Convexity meningiomas: study of recurrence factors with special emphasis on the cleavage plane in a series of 100 consecutive patients

Clinical article

Jorge E. Alvernia M.D.1,3, Nguyen D. Dang M.D.2, and Marc P. Sindou M.D., D.Sc.3
View More View Less
  • 1 Department of Neurosurgery, St. Edward Mercy Medical Center, Fort Smith, Arkansas;
  • | 2 Department of Radiation-Oncology, Baylor College of Medicine, Houston, Texas; and
  • | 3 Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, University of Lyon, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Convexity meningiomas are expected to have a low recurrence rate given their classically “easy resectability.” Nonetheless, recurrence can occur. Factors playing a role in their recurrence are analyzed here, including the extent of resection and tumor histological type, among others, with a special emphasis on the cleavage plane.

Methods

The authors reviewed 100 cases of convexity meningiomas surgically treated between 1987 and 2001 with a median follow-up of 86 months (range 2–16 years). Preoperative and postoperative functional status, Simpson resection grade, histological type, and intraoperative surgical plane with pial vessel invasion were studied and correlated with the recurrence rate.

Results

The average tumor size was 3.6 ± 0.4 cm. The pre- and postoperative Karnofsky Performance Scale scores were 92.6 ± 4.6 and 97.9 ± 2.2, respectively. Ninety-five lesions were benign (WHO Grade I) and 5 were atypical (WHO Grade II). Ninety-one and 9 tumors were subjected to Simpson Grade 1 and 3 resections (three Grade 3a and six Grade 3b), respectively. Surgical deaths did not occur. After a mean follow-up of 7.2 years, 4 meningiomas recurred; 2 (2.2%) after Simpson Grade 1 resections and 2 after Simpson Grade 3 (3a and 3b) resections (22.2%; p = 0.0034). When just the subgroup of Simpson Grade 1/WHO Grade I was studied, the recurrence rate decreased to 1.2% (1 of 86 cases). The recurrence of WHO Grade I tumors was higher in the subpial group than in the extrapial group (p = 0.025). No difference in recurrence according to the cleavage plane was seen in the WHO Grade II subgroup (p = 0.361). As for the subpial group, no difference in recurrence was noted between the WHO Grade I and II subgroups (p = 0.608). Importantly, however, the extrapial subgroup of WHO Grade II lesions had a higher recurrence rate compared with its counterpart in the WHO Grade I subgroup (p = 0.005).

Conclusions

Pial and vascular invasion affect the recurrence rate in convexity meningioma surgery. The recurrence rate of WHO Grade I tumors was higher among those with a subpial plane of dissection than among those with an extrapial one. Histological type did not determine the degree of pial invasion in WHO Grade I and II lesions.

Abbreviations used in this paper:

KPS = Karnofsky Performance Scale; MCA = middle cerebral artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Alaywan M, & Sindou M: [Prognostic factors in the surgery for intracranial meningioma. Role of the tumoral size and arterial vascularization originating from the pia mater. Study of 150 cases.]. Neurochirurgie 39:337347, 1993. (Fr)

    • Search Google Scholar
    • Export Citation
  • 2

    Alvernia JE, & Sindou MP: Preoperative neuroimaging findings as a predictor of the surgical plane of cleavage: prospective study of 100 consecutive cases of intracranial meningioma. J Neurosurg 100:422430, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Baird M, & Gallagher PJ: Recurrent intracranial and spinal meningiomas: clinical and histological features. Clin Neuropathol 8:4144, 1989

    • Search Google Scholar
    • Export Citation
  • 4

    Black PM, , Morokoff AP, & Zauberman J: Surgery for extra-axial tumors of the cerebral convexity and midline. Neurosurgery 62:6 Suppl 3 SHC1115SHC1123, 2008

    • Search Google Scholar
    • Export Citation
  • 5

    Borovich B, & Doron Y: Recurrence of intracranial meningiomas: the role played by regional multicentricity. J Neurosurg 64:5863, 1986

  • 6

    Borovich B, , Doron Y, , Braun J, , Guilburd JN, , Zaaroor M, & Goldsher D, et al.: Recurrence of intracranial meningiomas: the role played by regional multicentricity. Part 2: Clinical and radiological aspects. J Neurosurg 65:168171, 1986

    • Search Google Scholar
    • Export Citation
  • 7

    Chan RC, & Thompson GB: Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 60:5260, 1984

    • Search Google Scholar
    • Export Citation
  • 8

    Christensen D, , Laursen H, & Klinken L: Prediction of recurrence in meningiomas after surgical treatment. A quantitative approach. Acta Neuropathol 61:130134, 1983

    • Search Google Scholar
    • Export Citation
  • 9

    Colli BO, , Carlotti CG Jr, , Assirati JA Jr, , Dos Santos MB, , Neder L, & Dos Santos AC: Parasagittal meningiomas: follow-up review. Surg Neurol 66:Suppl 3 S20S28, 2006

