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Pre-Operative Factors Affecting Resectability of Giant Intracranial Meningiomas

Published online by Cambridge University Press:  02 December 2014

Alfredo Quiñones-Hinojosa ,
Tania Kaprealian ,
Kaisorn L. Chaichana ,
Nader Sanai ,
Andrew T. Parsa ,
Mitchel S. Berger  and
Michael W. McDermott
Alfredo Quiñones-Hinojosa*
Affiliation:
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD
Tania Kaprealian
Affiliation:
Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA
Kaisorn L. Chaichana
Affiliation:
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD
Nader Sanai
Affiliation:
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA
Andrew T. Parsa
Affiliation:
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA
Mitchel S. Berger
Affiliation:
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA
Michael W. McDermott
Affiliation:
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA
*
The Johns Hopkins Hospital, Department of Neurosurgery, Johns Hopkins University, CRB II, 1550 Orleans Street, Room 253, Baltimore, MD, 21231, USA
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Abstract

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Objective:

Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas ≥5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability.

Methods:

Sixty-seven patients undergoing surgery for a large intracranial meningioma (≥5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis.

Results:

Thirty-nine (58%) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58%) patients, remained unchanged in 20 (30%), and were aggravated in 8 (12%). In the multivariate model for all large meningiomas, age>45 years [OR(95%CI);0.127 (0.026-0.616),p=0.01] and superior sagittal sinus involvement [OR(95%CI);0.160 (0.026-0.976),p=0.05] were negative predictors of GTR, while preoperative embolization [OR(95%CI);8.087(1.719-38.044),p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95%CI);0.077 (0.010-0.571),p=0.01] and preoperative embolization [OR(95%CI);10.492(1.961-56.135),p=0.006] were independently associated with GTR.

Conclusions:

This study evaluated a subset of large intracranial meningiomas ≥5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 5 , September 2009 , pp. 623 - 630
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

