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Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome
Abstract:
Out of 936 primary intracranial meningiomas, 94.3% were histologically benign (grade I), 4.7% atypical (grade II), and 1.0% anaplastic (grade III); one recurrence was sarcomatous (grade IV). Meningiomas with histologic anaplasia (grades II-IV) occurred in 12% of the men, but only 4% of the women. Only 26% of atypical or anaplastic meningiomas appeared completely innocent on a computed tomography scan. Angiograms, usually showing a meningeal feeding artery, suggested meningioma when computed tomography scans did not. At 5 years after complete removal, the recurrence rate was only 3% (21% at 25 years) for benign meningiomas, but 38% for atypical ones, and 78% for anaplastic ones. The median times to recurrence were 7.5, 2.4, and 3.5 years, respectively. In spite of postoperative radiotherapy, four of five anaplastic meningiomas recurred.
Insights
Meningioma grade significantly impacts recurrence risk. Higher-grade meningiomas (atypical and anaplastic) show higher recurrence rates and shorter times to recurrence compared to benign types.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Intracranial meningiomas are common primary brain tumors.
- Histological grading is crucial for predicting tumor behavior and patient outcomes.
- Understanding recurrence patterns is vital for treatment planning.
Purpose of the Study:
- To analyze the incidence, clinical presentation, and recurrence rates of intracranial meningiomas based on histological grade.
- To evaluate the effectiveness of imaging and radiotherapy in managing meningiomas.
Main Methods:
- Retrospective analysis of 936 primary intracranial meningiomas.
- Histopathological grading (WHO I, II, III, IV).
- Review of imaging findings (CT, angiography) and treatment outcomes (recurrence, radiotherapy).
Main Results:
- 94.3% were Grade I (benign), 4.7% Grade II (atypical), 1.0% Grade III (anaplastic).
- Higher grades (II-IV) were more common in men (12%) than women (4%).
- Recurrence rates at 5 years: 3% (benign), 38% (atypical), 78% (anaplastic). Median recurrence times: 7.5, 2.4, 3.5 years, respectively.
- Only 26% of higher-grade tumors appeared benign on CT scans.
Conclusions:
- Histological grade is a strong predictor of meningioma recurrence.
- Atypical and anaplastic meningiomas have significantly higher recurrence rates and shorter recurrence-free intervals.
- Radiotherapy showed limited efficacy in preventing recurrence for anaplastic meningiomas.