gms | German Medical Science

Objective: Recent advances in radiotherapy and neuroimaging have questioned the traditional role of aggressive resections in patients with meningiomas. The present study reviews the authors’ institutional experience with a policy based on maximum safe resections for meningiomas, and analyses the impact of the degree of resection on functional outcome and progression free survival (PFS).

Method: We retrospectively analyzed 901 (WHO grade I: 716, II: 174, III: 11) consecutive patients with primary meningiomas who underwent resections in our institution between 1996 and 2008. Clinical and treatment parameters as well as tumor characteristics were analyzed using standard statistical methods.

Results: Median follow-up was 62 months. PFS rates at 5 and 10 yrs. were 92.6% and 86.0%, respectively. Younger age, higher preoperative Karnofsky Index (KPI) and convexity tumor location, but not the degree of resection were identified as independent predictors of a good functional outcome (defined as KPI = 90-100). Independent predictors of PFS were degree of resection (Simpson grade I vs. II vs. III vs. IV), MIB index (<5% vs. 5-10% vs.>10%), histological grade (WHO I vs. II vs. III), tumor size (</= 6 vs. > 6 cm), tumor multiplicity and location. Following a Simpson grade II rather than I resection more than doubled the risk of recurrence at 10 yrs. in the overall series (18.8 % vs. 8.5%). The impact of aggressive resections was much stronger in higher grade meningiomas.

Conclusions: A policy of maximum safe resections for meningiomas prolongs PFS and is not associated with increased morbidity.