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Indications and outcome in surgically treated asymptomatic meningiomas: a single-center case-control study
Olivia Näslund1,2,3, Thomas Skoglund4,5, Dan Farahmand5
1Sahlgrenska Academy, Gothenburg, Sweden. olivia.naslund@vgregion.se.
Background:
Many meningiomas are detected incidentally and remain asymptomatic until intervention. The goal of this study was to describe the management and outcome in this group of surgically treated asymptomatic meningiomas.
Methods:
From 2004 to 2017, 45 patients with asymptomatic meningioma were surgically treated at Sahlgrenska University Hospital, and their medical records and imaging data were analyzed. The asymptomatic cases were matched with symptomatic ones with respect to age at diagnosis, location, WHO (World Health Organization) grade, and Simpson grade.
Results:
Time from diagnosis to surgery differed between the asymptomatic and symptomatic patients (8.6 vs. 1.3 months; p < 0.001). Of symptomatic patients, 32.6% still used anti-epileptic drugs > 1 year after surgery, compared with 7.7% of the asymptomatic (p = 0.003). Thirty-day complication rate was significantly higher among the asymptomatic cases (35.6% vs. 24.4%; 0.001), as well as the proportion of older asymptomatic individuals (> 70 years) experiencing postoperative complication compared with symptomatic patients of the same age group.
Conclusion:
As expected, asymptomatic cases had smaller tumors and waited longer for surgery. Surprisingly, complication rate was significantly higher among asymptomatic cases compared with their symptomatic control. Taken into account that many asymptomatic tumors are removed surgically due to patient's wish, one might suggest a more restrictive approach, especially in the elderly.
Insights
Surgically treated asymptomatic meningiomas had a higher complication rate than symptomatic ones. This suggests a more conservative management approach, particularly for elderly patients, may be warranted.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Meningiomas are often incidentally discovered and asymptomatic until intervention.
- Management and outcomes of surgically treated asymptomatic meningiomas require detailed description.
Purpose of the Study:
- To describe the management and outcomes of surgically treated asymptomatic meningiomas.
- To compare outcomes of asymptomatic meningiomas with symptomatic ones.
Main Methods:
- Analysis of 45 surgically treated asymptomatic meningioma cases from 2004-2017.
- Matching asymptomatic cases with symptomatic controls based on age, location, and WHO/Simpson grade.
- Retrospective review of medical records and imaging data.
Main Results:
- Asymptomatic meningiomas had a longer diagnosis-to-surgery time (8.6 vs. 1.3 months).
- Higher 30-day complication rates were observed in asymptomatic cases (35.6% vs. 24.4%).
- Elderly asymptomatic patients (>70 years) had a higher complication rate post-surgery compared to symptomatic counterparts.
Conclusions:
- Asymptomatic meningiomas, despite smaller size, showed higher postoperative complication rates.
- Patient preference for surgery in asymptomatic cases may lead to increased risks.
- A more conservative management strategy, especially for elderly patients, is suggested.
