Influence of dural attachment on remnant progression after subtotal resection in WHO grade 1 meningioma

Meningioma resection remains partial in over 25% of cases, with few known predictors of residual disease progression. This study aims to assess if dural attachment, identified on postoperative imaging, influences meningioma progression following subtotal resection.

A retrospective cohort design was applied to patients who underwent subtotal meningioma resection at our institution. MRI data collected over time included remnant volumes, surface areas of contact with dura and signal intensity ratios. Progression was defined as an increase in remnant volume of at least 25%.

Sixty-one (61) remnants in 59 patients were followed for an average of 71.1 months postoperatively. Mean preoperative tumor volume and first remnant volume were 30.01 cm³ and 2.51 cm³, respectively. Criteria for progression was met in 35 remnants (57.4%), with a mean time to progression of 18.1 months. Greater surface area of contact with dura relative to total remnant surface area was a significant predictor of progression in both univariate and multivariate analyses. Smaller remnant diameter and larger extent of resection were marginally associated with progression. Signal intensity ratios failed to demonstrate association with progression.

The degree of meningioma remnant attachment to dura appears associated with progression. Reduction of dural involvement in residual disease intentionally left in place may be considered when appropriate, with further studies needed to refine surgical considerations.