Recurrence Of Intracranial Meningiomas Research Articles

Factors Associated with Recurrence of Intracranial Meningiomas After Surgical Resection: A Retrospective Single-Center Study

Summary Background Meningioma is one of the most common primary brain neoplasms with poor outcomes. The present study was aimed to determine clinical and surgical characteristics of intracranial meningiomas associated with tumor recurrence and complications. Methods A total of 138 patients undergoing surgical resection of intracranial meningiomas between Jan 2003 and Dec 2014 were included and followed for the period of at least 12 months. The demographic and clinical characteristics possibly associated with tumor recurrence were assessed, including age, gender, clinical symptoms, pathology data, tumor parameters, preoperative and postoperative Karnofsky Performance Scale (KPS), complications and recurrence rate. Results One hundred and twenty one lesions were benign (classified as Grade I) and 17 were atypical/malignant (classified as Grade II/III). The patients were of a mean age of 60.5 years and a mean follow-up duration of 36.8 months (range, 16.3–62.9 months). The 1, 3, 5-year recurrence/tumor enlargement rates were 3.4%, 7.2%, and 15.7%, respectively. In multivariate analysis, symptoms of disturbance of consciousness and palpable cranial mass were associated with increased recurrence/tumor enlargement. In addition, patients with Simpson grade IV were more likely to have recurrence/tumor enlargement. Conclusion The pattern of intracranial meningioma in this series is typical to other studies. Presenting symptoms is suggested to be predictive of recurrence.

Recurrence of intracranial meningiomas: did better methods of diagnosis and surgical treatment change the outcome in the last 30 years?

Objective: Meningiomas are benign intracranial tumors growing from the arachnoid cap cells. Although their behavior is usually benign, they tend to recur even after total removal, and their recurrence is dependent on different aspects.Methods: Between 1991 and 2002, 463 patients with an intracranial meningioma were operated in the Department of Neurosurgery, University of Kiel, Kiel, Germany. We compared the outcome of these patients after operation and the different methods of radiation therapy and chemotherapy with the data from Buhl (1994), who analysed 661 patients with intracranial meningioma who were operated on in the Department of Neurosurgery, University of Essen, Essen, Germany, between 1968 and 1988, to find out whether better methods of diagnosis like magnetic resonance imaging scans, magnetic resonance spectroscopy, post-operative radiation therapy and chemotherapy have an influence on the recurrence and outcome after surgical treatment.Results: The patients' mean age in both studies was between 50 and 59 years. Both studies underlined the preponderance of female patients for intracranial meningiomas. In the primary study, there were 506 female and 208 male patients, and in the new study, there were 366 female and 97 male patients. The gender distribution changed from 2.4 : 1 to 3.8 : 1. Complete removal of the tumor was possible in 86.7% in both studies. The recurrence rate in the first study was 11% (73/661), while it was 16% in the second study (73/463). The intracranial localization of the meningiomas was similar to the distribution of the histological subtypes and the rate of recurrence; only the malignant meningiomas showed a higher grade of recurrence in the last study. Indications for post-operative radiation therapy were given earlier in the last study owing to the experience from the primary study. The outcome of the patients after surgical removal was improving in the last years; the 30 day post-operative mortality after a primary operation on an intracranial meningioma decreased from 12.1 to 3%. After removal of a recurrent meningioma, the mortality declined from 20 to 12.5%.Conclusion: In the last 30 years, nothing important changed at the time of appearance of meningiomas, concerning the gender distribution and localisation as well as histological subtypes. With better operating modalities and additional treatment with radiation and gamma knife, the mortality decreased significantly from 12 to 3% and the outcome of the patients is still improving, so that even elderly patients with intracranial meningioma can undergo surgical treatment with minor risks.

Matrix metalloproteinase-2 and matrix metalloproteinase-9 expressions correlate with the recurrence of intracranial meningiomas.

We studied whether or not the expressions of MMP-2 and MMP-9 were correlated with the proliferative potential or recurrence of intracranial meningiomas. The expressions of MMP-2 and MMP-9 of 56 meningioma tissues were examined and scored by immunohistochemistry (IHC). Expressions of the mRNA of each MMP were also examined by reverse transcriptase polymerase chain reaction (RT-PCR) assay in 15 cases. The relationships between IHC score and each of age, sex, tumor location, histology, MIB-1 labeling index (LI), and recurrence or regrowth rate were studied. Nine of 56 cases showed recurrence or regrowth. IHC revealed that MMP-2 was highly expressed in 13 of 56 cases, whereas MMP-9 was highly expressed in 22 of 56 cases. Among the 15 cases analyzed by RT-PCR assay, MMP-2 and MMP-9 were expressed in 9 and 13 cases, respectively. Based on the Kaplan-Meier curve, the high expressions of MMPs were related to recurrence/regrowth (MMP-2: p < 0.001; MMP-9: p < 0.05). No significant relationship was observed between the expressions of MMPs and either age, sex, tumor location, or MIB-1 LI. Our study indicated that MMP-2 and MMP-9 expressions are prognostic factors predicting the recurrence of meningioma, independent of proliferative potential.

Intracranial meningiomas: analysis of recurrence after surgical treatment.

