Predictors of Survival in Subtotally Resected WHO Grade I Skull Base Meningiomas

Michele Da Broi,Paola Borrelli,Torstein R Meling

doi:10.3390/cancers13061451

Abstract

Simple SummaryRadical excision of meningiomas of the skull base has always been a major surgical challenge because of the complex location and the risk of neurovascular damage related to it. In these cases, the benefits of gross-total resection must be balanced with the quality of life after surgery. In the present study, we investigated a cohort of 212 consecutive patients who underwent partial resection of a benign skull base meningioma in order to find predictors of overall survival (OS). Moreover, we analyzed the clinical outcomes and cases of retreatment for progressive disease. In our case series, advanced age at surgery and a preoperative Karnofsky performance status of <70 were negative predictors of OS. Patients who underwent further procedures did not have reduced OS. Overall, surgical and neurological outcomes of STR skull base meningiomas were worse compared to case series, including also completely resected tumors.Background: Although gross total resection (GTR) is the goal in meningioma surgery, this can sometimes be difficult to achieve in skull base meningiomas. We analyzed clinical outcomes and predictors of survival for subtotally resected benign meningiomas. Methods: A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between 1990–2010 were investigated. Results: Median age was 57.7 [IQR 18.8] years, median preoperative Karnofsky performance status (KPS) was 80.0 [IQR 20.0], 75 patients (35.4%) had posterior fossa meningioma. After a median follow-up of 6.2 [IQR 7.9] years, retreatment (either radiotherapy or repeated surgery) rate was 16% at 1-year, 27% at 3-years, 34% at 5-years, and 38% at 10-years. Ten patients (4.7%) died perioperatively, 9 (3.5%) had postoperative hematomas, and 2 (0.8%) had postoperative infections. Neurological outcome at final visit was improved/stable in 122 patients (70%). Multivariable analysis identified advanced age and preoperative KPS < 70 as negative predictors for overall survival (OS). Patients who underwent retreatment had no significant reduction of OS. Conclusions: Advanced age and preoperative KPS were independent predictors of OS. Retreatments did not prolong nor shorten the OS. Clinical outcomes in STR skull base meningiomas were generally worse compared to cohorts with high rates of GTR.

Highlights

Radical excision of meningiomas located at the skull base has always been a major surgical challenge [1]
Schneider et al [15,16] showed in two recent publications that Simpson grade I resection in posterior fossa meningiomas and fronto-basal meningiomas were significantly associated with higher cranial nerve morbidity and CSF leakage rates as compared to less aggressive excisions
subtotal resection (STR) was defined as Simpson grade IV or V resections, as described by the Euro sociation of neuro-oncology

Summary

Introduction

Radical excision of meningiomas located at the skull base has always been a major surgical challenge [1]. Schneider et al [15,16] showed in two recent publications that Simpson grade I resection in posterior fossa meningiomas and fronto-basal meningiomas were significantly associated with higher cranial nerve morbidity and CSF leakage rates as compared to less aggressive excisions. In light of these reports, the prospect of a steady increase of STR skull base cases appears tangible. Methods: A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between. Patients who underwent retreatment had no significant reduction of OS

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Discussion

Conclusion