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Implementation of Minimally Invasive Brain Tumor Resection in Rodents for High Viability Tissue Collection
Published on: May 9, 2022
Single versus multiple reoperations for recurrent intracranial meningiomas
Francesco Maiuri1, Sergio Corvino2, Giuseppe Corazzelli1
1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, 80131, Naples, Italy.
Purpose:
To identify the risk factors and management of the multiple recurrences and reoperations for intracranial meningiomas.
Methods:
Data of a neurosurgical series of 35 patients reoperated on for recurrent intracranial meningiomas were reviewed. Analyzed factors include patient age and sex, tumor location, extent of resection, WHO grade, Ki67-MIB1 and PR expression at initial diagnosis, time to recurrence; pattern of regrowth, extent of resection, WHO grade and Ki67-MIB1 at first recurrence were also analyzed. All these factors were stratified into two groups based on single (Group A) and multiple reoperations (Group B).
Results:
Twenty-four patients (69%) belonged to group A and 11 (31%) to group B. The age < 65 years, male sex, incomplete resection at both initial surgery and first reoperation, and multicentric-diffuse pattern of regrowth at first recurrence are risk factors for multiple recurrences and reoperations. In group B, the WHO grade and Ki67-MIB1 increased in further recurrences in 54% and 64%, respectively. The time to recurrence was short in 7 cases (64%), whereas 4 patients (36%) further recurred after many years. Eight patients (73%) are still alive after 7 to 22 years and 2 to 4 reoperations.
Conclusion:
The extent of resection and the multicentric-diffuse pattern of regrowth at first recurrence are the main risk factors for multiple recurrences and reoperations. Repeated reoperations might be considered even in patients with extensive recurrent tumors before the anaplastic transformation occurs. In such cases, even partial tumor resections followed by radiation therapy may allow long survival in good clinical conditions.
Insights
Incomplete resection and diffuse tumor regrowth are key risks for multiple intracranial meningioma recurrences. Repeated surgeries, even partial, can prolong survival before malignant transformation.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Intracranial meningiomas can recur, necessitating reoperation.
- Understanding risk factors for multiple recurrences is crucial for patient management.
Purpose of the Study:
- To identify risk factors for multiple recurrences and reoperations in intracranial meningiomas.
- To evaluate management strategies for recurrent meningiomas.
Main Methods:
- Retrospective review of 35 patients undergoing reoperation for recurrent intracranial meningiomas.
- Analysis of patient demographics, tumor characteristics (WHO grade, Ki67-MIB1, PR expression), surgical extent, and recurrence patterns.
- Stratification into single (Group A) and multiple reoperation (Group B) cohorts.
Main Results:
- Age < 65, male sex, incomplete initial and first reoperation resection, and multicentric-diffuse regrowth patterns were risk factors for multiple reoperations.
- WHO grade and Ki67-MIB1 increased in subsequent recurrences for 54% and 64% of Group B patients, respectively.
- Long-term survival (7-22 years) was achieved in 73% of patients after 2-4 reoperations.
Conclusions:
- Extent of resection and multicentric-diffuse regrowth at first recurrence are primary risk factors for multiple reoperations.
- Repeated reoperations, even partial, are advisable before anaplastic transformation.
- Combined surgical and radiation approaches can lead to long-term survival in good clinical condition.
