Surgical Outcomes following Reoperation for Recurrent Intracranial Meningiomas

Background: We sometimes encounter refractory meningioma cases that are difficult to control, even after achieving a high resection rate or following radiation therapy (RT). In such cases, additional surgical resection might be attempted, but reports regarding outcomes of re-do surgery for recurrent meningiomas are scarce. Methods: This study was a retrospective review of patients who underwent re-do surgery for recurrent meningiomas. The risks of re-doing surgery were statistically analyzed. A comparative analysis between the patients who underwent primary surgery for intracranial meningiomas was also performed. Twenty-six patients underwent re-do surgeries for recurrent meningiomas. Results: At first re-do surgery, gross total resection was achieved in 20 patients (77%). The disease-free survival rate after the first re-do surgery was calculated as 73/58/44% at 1, 2, and 5 years, respectively. A significant factor affecting longer disease-free survival was WHO Grade 1 diagnosis at first re-do surgery (p = 0.02). Surgery-related risks were observed in 10 patients presenting a significant risk factor for skull base location (p = 0.04). When comparing with the risk at primary surgery, the risks of surgical site infection (p = 0.04) and significant vessel injury (p < 0.01) were significantly higher for the re-do surgery. Conclusions: Re-do surgery could increase surgery-related risks compared to the primary surgery; however, it could remain a crucial option, while the indication should be carefully examined in each case.