Advertisement

Posterior fossa meningiomas: perioperative predictors of extent of resection, overall survival and progression-free survival

  • Marco V. CorniolaEmail author
  • Jean-Michel Lemée
  • Michele Da Broi
  • Holger Joswig
  • Karl Schaller
  • Eirik Helseth
  • Torstein R. Meling
Original Article - Tumor - Meningioma
Part of the following topical collections:
  1. Tumor – Meningioma

Abstract

Background

Posterior fossa meningiomas (PFMs) often represent surgical challenges due to their proximity to neurovascular structures. Factors predicting the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS) were identified and integrated in a prediction tool to offer evidence-based personalized therapeutic strategies.

Methods

All meningiomas managed surgically from 1990 to 2010 from a single-center were reviewed. A classification tree was created using the classification and regression tree recursive partitioning analysis that incorporated patient and tumor data available before surgery in order to predict the rates of gross total resection (GTR).

Results

A total of 198 patients were identified (female-to-male ratio, 2.7; mean age, 59.1 years) and compared with 1271 supratentorial meningiomas (STMs) operated in the same institution during the same time period. GTR was achieved less often (59.6% versus 81.9%; p < 0.01) in PFMs than STMs. Preoperative neurological symptoms were predictive of higher Simpson grades (OR, 2.19 [1.05; 4.58]; p = 0.04). Age was associated with reduced OS (OR, 1.08 [1.04;1.12]; p < 0.001). A KPS ≥ 70 was associated with higher survival rates (OR, 2.70 [2.19;2.92]; p = 0.02). Higher WHO grades were associated with reduced OS (OR, 3.56 [1.02;12.47]; p = 0.05). The GTR rate varies from 80% in patients without a preoperative deficit to 40% patients with a preoperative deficit, younger than 60 years old, and with adjacent bone invasion.

Conclusions

This study provides a classification tree of the predictors of EOR in PFMs, based upon preoperative demographic, clinical, and radiological variables. An evidence-based management protocol with estimated EORs may guide the decision-making process in PFMs.

Keywords

Posterior Fossa Meningioma Overall survival Progression-free survival 

Notes

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization 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.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The study was regulated by the Personal Data Act/Personal Health Data Filing System Act and approved by the Data Protection Official at OUH (2017/5204). Informed consent was not required according to the Personal Data Act/Personal Health Data Filing System Act.

