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Recurrence of surgically treated parasagittal meningiomas: a meta-analysis of risk factors

  • Review Article - Tumor - Meningioma
  • Published:
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Abstract

Background

As the predictive role of many risk factors for parasagittal meningioma (PM) recurrence remains unclear, the objective of the meta-analysis was to make a comprehensive assessment of the predictive value of selected risk factors in these lesions.

Methods

Studies including data on selected risk factors, such as histology, tumor and sinus resection, sinus invasion, tumor localization, and immediate postoperative radiotherapy for PMs recurrence, were searched in the NCBI/NLM PubMed/MEDLINE, EBM Reviews/Cochrane Central, ProQuest, and Scopus databases, and analyzed using random effects modeling.

Results

Thirteen observational studies involving 1243 patients met the criteria for inclusion in the meta-analysis. WHO grading of meningiomas was identified as the most powerful risk factor for recurrence. WHO grade II meningiomas (OR 11.61; 95% CI 4.43–30.43; P < .01; I2 = 31%) or composite group of WHO grades II and III (OR 14.84; 95% CI 5.10–43.19; P < .01; I2 = 48%) had a significantly higher risk of recurrence than benign lesions. Moreover, an advanced sinus involvement (types IV–VI according to the Sindou classification) (OR 3.49; 95% CI 1.30–9.33; P = .01; I2 = 0%) and partial tumor resection (Simpson grades III–V) (OR 2.73; 95% CI 1.41–5.30; P = .03; I2 = 52%) were associated with a significantly higher risk of recurrence than their counterparts.

Conclusion

Among the selected risk factors, high-grade WHO lesions, advanced sinus invasion, and partial tumor resection were associated with a higher risk of PM recurrence, with WHO grading system being the most powerful risk factor.

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References

  1. Biroli A, Chiocchetta M, Gerosa M, Talacchi A (2012) Surgical treatment of parasagittal and falcine meningiomas of the posterior third. Acta Neurochir 154:1987–1995

    Article  Google Scholar 

  2. Black PM (1993) Meningiomas. Neurosurgery 32:643–657

    Article  CAS  Google Scholar 

  3. Black PM, Morokoff AP, Zauberman J (2008) Surgery for extra-axial tumors of the cerebral convexity and midline. Neurosurgery 62(6 Suppl 3):1115–1123

    PubMed  Google Scholar 

  4. Bonnal J, Brotchi J (1978) Surgery of the superior sagittal sinus in parasagittal meningiomas. J Neurosurg 48:935–945

    Article  CAS  Google Scholar 

  5. Borovich B, Doron Y (1986) Recurrence of intracranial meningiomas: the role played by regional multicentricity. J Neurosurg 64:58–63

    Article  CAS  Google Scholar 

  6. Borovich B, Doron Y, Braun J, Guilburd JN, Zaaroor M, Goldsher D, Lemberger A, Gruszkiewicz J, Feinsod M (1986) Recurrence of intracranial meningiomas: the role played by regional multicentricity. 2: clinical and radiological aspects. J Neurosurg 65:168–171

    Article  CAS  Google Scholar 

  7. Caroli E, Orlando ER, Mastronardi L, Ferrante L (2006) Meningiomas infiltrating the superior sagittal sinus: surgical considerations of 328 cases. Neurosurg Rev 29:236–241

    Article  Google Scholar 

  8. Chan RC, Thompson GB (1984) Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 60:52–60

    Article  CAS  Google Scholar 

  9. Colli BO, Carlotti CG, Assirati JA, Santos MBM, Neder L, Santos AC (2006) Parasagittal meningiomas: follow-up review. Surg Neurol 66(Suppl 3):S20–S28

    Article  Google Scholar 

  10. Cushing H, Heisenhardt L (1938) Meningiomas: their classification, regional behavior, life history, and surgical end results. Charles C Thomas, Springfield

    Google Scholar 

  11. DiMeco F, Li KW, Casali C, Ciceri E, Giombini S, Filippini G, Broggi G, Solero CL (2004) Meningiomas invading the superior sagittal sinus: surgical experience in 108 cases. Neurosurgery 55:1263–1274

    Article  Google Scholar 

  12. Giombini S, Solero CL, Lasio G, Morello G (1984) Immediate and late outcome of operations for parasagittal and falx meningiomas. Report of 342 cases. Surg Neurol 21:427–435

    Article  CAS  Google Scholar 

  13. Han MS, Kim YJ, Moon KS, Lee KH, Yang JI, Kang WD, Lim SH, Jang WY, Jung TY, Kim IY, Jung S (2016) Lessons from surgical outcome for intracranial meningioma involving major venous sinus. Medicine (Baltimore) 95(35):e4705

