Abstract
The optimal management of asymptomatic, skull-based meningiomas is not well defined. The aim of this study is to compare the imaging and clinical outcomes of patients with asymptomatic, skull-based meningiomas managed either with upfront stereotactic radiosurgery (SRS) or active surveillance. This retrospective, multicenter study involved patients with asymptomatic, skull-based meningiomas. The study end-points included local tumor control and the development of new neurological deficits attributable to the tumor. Factors associated with tumor progression and neurological morbidity were also analyzed. The combined unmatched cohort included 417 patients. Following propensity score matching for age, tumor volume, and follow-up 110 patients remained in each cohort. Tumor control was achieved in 98.2% and 61.8% of the SRS and active surveillance cohorts, respectively. SRS was associated with superior local tumor control (p < 0.001, HR = 0.01, 95% CI = 0.002-0.13) compared to active surveillance. Three patients (2.7%) in the SRS cohort and six (5.5%) in the active surveillance cohort exhibited neurological deterioration. One (0.9%) patient in the SRS-treated and 11 (10%) patients in the active surveillance cohort required surgical management of their meningioma during follow-up. SRS is associated with superior local control of asymptomatic, skull-based meningiomas as compared to active surveillance and does so with low morbidity rates. SRS should be offered as an alternative to active surveillance as the initial management of asymptomatic skull base meningiomas. Active surveillance policies do not currently specify the optimal time to intervention when meningioma growth is noted. Our results indicate that if active surveillance is the initial management of choice, SRS should be recommended when radiologic tumor progression is noted and prior to clinical progression.
Highlights
The wider availability and increased use of neuroimaging for nonspecific symptomatology has resulted in increased detection of incidental meningiomas [1, 2]
The unmatched cohorts included 307 stereotactic radiosurgery (SRS)-treated patients and 110 patients that were managed with active surveillance for an asymptomatic, skull-based meningioma
Radiological tumor control as defined by the Response Assessment in Neuro-Oncology (RANO) criteria [10], was achieved in 98.2% and 61.8% of the matched SRS and active surveillance cohorts respectively, and SRS was strongly associated with asymptomatic, skull base meningioma radiological control (p
Summary
The wider availability and increased use of neuroimaging for nonspecific symptomatology has resulted in increased detection of incidental meningiomas [1, 2]. Asymptomatic, skull base meningiomas account for up to 34% of incidentally discovered meningiomas [3]. Due to the lack of high level evidence, the optimal management of asymptomatic, skull-based meningiomas remains controversial [4,5,6]. The natural history of incidentally imaging-defined skull base meningiomas is unpredictable, with 39.5 to 45.7% of them demonstrating radiological progression in linear diameter measurements [7, 8] and 39.5% to 48.1% in volumetric studies [3, 8]. According to natural history studies 2.6-40% of patients with untreated, asymptomatic skull-based meningiomas will eventually experience neurological deterioration requiring treatment [4]
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