References

  1. 1.
    Aboukais R, Zairi F, Reyns N, Le Rhun E, Touzet G, Blond S, Lejeune JP (2014) Surgery followed by radiosurgery: a deliberate valuable strategy in the treatment of intracranial meningioma. Clin Neurol Neurosurg 124:123–126.  https://doi.org/10.1016/j.clineuro.2014.06.035 CrossRefGoogle Scholar
  2. 2.
    Adegbite AB, Khan MI, Paine KW, Tan LK (1983) The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg 58:51–56.  https://doi.org/10.3171/jns.1983.58.1.0051 CrossRefGoogle Scholar
  3. 3.
    Barrett OC, Hackney JR, McDonald AM, Willey CD, Bredel M, Fiveash JB (2019) Pathologic predictors of local recurrence in atypical meningiomas following gross total resection. Int J Radiat Oncol Biol Phys 103:453–459.  https://doi.org/10.1016/j.ijrobp.2018.09.019 CrossRefGoogle Scholar
  4. 4.
    Brokinkel B, Holling M, Spille DC, Hess K, Sauerland C, Bleimuller C, Paulus W, Wolfer J, Stummer W (2017) Surgery for meningioma in the elderly and long-term survival: comparison with an age- and sex-matched general population and with younger patients. J Neurosurg 126:1201–1211.  https://doi.org/10.3171/2016.2.JNS152611 CrossRefGoogle Scholar
  5. 5.
    Chen WC, Magill ST, Wu A, Vasudevan HN, Morin O, Aghi MK, Theodosopoulos PV, Perry A, McDermott MW, Sneed PK, Braunstein SE, Raleigh DR (2018) Histopathological features predictive of local control of atypical meningioma after surgery and adjuvant radiotherapy. J Neurosurg:1–8.  https://doi.org/10.3171/2017.9.JNS171609
  6. 6.
    Combs SE, Ganswindt U, Foote RL, Kondziolka D, Tonn JC (2012) State-of-the-art treatment alternatives for base of skull meningiomas: complementing and controversial indications for neurosurgery, stereotactic and robotic based radiosurgery or modern fractionated radiation techniques. Radiat Oncol 7:226.  https://doi.org/10.1186/1748-717X-7-226 CrossRefGoogle Scholar
  7. 7.
    Curry WT, McDermott MW, Carter BS, Barker FG 2nd (2005) Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg 102:977–986.  https://doi.org/10.3171/jns.2005.102.6.0977 CrossRefGoogle Scholar
  8. 8.
    DeMonte F, McDermott MW, Al-Mefty O Al-Mefty’s meningiomas. Thieme Medical, New YorkGoogle Scholar
  9. 9.
    Ehresman JS, Garzon-Muvdi T, Rogers D, Lim M, Gallia GL, Weingart J, Brem H, Bettegowda C, Chaichana KL (2018) The relevance of Simpson grade resections in modern neurosurgical treatment of World Health Organization grade I, II, and III meningiomas. World Neurosurg 109:e588–e593.  https://doi.org/10.1016/j.wneu.2017.10.028 CrossRefGoogle Scholar
  10. 10.
    Fors MM, Viada CE, Gonzalez P (2017) Use of recursive partitioning analysis in clinical trials and meta-analysis of randomized clinical trials, 1990–2016. Rev Recent Clin Trials 12:3–7.  https://doi.org/10.2174/1574887111666160916144658 CrossRefGoogle Scholar
  11. 11.
    Gennatas ED, Wu A, Braunstein SE, Morin O, Chen WC, Magill ST, Gopinath C, Villaneueva-Meyer JE, Perry A, McDermott MW, Solberg TD, Valdes G, Raleigh DR (2018) Preoperative and postoperative prediction of long-term meningioma outcomes. PLoS One 13:e0204161.  https://doi.org/10.1371/journal.pone.0204161 CrossRefGoogle Scholar
  12. 12.
    Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, von Deimling A, Stavrinou P, Lefranc F, Lund-Johansen M, Moyal EC, Brandsma D, Henriksson R, Soffietti R, Weller M (2016) EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 17:e383–e391.  https://doi.org/10.1016/S1470-2045(16)30321-7 CrossRefGoogle Scholar
  13. 13.
    Gousias K, Schramm J, Simon M (2016) The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. J Neurosurg 125:551–560.  https://doi.org/10.3171/2015.9.JNS15754 CrossRefGoogle Scholar
  14. 14.
    Harrison MJ, al-Mefty O (1997) Tentorial meningiomas. Clin Neurosurg 44:451–466Google Scholar
  15. 15.
    Hasseleid BF, Meling TR, Ronning P, Scheie D, Helseth E (2012) Surgery for convexity meningioma: Simpson grade I resection as the goal: clinical article. J Neurosurg 117:999–1006.  https://doi.org/10.3171/2012.9.JNS12294 CrossRefGoogle Scholar
