Journal of Neuro-Oncology

, Volume 110, Issue 1, pp 137–144 | Cite as

The influence of surgery on quality of life in patients with intracranial meningiomas: a prospective study

  • Asgeir S. JakolaEmail author
  • Michel Gulati
  • Sasha Gulati
  • Ole Solheim
Clinical Study


Meningiomas may influence both survival and neurological functions. Studies assessing the impact of surgery on health-related quality of life (HRQL) remain absent. In this prospective study we aimed to describe HRQL dynamics before and after surgery in patients with meningiomas. HRQL assessments were performed using EuroQol-5D (EQ-5D), a generic HRQL instrument. All adult patients with suspected intracranial meningioma from 2007 through 2011 were eligible for inclusion, and 54 patients were included after informed consent. All patients received a histopathological diagnosis of meningioma. The average preoperative EQ-5D index value (±SD) was 0.69 ± 0.26. The mean improvement 6 weeks after surgery was 0.06 (95 % CI, −0.03 to 0.16; p = 0.161) and the mean long term improvement was 0.09 (95 % CI, 0.00–0.17; p = 0.040). Surgery reduced pain/discomfort and anxiety/depression and improved the capability of performing usual activities. Clinically significant improvement at long-term assessment was noted in 25 patients (49 %) while a significant deterioration was reported in 10 patients (20 %). Patients who reported postoperative worsening of HRQL were also reporting better preoperative scores, suggesting a possible ceiling effect of EQ-5D in some of these patients. In our patients a modest average improvement in HRQL was seen after surgery for meningioma. About half of the patients reported a clinical important improvement at the late follow-up assessment. This improvement was mainly observed in the domains usual activities, pain/discomfort and anxiety/depression. However, one in five patients fared worse on late follow-up assessment, a figure of particular importance when treating asymptomatic meningiomas.


Craniotomy Meningioma Outcome Prospective Quality of Life 



We would like to thank Lisa M. Sagberg at St. Olav’s University Hospital for facilitating this research project by assisting in data collection.

Conflict of interest

None of the authors have any conflict of interests to declare.


