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Improvement in visual outcomes of patients with base of skull meningioma as a result of evolution in the treatment techniques in the last three decades: a systematic review

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Abstract

Purpose

We systematically reviewed visual outcomes over the last three decades in patients undergoing treatment for base of skull (BOS) meningiomas and provide recommendations to preserve vision.

Methods

In accordance with the PRISMA guidelines for systematic reviews, a search was conducted from 6/1/2022–9/1/2022 using PubMed and Web of Science. Inclusion criteria included (1) patients treated for BOS meningiomas (2) treatment modality specified (3) specifics of surgical techniques and/or dose/fractions of radiotherapy (4) individual patient outcomes of treatment. Each study was assessed for bias based on study design and heterogeneity of results.

Results

A total of 50 studies were included (N = 2911). When comparing improved vision versus unchanged or worsened vision, studies investigating surgery alone published from 2006 and onward had significantly better visual outcomes compared to pre-2006 studies (p = 0.02). When comparing improved vision versus unchanged or worsened vision, studies investigating combined therapy with surgery and radiation published from 2008 and onward had significantly better visual outcomes compared to pre-2008 studies (p < 0.01). Combined modality therapy was less likely to worsen vision compared to either surgery or radiation monotherapy (p < 0.01). However, surgery and radiation monotherapy were more likely to actually improve outcomes compared to combination therapy (p < 0.01).

Conclusion

For over a decade we have observed improvement in visual outcomes in patients managed for meningioma of BOS, likely attributing the innovation in microsurgical and more targeted and conformal radiation techniques. Combination therapy may be the safest option for preventing worsening of vision, but the highest rates of improving visual function are achieved through monotherapy when indicated.

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Data availability

Due to the nature of systematic reviews, all data included in this manuscript is available online in previously published works, as cited in this manuscript.

Abbreviations

BOS:

Base of skull

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Albany Medical College, Albany, NY, USA

    Matthew Holdaway

  2. Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 130 East 77th Street, New York, NY, 10065, USA

    John Starner & A. Gabriella Wernicke

  3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Roshal R. Patel

  4. SUNY Downstate College of Medicine, Brooklyn, NY, USA

    Joshua Salama

  5. Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA

    David J. Langer, Jason A. Ellis, John A. Boockvar, Randy S. D’Amico & A. Gabriella Wernicke

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MH, RP, JS, and JS. The first draft of the manuscript was written by MH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to A. Gabriella Wernicke.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. Due to the nature of systematic reviews, all data included in this manuscript is available online in previously published works, as cited in this manuscript.

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Due to the nature of this systematic review, ethics approval was not required.

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Holdaway, M., Starner, J., Patel, R.R. et al. Improvement in visual outcomes of patients with base of skull meningioma as a result of evolution in the treatment techniques in the last three decades: a systematic review. J Neurooncol 163, 485–503 (2023). https://doi.org/10.1007/s11060-023-04366-8

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