Acta Neurochirurgica

, Volume 155, Issue 3, pp 407–413 | Cite as

Malignant potential of skull base versus non-skull base meningiomas: clinical series of 1,663 cases

  • Jan Frederick Cornelius
  • Philipp Jörg SlottyEmail author
  • Hans Jakob Steiger
  • Daniel Hänggi
  • Marc Polivka
  • Bernard George
Clinical Article - Brain Tumors



About 90 % of meningiomas are benign (WHO grade I), atypical and anaplastic variants exist (WHO grade II/III, 10 %). Tumour grade has important implications for management. Non-invasive diagnosis of tumour grade is still not feasible. The purpose of this survey was to analyse epidemiological risk factors such as sex, age and location for a higher grade (WHO grade II/III) meningioma in a large surgical series.


A retrospective study comprising 1,663 patients operated on for an intracranial meningioma in a single tertiary-care centre. The population was analysed for correlations including WHO grade, histological subtype, tumour localisation, patient age and gender. Additionally correlations between Ki67 index/WHO grade and localisation were analysed.


A binary logistic regression analysis revealed non-skull base localisation (OR 1.779 [CI 1.069–2.960, p = 0.0027]) and age ≥65 years (OR 1.549 [CI 1.214–2.624, p = 0.012]) as significant risk factors for a higher WHO grade. Male gender showed a trend for a higher risk in χ2 analysis. An analysis of the Ki67 index revealed an increased index for non-skull base localisation compared with skull base (p < 0.001). Correlation analysis of Ki67 distribution in WHO grade I meningiomas revealed higher Ki67 indices for non skull base localisation (p = 0.0024).


Non-skull base localisation and age ≥65 years are independent risk factors for higher grade meningiomas. In other terms, the malignant potential of skull base meningiomas is low. This information is important when advising a patient about individual treatment options (observation, surgery or radio-surgery) and prognosis.


Localisation Meningioma Risk factor Skull base WHO grade 



We would like to thank the Neurosurgical Department of Rothschild Hospital, Paris for providing tumour material to the Neuropathology Department of Lariboisiere Hospital. We would like to thank Tadeusz Dobrowolski and Alice Jousselin for help in proofreading.

