Abstract
BackgroundNeurosurgical resection is the mainstay of meningioma treatment. Adverse event (AE) rates of meningioma resections are significant, but preoperative risk factors for major AEs in patients undergoing first-time meningioma surgery are largely unknown. The aim of this study was to explore major AEs and identify preoperative risk factors in patients undergoing first-time meningioma surgery.MethodsData on all meningioma resections performed at the University Hospital Zurich from 1 January 2013 to 31 December 2018 were collected in a prospective registry. All AEs that occurred within 3 months of surgery were documented in detail and classified as “minor” or “major.” Statistical analysis included initial individual bivariate analyses of all preoperative factors and the occurrence of major AEs. Statistically significant variables were then included in a logistic regression model to identify predictors.ResultsThree hundred forty-five patients were included in the study. Mean age was 58.1 years, and 77.1% of patients were female. The overall major AE rate was 20.6%; the most common of which was a new focal neurological deficit (12.8% of patients). Six preoperative factors showed a significant association with the occurrence of major AEs in bivariate analysis. All variables included in the logistic regression model showed increased odds of occurrence of major AE, but only tumor complexity as measured by the Milan Complexity Scale was a statistically significant predictor, with a score of 4 or more having twice the odds of major AEs (OR: 2.00, 95% CI: 1.15–3.48).ConclusionHigh tumor complexity is an independent predictor of the occurrence of major AEs following meningioma resection. Preoperative assessment of tumor complexity using the Milan Complexity Scale is warranted and can aid communication with patients about AE rates and surgical decision-making.
Highlights
Study design and recorded variablesNeurosurgical resection is the mainstay treatment for patients with intracranial meningioma [14]
An Milan Complexity Scale (MCS) score of 4 or more was associated with a significant increase in OR for major Adverse event (AE) (OR: 2.00, 95% CI: 1.15–3.48) (Fig. 2 “Odds ratios for preoperative risk factors for new focal neurological deficit and other major AEs after meningioma neurosurgery”)
This study showed a rate of overall major AE of 20.6% and a rate of 12.8% for onset of new focal neurological deficit, which are both in line with recently published studies in the literature [4, 22]
Summary
Study design and recorded variablesNeurosurgical resection is the mainstay treatment for patients with intracranial meningioma [14]. While most meningiomas are benign and the majority of patients can be cured by surgery alone [9, 27], the less common World Health Organization (WHO) grade II and grade III meningiomas are associated with increased mortality [4, 21] In these patients, surgery followed by adjuvant treatment is often recommended [14]. Adverse event (AE) rates of meningioma resections are significant, but preoperative risk factors for major AEs in patients undergoing first-time meningioma surgery are largely unknown. The aim of this study was to explore major AEs and identify preoperative risk factors in patients undergoing first-time meningioma surgery. Preoperative assessment of tumor complexity using the Milan Complexity Scale is warranted and can aid communication with patients about AE rates and surgical decision-making
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