    Article  Google Scholar 

  14. Hancq S, Baleriaux D, Brotchi J (2003) Surgical treatment of parasagittal meningiomas. Semin Neurosurg 14:203–210

    Article  Google Scholar 

  15. Harbord RM, Egger M, Sterne JA (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25:3443–3457

    Article  Google Scholar 

  16. Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions, vol 4. Wiley, Hoboken

    Google Scholar 

  17. Kleihues P, Burger PC, Scheithauer BW (1993) The new WHO classification of brain tumours. Brain Pathol 3:255–268

    Article  CAS  Google Scholar 

  18. Kleihues P, Cavenee WK (eds) (2000) World Health Organization classification of tumours: pathology and genetics of tumours of the nervous system. IARC Press, Lyon

    Google Scholar 

  19. Kleihues P, Louis DN, Scheithauer BW et al (2002) The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61:215–229

    Article  Google Scholar 

  20. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) (2007) WHO classification of tumours of the central nervous system. IARC, Lyon

    Google Scholar 

  21. Louis DN, Perry A, Reifenberger G et al (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131:803–820

    Article  Google Scholar 

  22. Mathiesen T, Pettersson-Segerlind J, Kihlström L, Ulfarsson E (2014) Meningiomas engaging major venous sinuses. World Neurosurg 81:116–124

    Article  Google Scholar 

  23. Mesa JAE, Morillejo EA, Carreño TP, Allut AH, Donate JMN, Roman PM, Jimenez AC, Garcia FP, Gonzalez JM (2018) Risk of recurrence in operated parasagittal meningiomas: a logistic binary regression model. World Neurosurg 110:e112–e118

    Article  Google Scholar 

  24. Mirian C, Duun-Henriksen AK, Juratli T, Sahm F, Spiegl-Kreinecker S, Peyre M, Biczok A, Tonn JC, Goutagny S, Bertero L, Maier AD, Møller Pedersen M, Law I, Broholm H, Cahill DP, Brastianos P, Poulsgaard L, Fugleholm K, Ziebell M, Munch T, Mathiesen T (2020) Poor prognosis associated with TERT gene alterations in meningioma is independent of the WHO classification: an individual patient data meta-analysis. J Neurol Neurosurg Psychiatry 91:378–387

    Article  Google Scholar 

  25. Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62:18–24

    Article  CAS  Google Scholar 

  26. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoSMed 6:e1000097

    Google Scholar 

  27. Nowak A, Dziedzic T, Czernicki T, Kunert P, Marchel A (2014) Surgical treatment of parasagittal and falcine meningiomas invading the superior sagittal sinus. Neurol Neurochir Pol 48:174–180

    Article  Google Scholar 

  28. Nowak A, Marchel A (2007) Surgical treatment of parasagittal and falx meningiomas. Neurol Neurochir Pol 41:306–314

    PubMed  Google Scholar 

  29. Pettersson-Segerlind J, Orrego A, Lönn S, Mathiesen T (2011) Long-term 25-year follow-up of surgically treated parasagittal meningiomas. World Neurosurg 76:564–571

    Article  Google Scholar 

  30. Raza SM, Gallia GL, Brem H, Weingart JD, Long DM, Olivi A (2010) Perioperative and long-term outcomes from the management of parasagittal meningiomas invading the superior sagittal sinus. Neurosurgery 67:885–893

    Article  Google Scholar 

  31. Ricci A, Di Vitantonio H, De Paulis D, Del Maestro M, Gallieni M, Dechcordi SR, Marzi S, Galzio RJ (2017) Parasagittal meningiomas: our surgical experience and the reconstruction technique of the superior sagittal sinus. Surg Neurol Int 8:1

    PubMed  PubMed Central  Google Scholar 

  32. Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S et al (2017) DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 18:682–694

    Article  CAS  Google Scholar 

  33. Samii M (1997) Radical resection of meningiomas and arteriovenous fistulas involving critical dural sinus segments: experience with intraoperative sinus pressure monitoring and elective sinus reconstruction in 10 patients. Neurosurgery 41:1018 (comment)

    Article  Google Scholar 

  34. Schunemann H, Brozek J, Guyatt G, Oxman A, eds GRADE handbook. Updated October 2013. Available at: https://gdt.gradepro.org/app/handbook/handbook.html. Accessed [June 13, 2019]

