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Indications and outcome in surgically treated asymptomatic meningiomas: a single-center case-control study.

ABSTRACT: BACKGROUND:Many meningiomas are detected incidentally and remain asymptomatic until intervention. The goal of this study was to describe the management and outcome in this group of surgically treated asymptomatic meningiomas. METHODS:From 2004 to 2017, 45 patients with asymptomatic meningioma were surgically treated at Sahlgrenska University Hospital, and their medical records and imaging data were analyzed. The asymptomatic cases were matched with symptomatic ones with respect to age at diagnosis, location, WHO (World Health Organization) grade, and Simpson grade. RESULTS:Time from diagnosis to surgery differed between the asymptomatic and symptomatic patients (8.6 vs. 1.3 months; p??1 year after surgery, compared with 7.7% of the asymptomatic (p?=?0.003). Thirty-day complication rate was significantly higher among the asymptomatic cases (35.6% vs. 24.4%; 0.001), as well as the proportion of older asymptomatic individuals (>?70 years) experiencing postoperative complication compared with symptomatic patients of the same age group. CONCLUSION:As expected, asymptomatic cases had smaller tumors and waited longer for surgery. Surprisingly, complication rate was significantly higher among asymptomatic cases compared with their symptomatic control. Taken into account that many asymptomatic tumors are removed surgically due to patient's wish, one might suggest a more restrictive approach, especially in the elderly.

SUBMITTER: Naslund O

PROVIDER: S-EPMC7415028 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Indications and outcome in surgically treated asymptomatic meningiomas: a single-center case-control study.

Näslund Olivia O Skoglund Thomas T Farahmand Dan D Bontell Thomas O TO Jakola Asgeir S AS

Acta neurochirurgica 20200203 9

<h4>Background</h4>Many meningiomas are detected incidentally and remain asymptomatic until intervention. The goal of this study was to describe the management and outcome in this group of surgically treated asymptomatic meningiomas.<h4>Methods</h4>From 2004 to 2017, 45 patients with asymptomatic meningioma were surgically treated at Sahlgrenska University Hospital, and their medical records and imaging data were analyzed. The asymptomatic cases were matched with symptomatic ones with respect to ...[more]

PMID: 32016587

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Project description:BACKGROUND:Clinical behaviour of atypical meningiomas is not uniform. While, as a group, they exhibit a high recurrence rate, some pursue a more benign course, whereas others progress early. We aim to investigate the imaging and pathological factors that predict risk of early tumour progression and to determine whether early progression is related to outcome. METHODS:Adult patients with WHO grade II meningioma treated in three regional referral centres between 2007 and 2014 were included. MRI and pathology characteristics were assessed. Gross total resection (GTR) was defined as Simpson 1-3. Recurrence was classified into early and late (??24 vs. >?24 months). RESULTS:Among the 220 cases, 37 (16.8%) patients progressed within 24 months of operation. Independent predictors of early progression were subtotal resection (STR) (p?=?0.005), parafalcine/parasagittal location (p?=?0.015), peritumoural oedema (p?=?0.027) and mitotic index (MI)?>?7 (p?=?0.007). Adjuvant radiotherapy was negatively associated with early recurrence (p?=?0.046). Thirty-two per cent of patients with residual tumour and 26% after GTR received adjuvant radiotherapy. There was a significantly lower proportion of favourable outcomes at last follow-up (mRS 0-1) in patients with early recurrence (p?=?0.001). CONCLUSIONS:Atypical meningiomas are a heterogeneous group of tumours with 16.8% patients having recurrence within 24 months of surgery. Residual tumour, parafalcine/parasagittal location, peritumoural oedema and a MI?>?7 were all independently associated with early recurrence. As administration of adjuvant radiotherapy was not protocolised in this cohort, any conclusions about benefits of irradiation of WHO grade II meningiomas should be viewed with caution. Patients with early recurrence had worse neurological outcome. While histological and imaging characteristics provide some prognostic value, further molecular characterisation of atypical meningiomas is warranted to aid clinical decision making.

Project description:ObjectiveRathke cleft cysts (RCC) are benign lesions of the sellar region that require surgical treatment in case of visual deterioration or progression of the cyst. However, the natural course is often stable and asymptomatic. We aimed to investigate the characteristics of patients with cyst progression during follow-up (FU) and to compare the natural history of patients with RCC with patients who underwent surgery.MethodsPatients with an MR morphologic cystic sellar lesion classified as RCC between 04/2001 and 11/2020 were included. Functional outcomes, including ophthalmologic, endocrinologic, and MRI data, were retrospectively analyzed and compared between surgically treated patients, patients on a "watch and wait" strategy (WWS), and patients on a WWS who underwent secondary surgery due to cyst progression.ResultsOne hundred forty patients (median age 42.8 years) with RCC on MRI were identified. 52/140 (37.1%) underwent primary surgery. Of 88 patients (62.9%) with initial WWS, 21 (23.9%) underwent surgery for secondary cyst progression. Patients on the WWS had significantly smaller cyst volumes (p = 0.0001) and fewer visual disturbances (p = 0.0004), but a similar rate of hormone deficiencies (p = 0.99) compared with surgically treated patients preoperatively. Postoperatively patients suffered significantly more often from hormone deficiencies than WWS patients (p = 0.001). Patients who switched to the surgical group were significantly more likely to have preoperative T1 hyperintense signals on MRI (p = 0.0001) and visual disturbances (p = 0.001) than patients with continuous WWS. Postoperatively, these patients suffered more frequently from new hormonal deficiencies (p = 0.001). Endocrine and ophthalmologic outcomes in patients with primary and secondary surgery were comparable. Multivariate analysis showed that WWS patients were at a higher risk of requiring surgery for cyst progression when perimetric deficits (p = 0.006), hyperprolactinemia (p = 0.003), and corticotropic deficits (p = 0.005) were present.ConclusionSurgical treatment of RCC may cause new hormonal deficiencies, which are rare in the natural course. Therefore, the indication for surgery should be carefully evaluated. Hyperprolactinemia and corticotropic deficits were significant indicators for a secondary cyst progression in patients with RCC. However, a significant amount of almost 25% of initially conservatively managed cysts showed deterioration, necessary for surgical intervention.

Dataset Information

Indications and outcome in surgically treated asymptomatic meningiomas: a single-center case-control study.

Publications

Indications and outcome in surgically treated asymptomatic meningiomas: a single-center case-control study.

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