  16. 16.
    Hwang WL, Marciscano AE, Niemierko A, Kim DW, Stemmer-Rachamimov AO, Curry WT, Barker FG 2nd, Martuza RL, Loeffler JS, Oh KS, Shih HA, Larvie M (2016) Imaging and extent of surgical resection predict risk of meningioma recurrence better than WHO histopathological grade. Neuro-Oncology 18:863–872.  https://doi.org/10.1093/neuonc/nov285 CrossRefGoogle Scholar
  17. 17.
    Ildan F, Erman T, Gocer AI, Tuna M, Bagdatoglu H, Cetinalp E, Burgut R (2007) Predicting the probability of meningioma recurrence in the preoperative and early postoperative period: a multivariate analysis in the midterm follow-up. Skull Base 17:157–171.  https://doi.org/10.1055/s-2007-970554 CrossRefGoogle Scholar
  18. 18.
    Jaaskelainen J (1986) Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 26:461–469CrossRefGoogle Scholar
  19. 19.
    Kaul D, Budach V, Wurm R, Gruen A, Graaf L, Habbel P, Badakhshi H (2014) Linac-based stereotactic radiotherapy and radiosurgery in patients with meningioma. Radiat Oncol 9:78.  https://doi.org/10.1186/1748-717X-9-78 CrossRefGoogle Scholar
  20. 20.
    Kim JH, Jang WY, Jung TY, Kim IY, Lee KH, Kang WD, Kim SK, Moon KS, Jung S (2017) Predictive factors for surgical outcome in anterior clinoidal meningiomas: analysis of 59 consecutive surgically treated cases. Medicine (Baltimore) 96:e6594.  https://doi.org/10.1097/MD.0000000000006594 CrossRefGoogle Scholar
  21. 21.
    Konglund A, Rogne SG, Lund-Johansen M, Scheie D, Helseth E, Meling TR (2013) Outcome following surgery for intracranial meningiomas in the aging. Acta Neurol Scand 127:161–169.  https://doi.org/10.1111/j.1600-0404.2012.01692.x CrossRefGoogle Scholar
  22. 22.
    Kressner M, Arlt F, Riepl W, Meixensberger J (2018) Prognostic factors of microsurgical treatment of intracranial meningiomas - a multivariate analysis. PLoS One 13:e0202520.  https://doi.org/10.1371/journal.pone.0202520 CrossRefGoogle Scholar
  23. 23.
    Larjavaara S, Haapasalo H, Sankila R, Helen P, Auvinen A (2008) Is the incidence of meningiomas underestimated? A regional survey. Br J Cancer 99:182–184.  https://doi.org/10.1038/sj.bjc.6604438 CrossRefGoogle Scholar
  24. 24.
    Mansouri A, Klironomos G, Taslimi S, Kilian A, Gentili F, Khan OH, Aldape K, Zadeh G (2016) Surgically resected skull base meningiomas demonstrate a divergent postoperative recurrence pattern compared with non-skull base meningiomas. J Neurosurg 125:431–440.  https://doi.org/10.3171/2015.7.JNS15546 CrossRefGoogle Scholar
  25. 25.
    Markham JW, Fager CA, Horrax G, Poppen JL (1955) Meningiomas of the posterior fossa; their diagnosis, clinical features, and surgical treatment. AMA Arch Neurol Psychiatry 74:163–170CrossRefGoogle Scholar
  26. 26.
    Martinez R, Vaquero J, Areitio E, Bravo G (1983) Meningiomas of the posterior fossa. Surg Neurol 19:237–243CrossRefGoogle Scholar
  27. 27.
    Mascarella MA, Tewfik MA, Aldosari M, Sirhan D, Zeitouni A, Di Maio S (2016) A simple scoring system to predict the resectability of skull base meningiomas via an endoscopic ENDONASAL approach. World Neurosurg 91:582–591 e581.  https://doi.org/10.1016/j.wneu.2016.04.093 CrossRefGoogle Scholar
  28. 28.
    Maurice-Williams RS, Kitchen ND (1992) Intracranial tumours in the elderly: the effect of age on the outcome of first time surgery for meningiomas. Br J Neurosurg 6:131–137CrossRefGoogle Scholar
  29. 29.
    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 112:925–933.  https://doi.org/10.3171/2009.9.JNS09617 CrossRefGoogle Scholar
  30. 30.
    Meling TR, Da Broi M, Scheie D, Helseth E (2018) Meningiomas: skull base versus non-skull base. Neurosurg Rev.  https://doi.org/10.1007/s10143-018-0976-7
  31. 31.
    Meling TR, Da Broi M, Scheie D, Helseth E (2018) Skull base versus non-skull base meningioma surgery in the elderly. Neurosurg Rev.  https://doi.org/10.1007/s10143-018-1005-6
