Skull base meningiomas: neurological outcome after microsurgical resection
- 407 Downloads
Microsurgical resection is the primary treatment of skull base meningiomas. Maximal resection provides the best tumor control rates but can be associated with high surgical morbidity. To understand the relation between extent of resection (EOR) and functional outcome we have analyzed the neurological improvement and recurrence rate in a large consecutive series of skull base meningioma patients. In addition, we defined anatomical and biological factors predictive for recurrence and overall outcome. We investigated 226 skull base meningioma patients receiving tumor resection in our institution. The most frequent location was the medial sphenoid ridge (29.6 %). EOR was rated according to the Simpson scale. Overall performance was measured by the Karnofsky performance score (KPS); neurological deficits were quantified using the Medical Research Council Neurological Severity Score (MRC-NPS). Complete resection was achieved in 62.8 % and the EOR was significantly correlated to tumor location. The morbidity and mortality rate was 32.1 and 2.7 % respectively, new permanent neurological deficits occurred in 3.5 % of all patients. From all patients with focal neurological deficits, 60.1 % experienced significant improvement. Both the MRC-NPS and the KPS significantly improved from the preoperative status to discharge, however the improvement rate was dependent on the tumor location. Recurrence rate was 15.5 %; tumor size, bone- and venous sinus infiltration, WHO grade, poor EOR but not MIB-1 labeling index were independent factors predictive for recurrence. Microsurgical resection of skull base meningiomas improves neurological impairment in the majority of patients. Specific risk factors for recurrence require consideration for postoperative management.
KeywordsSkull base Meningioma Recurrence Prognosis Surgery Radiosurgery
Conflict of interest
The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
- 3.Sutherland GR, Sima AAF (1991) Incidence and classification of meningiomas. In: Schmidek HH (ed) Meningiomas and their surgical management. Saunders, Philadelphia, pp 10–21Google Scholar
- 20.Couldwell WT, Heros R, Dolenc V (2011) Skull base meningiomas. Neurosurg Focus 30: 1p prior to E1Google Scholar
- 23.Kalkanis SN, Quinones-Hinojosa A, Buzney E, Ribaudo HJ, Black PM (2000) Quality of life following surgery for intracranial meningiomas at Brigham and Women’s Hospital: a study of 164 patients using a modification of the functional assessment of cancer therapy-brain questionnaire. J Neurooncol 48:233–241PubMedCrossRefGoogle Scholar