Recurrence of intracranial meningiomas after surgery has long been recognized, but there is still no consensus about factors responsible for recurrence. To better understand such factors, we analysed data on 276 patients with meningiomas who were treated at our institution from 1976 to 1990 (mean follow-up = 5.1 years). Effects of sex, tumour histology, tumour site, and radiotherapy on recurrence were closely studied. Using World Health Organization criteria to define malignancy, 254 of the tumours were benign and 22 were atypical or malignant. For data analysis, distinction was made between "recurrence"(i.e., reappearance of tumour after total resection) and "regrowth" (i.e., tumour enlargement after subtotal removal). Recurrence was seen in 2 of 183 benign meningiomas and in 10 of 16 malignant meningiomas. Recurrence and regrowth rates for malignant meningiomas far exceeded those for benign meningiomas (p = 0.001). Neither sex nor tumour site was associated with subsequent recurrences in patients whose tumours had been completely resected. The influence of radiotherapy was studied in terms of its effects on benign versus malignant meningiomas, whether given after complete or incomplete resection, and whether given after primary resection or on reoperation. We found that radiotherapy did not decrease "recurrence" or "regrowth" regardless of when administered, either at first resection or on recurrence. This was true for benign as well as malignant meningiomas. However, due to the small number in our series, we cannot conclude that radiotherapy has no beneficial role in the treatment of meningiomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Glucose utilization by intracranial meningiomas as an index of tumor aggressivity and probability of recurrence: a PET study.

Seventeen patients with intracranial meningiomas were studied with positron emission tomography and fluorine-18-2-fluorodeoxyglucose (PET-FDG) to assess the glucose utilization of these tumors. Four meningiomas followed for 3-5 years after PET-FDG and surgery showed no evidence of recurrence. These tumors had significantly lower glucose utilization rates (1.9 mg/dl/min +/- 1.0) than 11 recurrent or regrowing meningiomas (4.5 mg/dl/min +/- 1.96) (P less than .01). The glucose metabolic rates of meningiomas correlated with tumor growth, as estimated from changes in tumor size on repeated computed tomographic scans. Histopathologically, a syncytial (atypical) meningioma had the highest glucose utilization rate, followed by a papillary meningioma and an angioblastic meningioma. Individual transitional and syncytial (typical) meningiomas showed marked differences in glucose metabolism despite similar microscopic appearance. Glucose utilization rate appears to be at least as reliable as histologic classification and other proposed criteria for predicting the behavior and recurrence of intracranial meningiomas.

Recurrence of intracranial meningiomas: the role played by regional multicentricity.

Meningiomas are regarded as benign dural tumors that can be totally removed; however, after a resection that appears to the naked eye to be total, their recurrence rate is high. Malignancy in a few cases and an erroneous belief in many others that the excision was total are among the most accepted explanations. Few studies have mentioned multicentricity as a cause of "relapse." Therefore, the authors decided to examine the dura mater around globular meningiomas for evidence of regional multifocality. A radial strip of dura was removed from the line of attachment of globular meningiomas in 14 consecutive patients. Meningotheliomatous cell aggregates were demonstrated in 100% of these dural strips in the form of either intradural clusters or nodes protruding from the inner aspect of the dura. The benign appearance of the cells and the great prevalence in this study of the benign types of meningioma seem to exclude malignancy; the intradural position of the clusters and their independence from blood vessels apparently negate seeding and dural metastasis. Control strips of convexity dura mater taken from 10 neurosurgical patients without meningioma failed to show these meningotheliomatous conglomerates. These findings indicate that solitary globular meningiomas represent only the most visible growth in the midst of a neoplastic field change spreading over a wide area of dura mater. The authors believe that this can explain some unexpected "recurrences," and that a wide resection of dura around globular meningiomas, whenever possible, could reduce the incidence of clinical growth after true total excision of the most visible lesion. It remains to be determined what factors cause the acceleration of growth of these cell aggregates after removal of the dominant tumor.

The recurrence of intracranial meningiomas after surgical treatment.

A study of 114 surgically treated patients with intracranial meningiomas was carried out to evaluate factors influencing recurrence. The data of the initial surgery extended over a 24-year period from January, 1956, to December, 1979. The patients ranged in age from 1 1/2 years to 82 years. Seventy-one (62.3%) were females and 43 (37.7%) were males. The surgical procedure was graded according to Simpson's classification from 1 to 5 (Grade 1 = complete excision, Grade 5 = simple decompression). In this series, 33 procedures (28.9%) were Grade 1, 55 (48.2%) were Grade 2, seven (6.1%) were Grade 3, 18 (15.8%) were Grade 4, and one (0.9%) was Grade 5. There were eight (7%) postoperative deaths. Approximately 60% of the tumors were located in the sphenoid wing (23.7%), convexity (21.1%), and parasagittally (14.9%). Histological diagnosis in 96% of the patients was transitional (42.1%), syncytial (34.2%), and fibroblastic (20.2%) meningiomas. Eight (7%) patients received postoperative radiotherapy. There was evidence of recurrence in 22 patients (19.3%). Twenty-one underwent a second surgical procedure. Using survival analysis, it was determined that 80% of the patients were free of recurrence 5 years after the initial surgery, and approximately 50% showed no recurrence 20 years after the initial surgery. Only the grade of the initial surgery had a statistically significant influence on recurrence. Sex of patients, site and histology of the tumor, and postoperative radiotherapy had no statistically significant influence on recurrence. Angioblastic and malignant meningiomas were rare (only four cases), and recurred relatively quickly.

The recurrence of intracranial meningiomas

A series of 126 patients with meningioma, operated upon 7-17 years ago, is reviewed as to the recurrence of the tumour. The overall rate of recurrence of the histologically benign lesions was 29 per cent. The most important factors influencing the prognosis were the site of the tumour and the degree of radicality of excision. Both factors were illustrated best in the parasagittal meningiomas, which carry the highest rate of recurrence. Infiltration of tumour into adjacent bone does not necessarily carry a higher risk of a clinically relevant recurrence. There seems to be a great variation in the rate of growth of different meningiomas.