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Clinical, radiological, and histopathological predictors for long-term prognosis after surgery for atypical meningiomas

  • Original Article - Tumor - Meningioma
  • Published:
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Abstract

Background

Despite considerable rates of recurrence and mortality in atypical meningiomas, reliable predictors for estimating postoperative long-term prognosis remain elusive.

Methods

Clinical, histopathological, and radiological variables from 138 patients, including 64 females and 74 males (46% and 54%, median age 62 years), who underwent surgery for intracranial atypical meningioma were retrospectively analyzed. Associations between variables and recurrence and mortality were investigated using uni- and multivariate analyses.

Results

Gross total (GTR) and subtotal resection (STR) was achieved in 81% and 19% of cases, respectively. Within a median follow-up of 62 months, recurrence occurred in 52 (38%) and mortality in 22 (16%) cases. In patients who did not receive adjuvant irradiation, recurrence rates were higher after STR than after GTR (32% vs 63%, p = 0.025). In univariate analyses, only intratumoral calcifications on preoperative MRI (p = 0.012) and the presence of brain invasion in the absence of other histological grading criteria (p = 0.010) were correlated with longer progression-free intervals (PFI). In multivariate analyses, patient age was positively (HR 1.03, 95%CI 1.04–1.05; p = 0.018) and the presence of brain invasion as the only grading criterion (HR 0.37, 95%CI 0.19–0.74; p = 0.005) was negatively related with progression, while rising age at the time of surgery (HR 1.07, 95%CI 1.03–1.12; p = 0.001) was prognostic for mortality.

Conclusions

PFI was longer in brain invasive but otherwise histological benign meningiomas and in tumors displaying calcifications on preoperative MRI. Advancing patient age and lower Karnofsky Performance Score were associated with higher overall mortality.

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Funding

This research was funded by the “Codman Stipendium zur Förderung der kranialen Neurochirurgie” of the Deutsche Gesellschaft für Neurochirurgie.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany

    Eileen Maria Susanne Streckert, Markus Holling, Walter Stummer & Benjamin Brokinkel

  2. Institute for Neuropathology, University Hospital Münster, Münster, Germany

    Katharina Hess, Werner Paulus & Dorothee Cäcilia Spille

  3. Institute for Clinical Radiology, University Hospital Münster, Münster, Germany

    Peter B. Sporns, Alborz Adeli & Caroline Brokinkel

  4. Department of Radiation Oncology, University Hospital Münster, Münster, Germany

    Jan Kriz & Hans Theodor Eich

  5. Gamma Knife Center Krefeld, Krefeld, Germany

    Albertus T. C. J. van Eck

  6. Department of Neurological Surgery, University of California, San Francisco, CA, USA

    David R. Raleigh & Michael W. McDermott

  7. Department of Radiation Oncology, University of California, San Francisco, CA, USA

    David R. Raleigh

Authors
  1. Eileen Maria Susanne Streckert
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  2. Katharina Hess
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  3. Peter B. Sporns
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  9. Werner Paulus
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Corresponding author

Correspondence to Benjamin Brokinkel.

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Conflict of interest

Author BB received funding from the “Codman Stipendium zur Förderung der kranialen Neurochirurgie” of the Deutsche Gesellschaft für Neurochirurgie.” BB and all other authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Data collection and scientific use were approved by the local ethics committee (Münster 2018-061-f-S).

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Streckert, E.M.S., Hess, K., Sporns, P.B. et al. Clinical, radiological, and histopathological predictors for long-term prognosis after surgery for atypical meningiomas. Acta Neurochir 161, 1647–1656 (2019). https://doi.org/10.1007/s00701-019-03956-8

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