  32. 32.
    Nanda A, Konar SK, Maiti TK, Bir SC, Guthikonda B (2016) Stratification of predictive factors to assess resectability and surgical outcome in clinoidal meningioma. Clin Neurol Neurosurg 142:31–37.  https://doi.org/10.1016/j.clineuro.2016.01.005 CrossRefGoogle Scholar
  33. 33.
    Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS (2016) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro-Oncology 18:v1–v75.  https://doi.org/10.1093/neuonc/now207 CrossRefGoogle Scholar
  34. 34.
    Palma L, Celli P, Franco C, Cervoni L, Cantore G (1997) Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 86:793–800.  https://doi.org/10.3171/jns.1997.86.5.0793 CrossRefGoogle Scholar
  35. 35.
    Preusser M, Brastianos PK, Mawrin C (2018) Advances in meningioma genetics: novel therapeutic opportunities. Nat Rev Neurol 14:106–115.  https://doi.org/10.1038/nrneurol.2017.168 CrossRefGoogle Scholar
  36. 36.
    Roberti F, Sekhar LN, Kalavakonda C, Wright DC (2001) Posterior fossa meningiomas: surgical experience in 161 cases. Surg Neurol 56:8–20 discussion 20-21CrossRefGoogle Scholar
  37. 37.
    Rydzewski NR, Lesniak MS, Chandler JP, Kalapurakal JA, Pollom E, Tate MC, Bloch O, Kruser T, Dalal P, Sachdev S (2018) Gross total resection and adjuvant radiotherapy most significant predictors of improved survival in patients with atypical meningioma. Cancer 124:734–742.  https://doi.org/10.1002/cncr.31088 CrossRefGoogle Scholar
  38. 38.
    Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S, Okonechnikov K, Koelsche C, Reuss DE, Capper D, Sturm D, Wirsching HG, Berghoff AS, Baumgarten P, Kratz A, Huang K, Wefers AK, Hovestadt V, Sill M, Ellis HP, Kurian KM, Okuducu AF, Jungk C, Drueschler K, Schick M, Bewerunge-Hudler M, Mawrin C, Seiz-Rosenhagen M, Ketter R, Simon M, Westphal M, Lamszus K, Becker A, Koch A, Schittenhelm J, Rushing EJ, Collins VP, Brehmer S, Chavez L, Platten M, Hanggi D, Unterberg A, Paulus W, Wick W, Pfister SM, Mittelbronn M, Preusser M, Herold-Mende C, Weller M, von Deimling A (2017) DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 18:682–694.  https://doi.org/10.1016/S1470-2045(17)30155-9 CrossRefGoogle Scholar
  39. 39.
    Sicking J, Voss KM, Spille DC, Schipmann S, Holling M, Paulus W, Hess K, Steinbicker AU, Stummer W, Grauer O, Wolfer J, Brokinkel B (2018) The evolution of cranial meningioma surgery-a single-center 25-year experience. Acta Neurochir 160:1801–1812.  https://doi.org/10.1007/s00701-018-3617-6 CrossRefGoogle Scholar
  40. 40.
    Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39CrossRefGoogle Scholar
  41. 41.
    Solheim O, Torsteinsen M, Johannesen TB, Jakola AS (2014) Effects of cerebral magnetic resonance imaging in outpatients on observed incidence of intracranial tumors and patient survival: a national observational study. J Neurosurg 120:827–832.  https://doi.org/10.3171/2013.12.JNS131312 CrossRefGoogle Scholar
  42. 42.
    Umansky F, Ashkenazi E, Gertel M, Shalit MN (1992) Surgical outcome in an elderly population with intracranial meningioma. J Neurol Neurosurg Psychiatry 55:481–485CrossRefGoogle Scholar
  43. 43.
    Voss KM, Spille DC, Sauerland C, Suero Molina E, Brokinkel C, Paulus W, Stummer W, Holling M, Jeibmann A, Brokinkel B (2017) The Simpson grading in meningioma surgery: does the tumor location influence the prognostic value? J Neuro-Oncol 133:641–651.  https://doi.org/10.1007/s11060-017-2481-1 CrossRefGoogle Scholar
  44. 44.
    Wiemels J, Wrensch M, Claus EB (2010) Epidemiology and etiology of meningioma. J Neuro-Oncol 99:307–314.  https://doi.org/10.1007/s11060-010-0386-3 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical Neurosciences, Division of NeurosurgeryGeneva University HospitalsGenèveSwitzerland
  2. 2.Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Faculty of MedicineUniversity of GenevaGenevaSwitzerland
  4. 4.Department of NeurosurgeryOslo University HospitalOsloNorway

Personalised recommendations