoing surgery for a large intracranial meningioma (> or =5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis.

Thirty-nine (58%) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58%) patients, remained unchanged in 20 (30%), and were aggravated in 8 (12%). In the multivariate model for all large meningiomas, age>45 years [OR (95%CI); 0.127 (0.026-0.616), p=0.01] and superior sagittal sinus involvement [OR (95%CI); 0.160 (0.026-0.976), p=0.05] were negative predictors of GTR, while preoperative embolization [OR (95%CI); 8.087 (1.719-38.044), p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95%CI); 0.077 (0.010-0.571), p=0.01] and preoperative embolization [OR (95%CI); 10.492 (1.961-56.135), p=0.006] were independently associated with GTR.

This study evaluated a subset of large intracranial meningiomas > or =5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.