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Recurrence of intracranial meningiomas: the role played by regional multicentricity
Abstract:
Meningiomas are regarded as benign dural tumors that can be totally removed; however, after a resection that appears to the naked eye to be total, their recurrence rate is high. Malignancy in a few cases and an erroneous belief in many others that the excision was total are among the most accepted explanations. Few studies have mentioned multicentricity as a cause of "relapse." Therefore, the authors decided to examine the dura mater around globular meningiomas for evidence of regional multifocality. A radial strip of dura was removed from the line of attachment of globular meningiomas in 14 consecutive patients. Meningotheliomatous cell aggregates were demonstrated in 100% of these dural strips in the form of either intradural clusters or nodes protruding from the inner aspect of the dura. The benign appearance of the cells and the great prevalence in this study of the benign types of meningioma seem to exclude malignancy; the intradural position of the clusters and their independence from blood vessels apparently negate seeding and dural metastasis. Control strips of convexity dura mater taken from 10 neurosurgical patients without meningioma failed to show these meningotheliomatous conglomerates. These findings indicate that solitary globular meningiomas represent only the most visible growth in the midst of a neoplastic field change spreading over a wide area of dura mater. The authors believe that this can explain some unexpected "recurrences," and that a wide resection of dura around globular meningiomas, whenever possible, could reduce the incidence of clinical growth after true total excision of the most visible lesion. It remains to be determined what factors cause the acceleration of growth of these cell aggregates after removal of the dominant tumor.
Insights
Meningiomas often recur even after apparent total removal. This study found microscopic tumor cells in the surrounding dura mater, suggesting a widespread neoplastic field change, not just a single tumor. Wider dural resection may reduce recurrence.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Meningiomas, typically benign dural tumors, exhibit high recurrence rates despite seemingly complete surgical removal.
- Existing explanations for recurrence include malignancy, incomplete resection, and rarely, multicentricity.
- The concept of a widespread neoplastic field change in the dura mater has not been fully explored as a cause of meningioma recurrence.
Purpose of the Study:
- To investigate the presence of multifocality in the dura mater surrounding globular meningiomas.
- To determine if microscopic neoplastic changes in the dura contribute to the high recurrence rates of meningiomas.
- To evaluate the potential benefit of wider dural resection in reducing meningioma recurrence.
Main Methods:
- Radial dural strips were surgically resected from the attachment site of globular meningiomas in 14 patients.
- Histopathological examination of dural strips to identify meningotheliomatous cell aggregates.
- Comparison with control dural strips from 10 patients without meningiomas.
Main Results:
- Meningotheliomatous cell aggregates were identified in 100% of the dural strips from patients with meningiomas.
- These aggregates appeared as intradural clusters or nodes, distinct from blood vessels, ruling out seeding or metastasis.
- Control dural strips showed no such cell conglomerates, confirming their association with meningiomas.
Conclusions:
- Solitary globular meningiomas may represent the most prominent lesion within a broader neoplastic field change in the dura mater.
- This widespread dural involvement likely explains some instances of unexpected meningioma recurrence after apparent total excision.
- Wider resection of the surrounding dura mater, when feasible, could potentially decrease the incidence of clinical recurrence.