  35. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39

    Article  CAS  Google Scholar 

  36. Sindou MP, Alvernia JE (2006) Results of attempted radical tumor removal and venous repair in 100 consecutive meningiomas involving the major dural sinuses. J Neurosurg 105:514–525

    Article  Google Scholar 

  37. Sindou M, Auque J (2000) The intracranial venous system as a neurosurgeon’s perspective. Adv Tech Stand Neurosurg 26:131–216

    Article  CAS  Google Scholar 

  38. Slavik H, Balik V, Vrbkova J, Rehulkova A, Vaverka M, Hrabalek L, Ehrmann J, Vidlarova M, Gurska S, Hajduch M, Srovnal J (2020) Identification of meningioma patients at high risk of tumor recurrence using microRNA profiling. Neurosurgery. https://doi.org/10.1093/neuros/nyaa009

  39. Sterne JAC, Higgins JPT, Reeves BC, on behalf of the development group for ACROBAT-NRSI A Cochrane Risk Of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI), Version 1.0.0, 24 September 2014. Available at: http://www.riskofbias.info. Accessed [June 13, 2019]

  40. Sughrue ME, Rutkowski MJ, Shangari G, Parsa AT, Berger MS, McDermott MW (2011) Results with judicious modern neurosurgical management of parasagittal and falcine meningiomas. Clinical article. J Neurosurg 114:731–737

    Article  Google Scholar 

  41. Tomasello F, Conti A, Cardali S, Angileri FF (2013) Venous preservation-guided resection: a changing paradigm in parasagittal meningioma surgery. J Neurosurg 119:74–81

    Article  Google Scholar 

  42. Wells GA, Shea B, O’Connell D et al The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed [June 13, 2019]

  43. Zülch KJ (ed) (1979) Histologic typing of tumours of the central nervous system. World Health Organization, Geneva

    Google Scholar 

Download references

Funding

This study was supported by Ministerstvo Zdravotnictví České Republiky (Award Number: 15-29021A) and European Regional Development Fund (Award Number: ENOCH CZ 02.1.01/0.0/0.0/16_019/0000868).

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Authors and Affiliations

  1. Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hněvotínská 1333/5, I. P. Pavlova 6, 779 00, Olomouc, Czech Republic

    Vladimir Balik, Pavla Kourilova, Jana Vrbkova, Josef Srovnal & Marian Hajduch

  2. Department of Neurosurgery, Svet Zdravia Hospital Michalovce, Michalovce, Slovak Republic

    Vladimir Balik

  3. Institute of Neurobiology, Slovak Academy of Sciences, Kosice, Slovak Republic

    Igor Sulla

  4. Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan

    Katsumi Takizawa

Authors
  1. Vladimir Balik
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  2. Pavla Kourilova
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  3. Igor Sulla
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  4. Jana Vrbkova
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  6. Marian Hajduch
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  7. Katsumi Takizawa
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Corresponding author

Correspondence to Vladimir Balik.

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This article is part of the Topical Collection on Tumor – Meningioma.

Electronic supplementary material

Online Resource 1.

Quality assessment of studies included in the meta-analysis using the Newcastle-Ottawa Assessment Scale (PDF 157 kb).

Online Resource 2.

The results of meta-regression analysis of the publication date of the eligible studies with the ORs of the outcomes in the studies: a, extent of tumor resection; b, sinus resection; c, radiotherapy pattern after partial tumor resection; d-e, tumor location along the superior sagittal sinus; f-g, extent of sinus involvement; and h-j, WHO grades. i, A statistically meaningful relationship was revealed only while comparing WHO grade I meningiomas with higher grade lesions (PDF 1448 kb).

Online Resource 3.

Funnel plots assessing publication bias in the meta-analysis of respective studies comparing tumor recurrence in patients with various: a, extent of tumor resection; b, sinus resection; c, radiotherapy pattern after partial tumor resection; d-e, tumor location along the superior sagittal sinus; f-i, extent of sinus involvement; and j-l, WHO grades (PDF 1374 kb).

Online Resource 4.

Risk-of-bias assessment of studies included in the meta-analysis using the Cochrane risk of bias assessment tool (PDF 83 kb).

Online Resource 5.

Level of evidence informing primary outcome (recurrence) assessed using the GRADE framework (PDF 125 kb).

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Balik, V., Kourilova, P., Sulla, I. et al. Recurrence of surgically treated parasagittal meningiomas: a meta-analysis of risk factors. Acta Neurochir 162, 2165–2176 (2020). https://doi.org/10.1007/s00701-020-04336-3

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  • DOI: https://doi.org/10.1007/s00701-020-04336-3

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