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Factors associated with recurrence and morbidity for surgically treated WHO grade I parasagittal meningiomas
Hun Ho Park1, Tae Hoon Roh2, Jihwan Yoo1
1Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
Objective:
The balance between surgical resection and morbidity can be a challenge for parasagittal meningiomas (PMs) in terms of superior sagittal sinus (SSS) manipulation. In the era of multimodal approach, the role of microsurgery alone is still controversial, but not well defined. The authors investigate the factors associated with recurrence and morbidity for surgically treated WHO grade I PMs.
Methods:
A hundred and fifteen patients underwent microsurgery for newly diagnosed WHO grade I PMs from 2005 to 2025. The factors associated with recurrence and surgical morbidities were retrospectively analyzed during a mean follow-up of 67 months (range, 12-234 months). A hypothesis-generating stratification of recurrence was performed.
Results:
Simpson resection grade rates from I to III were 24.3%, 60%, and 15.7%, respectively. Recurrence occurred in 16 patients (13.9%) with a mean progression-free survival (PFS) of 50.1 months (range, 10.7-153.2 months). There were 12 patients (10.4%) with surgical morbidities. Identified factors associated with recurrence were sex (p = 0.001), extent of sinus invasion (ESI) (p = 0.001), extent of resection (EOR) (p = 0.001), and Ki-67 proliferation index (PI) (p = 0.010). Significant factors associated with surgical morbidity were tumor localization (p = 0.005), EOR (p = 0.001), and newly developed SSS occlusion (p = 0.010). According to our analysis, low grade PMs with Simpson resection grade II had the lowest and high grade PMs with Simpson resection grade III had the highest incidence of recurrence, respectively. A Simpson resection grade I could be feasible for high grade PMs if preoperative SSS occlusion is confirmed on angiography.
Conclusions:
Sex, ESI, EOR, Ki-67 PI, tumor localization, and newly developed SSS occlusion were factors associated with recurrence and surgical morbidity. The role of microsurgery will only be clarified if factors associated with recurrence and morbidity are identified and applied to balance surgical resection and morbidity for the optimal treatment outcome of PMs.