Conflicts of interest



  1. 1.
    Aghi MK, Carter BS, Cosgrove GR, Ojemann RG, Amin-Hanjani S, Martuza RL, Curry WT Jr, Barker FG 2nd (2009) Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64:56–60, discussion 60PubMedCrossRefGoogle Scholar
  2. 2.
    Buccoliero AM, Castiglione F, Degl’Innocenti DR, Gheri CF, Garbini F, Taddei A, Ammannati F, Mennonna P, Taddei GL (2007) NF2 gene expression in sporadic meningiomas: relation to grades or histotypes real time-pCR study. Neuropathology 27:36–42PubMedCrossRefGoogle Scholar
  3. 3.
    Cea-Soriano L, Blenk T, Wallander MA, Rodriguez LA (2011) Hormonal therapies and meningioma: is there a link? Cancer Epidemiol 36:198-205Google Scholar
  4. 4.
    Chamberlain MC, Barnholtz-Sloan JS (2011) Medical treatment of recurrent meningiomas. Expert Rev Neurother 11:1425–1432PubMedCrossRefGoogle Scholar
  5. 5.
    Chamberlain MC, Glantz MJ (2008) Interferon-alpha for recurrent World Health Organization grade 1 intracranial meningiomas. Cancer 113:2146–2151PubMedCrossRefGoogle Scholar
  6. 6.
    Cornelius JF, Langen KJ, Stoffels G, Hanggi D, Sabel M, Steiger HJ (2012) PET imaging of meningioma in clinical practice: review of literature and future directions. Neurosurgery 70(4):1033–1041, discussion 1042PubMedCrossRefGoogle Scholar
  7. 7.
    Durand A, Labrousse F, Jouvet A, Bauchet L, Kalamarides M, Menei P, Deruty R, Moreau JJ, Fevre-Montange M, Guyotat J (2009) WHO grade II and III meningiomas: a study of prognostic factors. J Neurooncol 95:367–375PubMedCrossRefGoogle Scholar
  8. 8.
    Engenhart-Cabillic R, Farhoud A, Sure U, Heinze S, Henzel M, Mennel HD, Bertalanffy H (2006) Clinicopathologic features of aggressive meningioma emphasizing the role of radiotherapy in treatment. Strahlenther Onkol 182:641–646PubMedCrossRefGoogle Scholar
  9. 9.
    Jaaskelainen J, Haltia M, Servo A (1986) Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome. Surg Neurol 25:233–242PubMedCrossRefGoogle Scholar
  10. 10.
    Kalamarides M, Stemmer-Rachamimov AO, Niwa-Kawakita M, Chareyre F, Taranchon E, Han ZY, Martinelli C, Lusis EA, Hegedus B, Gutmann DH, Giovannini M (2011) Identification of a progenitor cell of origin capable of generating diverse meningioma histological subtypes. Oncogene 30:2333–2344PubMedCrossRefGoogle Scholar
  11. 11.
    Kane AJ, Sughrue ME, Rutkowski MJ, Shangari G, Fang S, McDermott MW, Berger MS, Parsa AT (2011) Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer 117:1272–1278PubMedCrossRefGoogle Scholar
  12. 12.
    Kasuya H, Kubo O, Tanaka M, Amano K, Kato K, Hori T (2006) Clinical and radiological features related to the growth potential of meningioma. Neurosurg Rev 29:293–296, discussion 296–297PubMedCrossRefGoogle Scholar
  13. 13.
    Keller A, Ludwig N, Comtesse N, Hildebrandt A, Meese E, Lenhof HP (2006) A minimally invasive multiple marker approach allows highly efficient detection of meningioma tumors. BMC Bioinforma 7:539CrossRefGoogle Scholar
  14. 14.
    Kim DG, Kim Ch H, Chung HT, Paek SH, Jeong SS, Han DH, Jung HW (2005) Gamma knife surgery of superficially located meningioma. J Neurosurg 102(Suppl):255–258PubMedCrossRefGoogle Scholar
  15. 15.
    Kleihues P, Sobin LH (2000) World Health Organization classification of tumors. Cancer 88:2887PubMedCrossRefGoogle Scholar
  16. 16.
    Kollova A, Liscak R, Novotny J Jr, Vladyka V, Simonova G, Janouskova L (2007) Gamma Knife surgery for benign meningioma. J Neurosurg 107:325–336PubMedCrossRefGoogle Scholar
  17. 17.
    Korhonen K, Raitanen J, Isola J, Haapasalo H, Salminen T, Auvinen A (2010) Exogenous sex hormone use and risk of meningioma: a population-based case-control study in Finland. Cancer Causes Control 21:2149–2156PubMedCrossRefGoogle Scholar
  18. 18.
    Lohmann CM, Brat DJ (2000) A conceptual shift in the grading of meningiomas. Adv Anat Pathol 7:153–157PubMedCrossRefGoogle Scholar
  19. 19.
