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Long-term outcome of Simpson IV meningioma resection: Would it improve with adjuvant SRS?
Michaela Dedeciusova1, Martin Majovsky1, Ladislav Pecen2
1Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic; First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Objective:
Subtotal meningioma resection (STR) is often performed to minimize surgical morbidity. Nevertheless, only a few studies have reported on patient outcome after STR. We studied the long-term outcome of SIV (Simpson grade IV) resection and identified predictive factors of overall survival (OS), progression-free survival (PFS) and time to progression (TTP).
Methods:
A retrospective analysis was performed on 68 patients who underwent SIV resection of meningioma (grade I) from 2004 to 2010. Data were collected from clinical, surgical and pathology records and radiological imaging. Long-term outcomes were evaluated at least 10 years after surgery.
Results:
Permanent morbidity was 11.8%, 30-day mortality 2.9% and progression rate 50.0% for a median follow-up duration of 126.6 months. Median TTP was 86.2 months. Adjuvant SRS was the only significant factor associated with longer PFS (p = 0.0052) and TTP (p = 0.0079). Higher age (p = 0.0022), KPS (p = 0.0182), postoperative ECOG score (p = 0.0182) were reliable predictors of shortened OS and aSRS (p = 0.0445) was reliable predictor of longer OS.
Conclusion:
STR in intracranial meningioma is still viable and often the only treatment option available in high-risk patients or high-risk tumors. Although surgical morbidity and mortality are high, the OS rate was 85.3% at 5 years and 79.4% at 10 years. Because of the considerable progression rate and rather a long term OS the adjuvant SRS should be considered following SIV resection.
Insights
Subtotal meningioma resection (STR) is a viable option for high-risk patients, offering long-term survival despite significant morbidity. Adjuvant stereotactic radiosurgery (SRS) improves progression-free survival after Simpson Grade IV resection.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Subtotal meningioma resection (STR) aims to reduce surgical morbidity.
- Limited data exists on long-term patient outcomes following STR.
- This study investigates outcomes after Simpson Grade IV (SIV) resection.
Purpose of the Study:
- To evaluate the long-term outcomes of SIV resection for meningioma.
- To identify predictors of overall survival (OS), progression-free survival (PFS), and time to progression (TTP).
Main Methods:
- Retrospective analysis of 68 patients undergoing SIV resection of grade I meningioma (2004-2010).
- Data collected from clinical, surgical, pathology, and imaging records.
- Long-term outcomes assessed at least 10 years post-surgery.
Main Results:
- Permanent morbidity: 11.8%; 30-day mortality: 2.9%; Progression rate: 50.0%.
- Median follow-up: 126.6 months; Median TTP: 86.2 months.
- Adjuvant SRS correlated with longer PFS and TTP. Age, KPS, and ECOG score predicted OS. aSRS predicted longer OS.
Conclusions:
- STR remains a viable treatment for intracranial meningioma, especially in high-risk cases.
- Despite high morbidity/mortality, 10-year OS was 79.4%.
- Adjuvant SRS should be considered post-SIV resection due to significant progression rates and long-term survival.
