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Brain invasion in meningiomas: does surgical sampling impact specimen characteristics and histology?

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Abstract

Brain invasion (BI) is a new criterion for atypia in meningiomas and therefore potentially impacts adjuvant treatment. However, it remains unclear whether surgical practice and specimen characteristics influence histopathological analyses and the accuracy of detecting BI. Tumor location, specimen characteristics, and rates of BI were compared in meningioma samples obtained from 2938 surgeries in different neurosurgical departments but diagnosed in a single neuropathological institute. Non-skull base tumor location was associated with CNS tissue on the microscopic slides (OR 1.45; p < .001), increasing specimen weight (OR 1.01; p < .001), and remaining tissue not subjected to neuropathological analyses (OR 2.18; p < .001) but not with BI (OR 1.29; p = .199). Specimen weight, rates of residual tissue not subjected to histopathological analyses, of BI and of brain tissue, on the microscopic slides differed among the neurosurgical centers (p < .001, each). Frequency of BI was increased in one department (OR 2.07; p = .002) and tended to be lower in another (OR .61; p = .088). The same centers displayed the highest and lowest rates of brain tissue in the specimen, respectively (p < .001). Moreover, the correlation of BI with the neurosurgical center was not confirmed when only analyzing specimen with evidence of brain tissue in microscopic analyses (p = .223). Detection of BI was not correlated with the intraoperative use of CUSA in subgroup analyses. Rates of brain invasion in neuropathological analyses are not associated with tumor location but differ among some neurosurgical centers. Evidence raises that surgical nuances impact specimen characteristics and therefore the accuracy of the detection of BI.

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References

  1. Adeli A, Hess K, Mawrin C, Streckert EMS, Stummer W, Paulus W, Kemmling A, Holling M, Heindel W, Schmidt R, Spille DC, Sporns PB, Brokinkel B (2018) Prediction of brain invasion in patients with meningiomas using preoperative magnetic resonance imaging. Oncotarget 9:35974–35982. https://doi.org/10.18632/oncotarget.26313

    Article  PubMed  PubMed Central  Google Scholar 

  2. Brokinkel B, Hess K, Mawrin C (2017) Brain invasion in meningiomas-clinical considerations and impact of neuropathological evaluation: a systematic review. Neuro-Oncology 19:1298–1307. https://doi.org/10.1093/neuonc/nox071

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brokinkel B, Sicking J, Spille DC, Hess K, Paulus W, Stummer W (2018) Letter to the editor. Brain invasion and the risk for postoperative hemorrhage and neurological deterioration after meningioma surgery. J Neurosurg 129:849–851. https://doi.org/10.3171/2018.5.JNS181287

    Article  PubMed  Google Scholar 

  4. Brokinkel B, Stummer W (2016) Brain invasion in meningiomas: the rising importance of a uniform neuropathologic assessment after the release of the 2016 World Health Organization Classification of Central Nervous System Tumors. World Neurosurg 95:614–615. https://doi.org/10.1016/j.wneu.2016.08.047

    Article  PubMed  Google Scholar 

  5. Cornelius JF, Slotty PJ, Steiger HJ, Hanggi D, Polivka M, George B (2013) Malignant potential of skull base versus non-skull base meningiomas: clinical series of 1,663 cases. Acta Neurochir 155:407–413. https://doi.org/10.1007/s00701-012-1611-y

    Article  PubMed  Google Scholar 

  6. Hess K, Spille DC, Adeli A, Sporns PB, Brokinkel C, Grauer O, Mawrin C, Stummer W, Paulus W, Brokinkel B (2018) Brain invasion and the risk of seizures in patients with meningioma. J Neurosurg:1–8. https://doi.org/10.3171/2017.11.JNS172265

  7. Jenkinson MD, Santarius T, Zadeh G, Aldape KD (2017) Atypical meningioma-is it time to standardize surgical sampling techniques? Neuro-Oncology 19:453–454. https://doi.org/10.1093/neuonc/now245

    Article  PubMed  Google Scholar 

  8. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF (2018) S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Mammakarzinoms, Version 4.1, 2018 AWMF Registernummer: 032-045OL. http://www.leitlinienprogramm-onkologie.de/leitlinien/mammakarzinom/. Accessed 20 Feb 2019