    Ludwig N, Keller A, Heisel S, Leidinger P, Rheinheimer S, Andres C, Stephan B, Steudel WI, Donauer E, Graf N, Burgeth B, Weickert J, Lenhof HP, Meese E (2011) Novel immunogenic antigens increase classification accuracy in meningioma to 93.84 %. Int J Cancer 128:1493–1501PubMedCrossRefGoogle Scholar
  20. 20.
    McGovern SL, Aldape KD, Munsell MF, Mahajan A, DeMonte F, Woo SY (2010) A comparison of World Health Organization tumor grades at recurrence in patients with non-skull base and skull base meningiomas. J Neurosurg 112:925–933PubMedCrossRefGoogle Scholar
  21. 21.
    Michaud DS, Gallo V, Schlehofer B, Tjonneland A, Olsen A, Overvad K, Dahm CC, Kaaks R, Lukanova A, Boeing H, Schutze M, Trichopoulou A, Bamia C, Kyrozis A, Sacerdote C, Agnoli C, Palli D, Tumino R, Mattiello A, Bueno-de-Mesquita HB, Ros MM, Peeters PH, van Gils CH, Lund E, Bakken K, Gram IT, Barricarte A, Navarro C, Dorronsoro M, Sanchez MJ, Rodriguez L, Duell EJ, Hallmans G, Melin BS, Manjer J, Borgquist S, Khaw KT, Wareham N, Allen NE, Tsilidis KK, Romieu I, Rinaldi S, Vineis P, Riboli E (2010) Reproductive factors and exogenous hormone use in relation to risk of glioma and meningioma in a large European cohort study. Cancer Epidemiol Biomarkers Prev 19:2562–2569PubMedCrossRefGoogle Scholar
  22. 22.
    Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J (2007) Intensity-modulated radiotherapy for complex-shaped meningioma of the skull base: long-term experience of a single institution. Int J Radiat Oncol Biol Phys 68:858–863PubMedCrossRefGoogle Scholar
  23. 23.
    Modha A, Gutin PH (2005) Diagnosis and treatment of atypical and anaplastic meningiomas: a review. Neurosurgery 57:538–550, discussion 538–550PubMedCrossRefGoogle Scholar
  24. 24.
    Moradi A, Semnani V, Djam H, Tajodini A, Zali AR, Ghaemi K, Nikzad N, Madani-Civi M (2008) Pathodiagnostic parameters for meningioma grading. J Clin Neurosci 15:1370–1375PubMedCrossRefGoogle Scholar
  25. 25.
    Nakasu S, Nakasu Y, Nakajima M, Matsuda M, Handa J (1999) Preoperative identification of meningiomas that are highly likely to recur. J Neurosurg 90:455–462PubMedCrossRefGoogle Scholar
  26. 26.
    Riemenschneider MJ, Perry A, Reifenberger G (2006) Histological classification and molecular genetics of meningiomas. Lancet Neurol 5:1045–1054PubMedCrossRefGoogle Scholar
  27. 27.
    Sade B, Chahlavi A, Krishnaney A, Nagel S, Choi E, Lee JH (2007) World Health Organization Grades II and III meningiomas are rare in the cranial base and spine. Neurosurgery 61:1194–1198, discussion 1198PubMedCrossRefGoogle Scholar
  28. 28.
    Sioka C, Kyritsis AP (2009) Chemotherapy, hormonal therapy, and immunotherapy for recurrent meningiomas. J Neurooncol 92:1–6PubMedCrossRefGoogle Scholar
  29. 29.
    van Nieuwenhuizen D, Klein M, Stalpers LJ, Leenstra S, Heimans JJ, Reijneveld JC (2007) Differential effect of surgery and radiotherapy on neurocognitive functioning and health-related quality of life in WHO grade I meningioma patients. J Neurooncol 84:271–278PubMedCrossRefGoogle Scholar
  30. 30.
    van Tilborg AA, Morolli B, Giphart-Gassler M, de Vries A, van Geenen DA, Lurkin I, Kros JM, Zwarthoff EC (2006) Lack of genetic and epigenetic changes in meningiomas without NF2 loss. J Pathol 208:564–573PubMedCrossRefGoogle Scholar
  31. 31.
    Whittle IR, Smith C, Navoo P, Collie D (2004) Meningiomas. Lancet 363:1535–1543PubMedCrossRefGoogle Scholar
  32. 32.
    Wiemels J, Wrensch M, Claus EB (2010) Epidemiology and etiology of meningioma. J Neurooncol 99:307–314PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Jan Frederick Cornelius
    • 1
  • Philipp Jörg Slotty
    • 1
    • 4
    Email author
  • Hans Jakob Steiger
    • 1
  • Daniel Hänggi
    • 1
  • Marc Polivka
    • 3
  • Bernard George
    • 2
  1. 1.Neurochirurgische KlinikUniversitätsklinikum Düsseldorf, Heinrich-Heine-UniversitätDüsseldorfGermany
  2. 2.Service de neurochirurgieHôpital Universitaire Lariboisière, Université Paris 7ParisFrance
  3. 3.Service d’Anatomie et Cytologie PathologiquesHôpital Lariboisière, 2ParisFrance
  4. 4.Neurosurgical ClinicHeinrich-Heine-Universität DüsseldorfDüsseldorfGermany

Personalised recommendations