  1. 1.
    van Alkemade H, de Leau M, Dieleman EMT, Kardaun JWPF, van Os R, Vandertop WP, van Furth WR, Stalpers LJA (2012) Impaired survival and long-term neurological problems in benign meningioma. Neuro-Oncology 14(5):658–666PubMedCrossRefGoogle Scholar
  2. 2.
    Chen C-M, Huang A, Kuo L-T, Tu Y-K (2011) Contemporary surgical outcome for skull base meningiomas. Neurosurg Rev 34(3):281–296PubMedCrossRefGoogle Scholar
  3. 3.
    Waagemans ML, van Nieuwenhuizen D, Dijkstra M, Wumkes M, Dirven CMF, Leenstra S, Reijneveld JC, Klein M, Stalpers LJA (2011) Long-term impact of cognitive deficits and epilepsy on quality of life in patients with low-grade meningiomas. Neurosurgery 69(1):72–79. doi: 10.1227/NEU.1220b1013e318212badb PubMedCrossRefGoogle Scholar
  4. 4.
    Ibañez FAL, Hem S, Ajler P, Vecchi E, Ciraolo C, Baccanelli M, Tramontano R, Knezevich F, Carrizo A (2011) A new classification of complications in neurosurgery. World Neurosurg 75(5–6):709–715CrossRefGoogle Scholar
  5. 5.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383PubMedCrossRefGoogle Scholar
  6. 6.
    Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen H-J (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7(5):392–401PubMedCrossRefGoogle Scholar
  7. 7.
    Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20(1):22–39PubMedCrossRefGoogle Scholar
  8. 8.
    The EuroQol Group (1990) EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRefGoogle Scholar
  9. 9.
    Rabin R, Charro Fd (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33(5):337–343PubMedCrossRefGoogle Scholar
  10. 10.
    Burström K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 10(7):621–635PubMedCrossRefGoogle Scholar
  11. 11.
    Jakola AS, Unsgard G, Solheim O (2011) Quality of life in patients with intracranial gliomas: the impact of modern image-guided surgery. J Neurosurg 114(6):1622–1630PubMedCrossRefGoogle Scholar
  12. 12.
    Nord E (1991) EuroQol©: health-related quality of life measurement. Valuations of health states by the general public in Norway. Health Policy 18(1):25–36PubMedCrossRefGoogle Scholar
  13. 13.
    Dolan PD (1997) Modeling valuations for Euroqol health states. Med Care 35(11):1095–1108PubMedCrossRefGoogle Scholar
  14. 14.
    Kvam AK, Fayers PM, Wisloff F (2011) Responsiveness and minimal important score differences in quality-of-life questionnaires: a comparison of the EORTC QLQ-C30 cancer-specific questionnaire to the generic utility questionnaires EQ-5D and 15D in patients with multiple myeloma. Eur J Haematol 87(4):330–337PubMedCrossRefGoogle Scholar
  15. 15.
    Pickard AS, Neary MP, Cella D (2007) Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health Qual Life Outcomes 5:70PubMedCrossRefGoogle Scholar
  16. 16.
    Walters SJ, Brazier JE (2005) Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res 14(6):1523–1532PubMedCrossRefGoogle Scholar
  17. 17.
    Jakola AS, Gulati S, Weber C, Unsgård G, Solheim O (2011) Postoperative deterioration in health related quality of life as predictor for survival in patients with glioblastoma: a prospective study. PLoS One 6(12):e28592PubMedCrossRefGoogle Scholar
  18. 18.
    Johnson JA, Pickard AS (2000) Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta. Canada. Med Care 38(1):115–121CrossRefGoogle Scholar
  19. 19.
    Zlotnick D, Kalkanis S, Quinones-Hinojosa A, Chung K, Linskey M, Jensen R, DeMonte F, Barker F, Racine C, Berger M, Black P, Cusimano M, Sekhar L, Parsa A, Aghi M, McDermott M (2010) FACT-MNG: tumor site specific web-based outcome instrument for meningioma patients. J Neurooncol 99(3):423–431PubMedCrossRefGoogle Scholar
  20. 20.
    Oya S, Kim SH, Sade B, Lee JH (2011) The natural history of intracranial meningiomas. J Neurosurg 114(5):1250–1256PubMedGoogle Scholar
  21. 21.
    Vernooij MW, Ikram MA, Tanghe HL, Vincent AJPE, Hofman A, Krestin GP, Niessen WJ, Breteler MMB, van der Lugt A (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357(18):1821–1828PubMedCrossRefGoogle Scholar
  22. 22.
    Curry WT, McDermott MW, Carter BS, Barker FG (2005) Craniotomy for meningioma in the US between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg 102(6):977–986PubMedCrossRefGoogle Scholar
  23. 23.
    Rocha-Filho P, Gherpelli J, de Siqueira J, Rabello G (2010) Post-craniotomy headache: a proposed revision of IHS diagnostic criteria. Cephalalgia 30(5):560–566PubMedGoogle Scholar
  24. 24.
    Solheim O, Eloqayli H, Muller TB, Unsgaard G (2006) Quality of life after treatment for incidental, unruptured intracranial aneurysms. Acta Neurochir 148(8):821–830CrossRefGoogle Scholar
  25. 25.
    Boviatsis EJ, Bouras TI, Kouyialis AT, Themistocleous MS, Sakas DE (2007) Impact of age on complications and outcome in meningioma surgery. Surg Neurol 68(4):407–411 discussion 411PubMedCrossRefGoogle Scholar
  26. 26.
    Bateman BT, Pile-Spellman J, Gutin PH, Berman MF (2005) Meningioma resection in the elderly: nationwide inpatient sample, 1998–2002. Neurosurgery 57(5):866–872 discussion 866-872PubMedCrossRefGoogle Scholar
  27. 27.
    Konglund A, Rogne SG, Lund-Johansen M, Scheie D, Helseth E, Meling TR (2012) Outcome following surgery for intracranial meningiomas in the aging. Acta Neurol Scand. doi: 10.1111/j.1600-0404.2012.01692 PubMedGoogle Scholar
  28. 28.
    Pringle AM, Taylor R, Whittle IR (1999) Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. Br J Neurosurg 13(1):46–51PubMedCrossRefGoogle Scholar
  29. 29.
    Tsay S-L, Chang J-Y, Yates P, Lin K-C, Liang S-Y (2010) Factors influencing quality of life in patients with benign primary brain tumors: prior to and following surgery. Support Care Cancer 20(1):57–64PubMedCrossRefGoogle Scholar
  30. 30.
    Liu R, Page M, Solheim K, Fox S, Chang SM (2009) Quality of life in adults with brain tumors: current knowledge and future directions. Neuro Oncol 11(3):330–339PubMedCrossRefGoogle Scholar
  31. 31.
    Krupp W, Klein C, Koschny R, Holland H, Seifert V, Meixensberger J (2009) Assessment of neuropsychological parameters and quality of life to evaluate outcome in patients with surgically treated supratentorial meningiomas. Neurosurgery 64(1):40–47PubMedCrossRefGoogle Scholar
  32. 32.
    Tucha O, Smely C, Preier M, Becker G, Paul GM, Lange KW (2003) Preoperative and postoperative cognitive functioning in patients with frontal meningiomas. J Neurosurg 98(1):21–31PubMedCrossRefGoogle Scholar
  33. 33.
    Tucha O, Smely C, Preier M, Lange KW (2000) Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47(2):324–334PubMedCrossRefGoogle Scholar
  34. 34.
    van Nieuwenhuizen D, Klein M, Stalpers L, Leenstra S, Heimans J, Reijneveld J (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(3):271–278PubMedCrossRefGoogle Scholar
  35. 35.
    Dijkstra M, van Nieuwenhuizen D, Stalpers LJA, Wumkes M, Waagemans M, Vandertop WP, Heimans JJ, Leenstra S, Dirven CM, Reijneveld JC, Klein M (2009) Late neurocognitive sequelae in patients with WHO grade I meningioma. J Neurol Neurosurg Psychiatr 80(8):910–915PubMedCrossRefGoogle Scholar
  36. 36.
    Taphoorn MJB, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neuro 3(3):159–168CrossRefGoogle Scholar
  37. 37.
    Kalkanis SN, Quiñones-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(3):233–241PubMedCrossRefGoogle Scholar
  38. 38.
    Maglinte GA, Hays RD, Kaplan RM (2012) US general population norms for telephone administration of the SF-36v2. J Clin Epidemiol 65(5):497–502PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Asgeir S. Jakola
    • 1
    • 2
    • 3
    Email author
  • Michel Gulati
    • 4
  • Sasha Gulati
    • 1
  • Ole Solheim
    • 1
    • 2
    • 5
  1. 1.Department of NeurosurgerySt. Olavs University HospitalTrondheimNorway
  2. 2.MI LabNorwegian University of Science and TechnologyTrondheimNorway
  3. 3.Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway
  4. 4.Department of Circulation and Medical ImagingNorwegian University of Science and TechnologyTrondheimNorway
  5. 5.National Center for 3D Ultrasound in SurgeryTrondheimNorway

Personalised recommendations