    • Search Google Scholar
    • Export Citation
  • 10

    Condra KS, , Buatti JM, , Mendenhall WM, , Friedman WA, , Marcus RB Jr, & Rhoton AL: Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 39:427436, 1997

    • Search Google Scholar
    • Export Citation
  • 11

    Giombini S, , Solero CL, & Morello G: Late outcome of operations for supratentorial convexity meningiomas. Report on 207 cases. Surg Neurol 22:588594, 1984

    • Search Google Scholar
    • Export Citation
  • 12

    Girvigian MR, , Chen JC, , Rahimian J, , Miller MJ, & Tome M: Comparison of early complications for patients with convexity and parasagittal meningiomas treated with either stereotactic radiosurgery or fractionated stereotactic radiotherapy. Neurosurgery 62:5 Suppl A19A28, 2008

    • Search Google Scholar
    • Export Citation
  • 13

    Ho DM, , Hsu CY, , Ting LT, & Chiang H: Histopathology and MIB-1 labeling index predicted recurrence of meningiomas: a proposal of diagnostic criteria for patients with atypical meningioma. Cancer 94:15381547, 2002

    • Search Google Scholar
    • Export Citation
  • 14

    Kamitani H, , Masuzawa H, , Kanazawa I, & Kubo T: Recurrence of convexity meningiomas: tumor cells in the arachnoid membrane. Surg Neurol 56:228235, 2001

    • Search Google Scholar
    • Export Citation
  • 15

    Kasuya H, , Kubo O, , Tanaka M, , Amano K, , Kato K, & Hori T: Clinical and radiological features related to the growth potential of meningioma. Neurosurg Rev 29:293297, 2006

    • Search Google Scholar
    • Export Citation
  • 16

    Kim YJ, , Ketter R, , Henn W, , Zang KD, , Steudel WI, & Feiden W: Histopathologic indicators of recurrence in meningiomas: correlation with clinical and genetic parameters. Virchows Arch 449:529538, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Kondziolka D, , Mathieu D, , Lunsford LD, , Martin JJ, , Madhok R, & Niranjan A, et al.: Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 62:5360, 2008

    • Search Google Scholar
    • Export Citation
  • 18

    Logue V, Parasagittal meningiomas. Krayenbühl H: Advances and Technical Standards in Neurosurgery Wien/New York, Springer-Verlag, 2:1975. 171198

    • Search Google Scholar
    • Export Citation
  • 19

    Mathiesen T, , Lindquist C, , Kihlström L, & Karlsson B: Recurrence of cranial base meningiomas. Neurosurgery 39:29, 1996

  • 20

    Mirimanoff RO, , Dosoretz DE, , Linggood RM, , Ojemann RG, & Martuza RL: Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62:1824, 1985

    • Search Google Scholar
    • Export Citation
  • 21

    Morokoff AP, , Zauberman J, & Black PM: Surgery for convexity meningiomas. Neurosurgery 63:427434, 2008

  • 22

    Nicolato A, , Foroni R, , Alessandrini F, , Bricolo A, & Gerosa M: Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 51:11531161, 2002

    • Search Google Scholar
    • Export Citation
  • 23

    Petty AM, , Kun LE, & Meyer GA: Radiation therapy for incompletely resected meningiomas. J Neurosurg 62:502507, 1985

  • 24

    Sandberg Nordqvist AC, , Smurawa H, & Mathiesen T: Expression of matrix metalloproteinases 2 and 9 in meningiomas associated with different degrees of brain invasiveness and edema. J Neurosurg 95:839844, 2001

    • Search Google Scholar
    • Export Citation
  • 25

    Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:2239, 1957

  • 26

    Sindou MP, & Alaywan M: Most intracranial meningiomas are not cleavable tumors: anatomic-surgical evidence and angiographic predictibility. Neurosurgery 42:476480, 1998

    • Search Google Scholar
    • Export Citation
  • 27

    Torp SH, , Lindboe CF, , Grønberg BH, , Lydersen S, & Sundstrøm S: Prognostic significance of Ki-67/MIB-1 proliferation index in meningiomas. Clin Neuropathol 24:170174, 2005

    • Search Google Scholar
    • Export Citation
  • 28

    Yamasaki F, , Yoshioka H, , Hama S, , Sugiyama K, , Arita K, & Kurisu K: Recurrence of meningiomas. Cancer 89:11021110, 2000

  • 29

    Yamashita J, , Handa H, , Iwaki K, & Abe M: Recurrence of intracranial meningiomas, with special reference to radiotherapy. Surg Neurol 14:3340, 1980

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 629 118 13
Full Text Views 214 15 2
PDF Downloads 142 8 1
EPUB Downloads 0 0 0