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

Clinical article

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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.

Article Information

Address correspondence to: Jorge E. Alvernia, M.D., Department of Neurosurgery, St. Edward Mercy Medical Center, Fort Smith, Arkansas 72903. email: jalvernia@yahoo.com.

Please include this information when citing this paper: published online June 10, 2011; DOI: 10.3171/2011.4.JNS101922.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Left: Selective external carotid artery angiogram showing the tumor blush (asterisk) of a parietal convexity meningioma fed by the occipital artery and from the posterior branches of the middle meningeal artery (black arrows). Right: Selective internal carotid artery injection angiogram showing a pial tumor blush (asterisk) heralding the pial invasion by this tumor (black arrows).

  • View in gallery

    Preoperative and postoperative CT scans showing a right frontotemporal convexity meningioma. Left: Peritumoral edema (black arrows) heralding the presence of pial involvement. Right: Note the postoperative changes (spots of hemorrhagic infarction) associated with a subpial surgical plane (black arrows), after complete tumor removal.

  • View in gallery

    Intraoperative photograph showing a convexity meningioma (M) with both an extrapial and a subpial cleavage plane.

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