Elsevier

Surgical Neurology

Volume 59, Issue 1, January 2003, Pages 47-53
Surgical Neurology

Neoplasm
Meningeal hemangiopericytomas: long-term outcome and biological behavior

https://doi.org/10.1016/S0090-3019(02)00917-5Get rights and content

Abstract

Background

The authors present a retrospective clinical analysis of meningeal hemangiopericytomas. The long-term outcome and biologic behavior, including local recurrence and extraneural distant metastasis, are elucidated.

Method

Clinical records and radiologic findings of 31 cases with meningeal hemangiopericytoma treated at Seoul National University Hospital and Asian Medical Center between 1982 and 1999 were carefully reviewed. The final outcome was determined by direct or phone contact and questionnaire by mail. The duration of follow-up was from 1 to 216 months (mean 77). All patients underwent craniotomy and Simpson Grade I or II resection was possible in 24 patients. Conventional radiotherapy was given in 11 patients (in 5 after total excision and in 6 for residual mass) and stereotactic radiosurgery was conducted in 6 cases.

Results

Intracranial recurrence was seen in 12 cases (38.7%) and the mean period before the first recurrence was 104 months. The recurrence was at the primary site in 11 cases and diffuse leptomeningeal seeding occurred in the remaining case. The 5-year recurrence free rate was 59.2% and the extent of excision was the significant factor (72.7% in total excision group and 20.8% in the incomplete excision group, p = 0.006). In four patients (12.9%), extraneural metastases developed at an average of 107 months. Six patients died during the follow-up period; however, 2 of these died of unrelated causes.

Conclusions

Complete excision is the most important factor in reducing recurrence. However, recurrence may occur even after complete excision. Careful long-term follow-up is mandatory because of the long disease-free interval.

Section snippets

Materials and methods

During the years between 1982 and 1999, 31 patients with primary M-HPC were treated at our institutions. M-HPC constituted 2.4% of all intracranial meningiomas during the same period (31 months-HPCs: 1309 intracranial meningiomas). Data were collected from review of the clinical records and neuroradiological investigations, and histologic slides were re-examined by an experienced neuropathologist. Information on the postoperative course was obtained from our patient records, phone contacts, and

Results

Patient characteristics, including extent of resection, radiotherapy, recurrence, time to first recurrence, and most recent follow-up status, are summarized in Table 1.

The average follow-up period was 77 months (range: 1–216 months). Six out of 31 patients died during the follow-up period, two of whom died of unrelated disease. The 5- and 10-year survival rates after first surgery were 96.3% and 75.7%, respectively (Figure 1). The rate of local recurrence was 38.7% (12/31). The overall

Discussion

M-HPC was first described by Begg and Garret [3], who noted its similarity to angioblastic meningioma. Since that time, controversy has continued as to whether M-HPC should be classified as a variant of true meningioma or as a central form of peripheral HPC [16]. Histologic examinations, including ultrastructural studies, demonstrate the M-HPC tumor cells to be derived from a pericyte around the capillary wall. Further, recent immunohistochemical and genetic studies have also shown that M-HPC

Conclusions

M-HPC is aggressive, and tends to recur even after gross total resection. Complete excision followed by adjuvant radiotherapy of more than 50 Gy significantly reduces the risk of recurrence. Stereotactic radiosurgery is of value for treatment of CNS recurrences of smaller size (volume), even in previously irradiated fields or after multiple resections. Late extraneural metastases after a prolonged disease-free interval are common in the course of M-HPC, emphasizing the need for long-term

Acknowledgements

This work was supported in part by a Seoul National University Hospital Research Grant.

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