Artikel
Prediction and impact of meningioma consistency for surgical outcome: an interim analysis
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: The consistency of meningioma is thought to be linked with surgical resectibility and morbidity especially when the tumor is associated with important neurovascular structures. Data to predict the texture of meningioma preoperatively are controversial and so far no study has demonstrated the predictive value of tumor consistency for surgical outcome. In this analysis we aimed to examine the interrelation between preoperative imaging, intraoperative tumor-characteristics and surgical outcome.
Method: Patients with intracranial meningioma treated between 08/2014-10/2015 were prospectively collected for demographics, clinical presentation, histology and surgical treatment with related morbidity and extend of resection (EOR). Tumor characteristics were reported by the surgeon using a standardized questionnaire with items about consistency, homogeneity, vascularization and adherence to surrounding structures. Imaging data was analyzed by measurements of signal intensity of tumor to cortex in T2, T1 native, T1 post-contrast and ADC-weighted images.
Results: 110 patients (72 female, 38 male) with meningioma of the convexity (n=29), sphenoid wing (n=29), cerebellopontine angle/petroclival (n=17), frontal base (n=15), falx (n=12), craniocervical junction (n=4), tentorium-supratentorial (n=3) and clivus (n=1) were included with a mean age of 57.1 years (range 27 to 83). Surgical morbidity consisted of 21.8% transient and 2.8% permanent deficits, one patient died. The mean follow-up period was 4.6 months. Average mRS was 1.4 preoperatively, 1.5 postoperatively and 1.0 at follow-up. 91 tumors were classified as WHO I and 19 as WHO II. Tumors with firm consistency had a higher risk for postoperative complications (OR 3.98 (95% CI: 1.1-14.9, p= 0.03) but no significant correlation with EOR (Simpson grade: I: 25%, II: 54%, III: 7%, IV: 14%, V: 0%). No routine modality of preoperative imaging displayed a consistent predictive value for intraoperative tumor characteristics but higher age was associated with a soft texture (r= -0.3, p=0.001).
Conclusions: Our interim analysis supports the notion that a firm consistency of meningioma is related with surgical outcome. Preoperative prediction of tumor consistency is therefore required for optimized risk assessment and surgical planning. However, routine MRI techniques provided no clues for tumor texture to be expected intraoperatively.