1.Drummond, KJ, Zhu, JJ, Black, PM.Meningiomas: updating basic science, management, and outcome. Neurologist. 2004;10(3): 113–30.CrossRefGoogle ScholarPubMed
2.Claus, EB, Bondy, ML, Schildkraut, JM, Wiemels, JL, Wrensch, M, Black, PM.Epidemiology of intracranial meningioma. Neurosurgery. 2005;57(6):1088–95; discussion 95.Google Scholar
3.Buhl, R, Nabavi, A, Wolff, S, Hugo, HH, Alfke, K, Jansen, O, et al.MR spectroscopy in patients with intracranial meningiomas. Neurol Res. 2007;29(1):43–6.Google Scholar
4.d’Avella, D, Salpietro, FM, Alafaci, C, Tomasello, F.Giant olfactory meningiomas: the pterional approach and its relevance for minimizing surgical morbidity. Skull Base Surg. 1999;9(1): 23–31.CrossRefGoogle ScholarPubMed
5.Hirsh, LF, Mancall, EL.Giant meningiomas of the posterior fossa. JAMA. 1978;240(15):1626–7.CrossRefGoogle ScholarPubMed
6.Lopez, MJ, Olivares, JL, Ramos, F, Redondo, JA, Ramon y Cajal, S, Banzo, J, et al.Giant meningioma in a 5-month-old infant. Childs Nerv Syst. 1988;4(2):112–5.CrossRefGoogle Scholar
7.Pomeranz, S, Umansky, F, Elidan, J, Ashkenazi, E, Valarezo, A, Shalit, M.Giant cranial base tumours. Acta Neurochir (Wien). 1994; 129(3-4):121–6.Google Scholar
8.Simpson, D.The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20(1): 22–39.Google Scholar
9.Chun, JY, McDermott, MW, Lamborn, KR, Wilson, CB, Higashida, R, Berger, MS.Delayed surgical resection reduces intraoperative blood loss for embolized meningiomas. Neurosurgery. 2002; 50(6):1231–5; discussion 5-7.Google Scholar
10.Martin, AJ, Cha, S, Higashida, RT, Cullen, SP, Halbach, V, Dowd, CF, et al.Assessment of vasculature of meningiomas and the effects of embolization with intra-arterial MR perfusion imaging: a feasibility study. AJNR Am J Neuroradiol. 2007;28(9):1771–7.Google Scholar
11.Sindou, MP, Alvernia, JE.Results of attempted radical tumor removal and venous repair in 100 consecutive meningiomas involving the major dural sinuses. J Neurosurg. 2006;105(4): 514–25.Google Scholar
12.Cech, DA, Leavens, ME, Larson, DL.Giant intracranial and extracranial meningioma: case report and review of the literature. Neurosurgery. 1982;11(5):694–7.Google Scholar
13.Cushing, H, Eisenhardt, L.Meningiomas: Their classification, regional behavior, life history, and surgical end results. Springfield, Illinois; 1938.Google Scholar
14.Alp, H, Ceviker, N, Baykaner, K, Orbay, T.Giant meningioma in a fourteen-month-old infant. Surg Neurol. 1985;24(1):77–9.Google Scholar
15.Benli, K, Cataltepe, O, Oge, HK, Onol, B.Giant congenital meningioma in a newborn. Childs Nerv Syst. 1990;6(8):462–4.CrossRefGoogle ScholarPubMed
16.Sekhar, LN, Swamy, NK, Jaiswal, V, Rubinstein, E, Hirsch, WE Jr., Wright, DC.Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration. J Neurosurg. 1994;81(6): 860–8.Google Scholar
17.Jiang, YG, Xiang, J, Wen, F, Zhang, LY.Microsurgical excision of the large or giant cerebellopontine angle meningioma. Minim Invasive Neurosurg. 2006;49(1):43–8.Google Scholar
18.Roser, F, Ebner, FH, Ritz, R, Samii, M, Tatagiba, MS, Nakamura, M.Management of skull based meningiomas in the elderly patient. J Clin Neurosci. 2007;14(3):224–8.CrossRefGoogle ScholarPubMed
19.Papo, I.Intracranial meningiomas in the elderly in the CT scan era. Acta Neurochir (Wien). 1983;67(3-4):195–204.Google Scholar
20.Awad, IA, Kalfas, I, Hahn, JF, Little, JR.Intracranial meningiomas in the aged: surgical outcome in the era of computed tomography. Neurosurgery. 1989;24(4):557–60.Google Scholar
21.Cornu, P, Chatellier, G, Dagreou, F, Clemenceau, S, Foncin, JF, Rivierez, M, et al.Intracranial meningiomas in elderly patients. Postoperative morbidity and mortality. Factors predictive of outcome. Acta Neurochir (Wien). 1990;102(3-4):98–102.Google Scholar
22.Mastronardi, L, Ferrante, L, Qasho, R, Ferrari, V, Tatarelli, R, Fortuna, A.Intracranial meningiomas in the 9th decade of life: a retrospective study of 17 surgical cases. Neurosurgery. 1995;36 (2):270–4.Google Scholar
23.Ayerbe, J, Lobato, RD, de la Cruz, J, Alday, R, Rivas, JJ, Gomez, PA, et al.Risk factors predicting recurrence in patients operated on for intracranial meningioma. A multivariate analysis. Acta Neurochir (Wien). 1999;141(9):921–32.CrossRefGoogle ScholarPubMed
24.DiMeco, F, Li, KW, Casali, C, Ciceri, E, Giombini, S, Filippini, G, et al.Meningiomas invading the superior sagittal sinus: surgical experience in 108 cases. Neurosurgery. 2004;55(6):1263–72; discussion 72-4.Google Scholar
25.Hieshima, GB, Everhart, FR, Mehringer, CM, Tsai, F, Hasso, AH, Grinnell, VS, et al.Preoperative embolization of meningiomas. Surg Neurol. 1980;14(2):119–27.Google Scholar
26.Manelfe, C, Lasjaunias, P, Ruscalleda, J.Preoperative embolization of intracranial meningiomas. AJNR Am J Neuroradiol. 1986;7 (5):963–72.Google Scholar
27.Richter, HP, Schachenmayr, W.Preoperative embolization of intracranial meningiomas. Neurosurgery. 1983;13(3):261–8.Google Scholar
28.Bendszus, M, Rao, G, Burger, R, Schaller, C, Scheinemann, K, Warmuth-Metz, M, et al.Is there a benefit of preoperative meningioma embolization? Neurosurgery. 2000;47(6):1306–11; discussion 11-2.Google Scholar
29.Bendszus, M, Monoranu, CM, Schutz, A, Nolte, I, Vince, GH, Solymosi, L.Neurologic complications after particle embolization of intracranial meningiomas. AJNR Am J Neuroradiol. 2005;26(6):1413–9.Google Scholar