Abstract
Background
Many incidental meningiomas are detected and need to be assessed for further management. Better knowledge of the long-term natural history is necessary for optimal management.
Methods
We have retrospectively evaluated a cohort of consecutive patients who were referred to the authors at the Department of Neurosurgery with incidentally diagnosed asymptomatic meningiomas from 1991–1998 and followed prospectively. All patients were followed for a minimum of 10 years or until they reached the endpoint of demonstrated tumour growth or died.
Results
During follow-up, 35.4 % of the tumours grew, resulting in a 75 % 15-year growth rate by life-table statistics. The growth rates were similar in smaller (<2 cm) and larger tumours, while calcified tumours grew at a lower rate. The latter difference was, however, not statistically significant.
Conclusion
Long-term tumour growth of incidentally detected asymptomatic meningiomas appeared to be much higher than expected. This information needs to be considered when discussing surgery, since the indication for surgery may be stronger than previously stated, especially for younger patients with tumours that can be reached at low risk.
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All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
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Comment
Meningiomas are tumours and tumours grow. Luckily, small incidental ones do not in general grow very much. However, this very long-term observational study shows that if you wait long enough, a proportion may grow a little and sometimes cause problems. The trick is to have some system for making the decision when to intervene. Calcification may give us some information; otherwise it is down to careful review. The study reminds us that the surgeon does not need to offer surgery every time.
Michael Powell
London, UK
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Jadid, K.D., Feychting, M., Höijer, J. et al. Long-term follow-up of incidentally discovered meningiomas. Acta Neurochir 157, 225–230 (2015). https://doi.org/10.1007/s00701-014-2306-3
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DOI: https://doi.org/10.1007/s00701-014-2306-3