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World Neurosurg. 2019 Jan 24. pii: S1878-8750(19)30137-8. doi: 10.1016/j.wneu.2019.01.042. [Epub ahead of print]

Meningioma Surgery-Are We Making Progress?

Author information

1
Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Department of Neurosurgery, Geneva University Medical Center, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address: torsteinrmeling@gmail.com.
2
Faculty of Medicine, University of Oslo, Oslo, Norway.
3
Section of Neuropathology, Rigshospitalet, Copenhagen, Denmark.
4
Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
5
School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.

Abstract

BACKGROUND:

To study improvements in outcomes after surgery for intracranial meningiomas.

METHODS:

We performed a longitudinal observational study comparing 1469 patients operated on for intracranial meningioma in 4 consecutive time frames (1990-1994, 1995-1999, 2000-2004, and 2005-2010).

RESULTS:

Median age at surgery was 58.3 years. Median follow-up was 7 years. Patients in later periods were older than in the earlier ones (odds ratio [OR], 1.19 [1.09-1.32]; P < 0.0005), indicating a trend toward operating on more elderly patients. Before 2000, 42%, 32%, 6%, 19%, and 0.3% achieved Simpson grade (SG) I, II, III, IV, and V, respectively, whereas the SG rates were 35%, 37%, 4%, 23%, and 0.9% after 2000 (OR, 1.18 [1.06-1.30]; P < 0.005). The perioperative mortality (OR, 0.65 [0.46-0.91]; P < 0.05) and worsened neurologic outcome rate (OR, 0.70 [0.60-0.83]; P < 0.0001) were significantly lower in later decades, but the 4 surgical periods were similar regarding postoperative infections and hematomas. Retreatment-free survival (RFS) and overall survival (OS) increased significantly over the 4 time frames (P < 0.05 and P < 0.0001, respectively). Multivariate analysis confirmed the improvement of surgical radicality, neurologic outcome, perioperative mortality, OS, and RFS.

CONCLUSIONS:

Meningioma surgery as well as patient population changed over the 2 decades considered in this study. We observed higher rates of gross total resection in the later period and the perioperative outcomes improved or were unchanged, which signifies better long-term outcomes, RFS, and OS.

KEYWORDS:

Complications; Craniotomy; Improvement; Intracranial tumor; Meningioma; Overall survival; Retreatment-free survival

PMID:
30684722
DOI:
10.1016/j.wneu.2019.01.042

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