  9. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW (2016) The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 131:803–820. https://doi.org/10.1007/s00401-016-1545-1

    Article  PubMed  Google Scholar 

  10. Mantle RE, Lach B, Delgado MR, Baeesa S, Belanger G (1999) Predicting the probability of meningioma recurrence based on the quantity of peritumoral brain edema on computerized tomography scanning. J Neurosurg 91:375–383. https://doi.org/10.3171/jns.1999.91.3.0375

    Article  CAS  PubMed  Google Scholar 

  11. Perry A, Louis DN, von Deimling A, Sahm F, Rushing EJ, Mawrin C, Claus EB, Loeffler J, Sadetzki S (2016) Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD et al (eds) WHO Classification of Tumors of the Central Nervous System. International Agency on Cancer Research, Lyon, pp 232–245

    Google Scholar 

  12. Pizem J, Velnar T, Prestor B, Mlakar J, Popovic M (2014) Brain invasion assessability in meningiomas is related to meningioma size and grade, and can be improved by extensive sampling of the surgically removed meningioma specimen. Clin Neuropathol 33:354–363. https://doi.org/10.5414/NP300750

    Article  PubMed  Google Scholar 

  13. Spille DC, Hess K, Sauerland C, Sanai N, Stummer W, Paulus W, Brokinkel B (2016) Brain invasion in meningiomas: incidence and correlations with clinical variables and prognosis. World Neurosurg 93:346–354. https://doi.org/10.1016/j.wneu.2016.06.055

    Article  PubMed  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. Vranic A, Popovic M, Cor A, Prestor B, Pizem J (2010) Mitotic count, brain invasion, and location are independent predictors of recurrence-free survival in primary atypical and malignant meningiomas: a study of 86 patients. Neurosurgery 67:1124–1132. https://doi.org/10.1227/NEU.0b013e3181eb95b7

    Article  PubMed  Google Scholar 

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Author notes

  1. Katharina Hess and Benjamin Brokinkel contributed equally to this work.

Authors and Affiliations

  1. Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, W30, 48149, Münster, Germany

    Maximilian Timme

  2. Institute for Neuropathology, University Hospital Münster, Pottkamp 2, 48149, Münster, Germany

    Christian Thomas & Katharina Hess

  3. Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany

    Dorothee Cäcilia Spille, Walter Stummer, Markus Holling & Benjamin Brokinkel

  4. Department of Neurosurgery, St. Barbara-Klinik Hamm, Am Heessener Wald 1, 59073, Hamm, Germany

    Heinrich Ebel & Christian Ewelt

  5. Department of Neurosurgery, Paracelsus Kliniken Osnabrück, Am Natruper Holz 69, 40076, Osnabrück, Germany

    Franz-Josef Hans

  6. Department of Neurosurgery, Clemenshospital Münster, Duesbergweg 124, 48153, Münster, Germany

    Uta Schick

  7. Department of Neurosurgery, Klinikum Vest, Dorstener Straße 151, 45657, Recklinghausen, Germany

    Maximilian Puchner

  8. Department of Neurosurgery, Bergmannsheil Gelsenkirchen-Buer, Schernerweg 4, 45894, Gelsenkirchen, Germany

    Uwe Wildförster

  9. Department of Neurosurgery, Helios Klinikum Meiningen, Bergstraße 3, 98617, Meiningen, Germany

    Bernhard Bruns

  10. Department of Neurosurgery, Klinikum Bayreuth, Preuschwitzer Str. 101, 95445, Bayreuth, Germany

    Hans Axel Trost

  11. Department of Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany

    Oliver Grauer

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  1. Maximilian Timme
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  2. Christian Thomas
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  3. Dorothee Cäcilia Spille
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  15. Katharina Hess
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  16. Benjamin Brokinkel
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Correspondence to Benjamin Brokinkel.

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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.

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Timme, M., Thomas, C., Spille, D.C. et al. Brain invasion in meningiomas: does surgical sampling impact specimen characteristics and histology?. Neurosurg Rev 43, 793–800 (2020). https://doi.org/10.1007/s10143-019-01125-0

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  • DOI: https://doi.org/10.1007/s10143-019-01125-0

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