gms | German Medical Science

Objective: Meningiomas account for about 20% of all intracranial tumors and are classified into three grades of malignancy. Extent of resection (EOR) is an important denominator for recurrence free survival, thus maximal resection is the most important treatment paradigm. Supratentorial meningiomas show a different biology and clinical dynamics in contrast to skull base meningiomas. We therefore attempted to analyze the functional improvement rates as well as factors associated with recurrence and tumor – related death in patients with supratentorial meningiomas.

Methods: We analyzed a cohort of 300 patients (mean age 58.7 years; female/male ratio 209/91) treated surgically for supratentorial meningiomas. EOR was graded according to Simpson classification, neurological and functional status was measured by the medical research neurological performance status (NPS) and the Karnofsky performance score (KPS). In addition, recovery rates of 4 neurological impairment types (hemiparesis, aphasia, visual field deficit, cranial nerve dysfunction) were analyzed. Tumor recurrence, progression free interval (PFS) and tumor related death rate was recorded, followed by uni- and multivariate analysis of potential risk factors associated with tumor progression and tumor related death.

Results: Most frequent presentation symptom was headaches (32.3%), followed by seizures and hemiparesis (18.3%, 17.3%). EOR according to Simpson grading were 1=51%, 2=28.4%, 3=7%, 4=13.3% and 5=0.3%. Sinus infiltration was detected in 24.0%, bone infiltration in 24.7%. Most tumors were classified as WHO grade 1 (84.3%), followed by grade 2 (14.7%) and 3 (1%). Both KPS and NPS significantly improved postsurgically. Recovery rates were best for aphasia (89.3%) and hemiparesis (72.4%) and worst for visual field deficits (27.3%). Recurrence rate was 14% with a median PFS of 45.9 months. Multivariate analysis identified poor EOR, higher WHO grade, sinus infiltration, and tumor diameter > 50 mm as independent factors associated with recurrence. 19 patients (6.3%) died due to tumor progression, 6 of these (31.6%) had WHO grade 1 tumors. Poor EOR and higher WHO grade are independent factor associated with tumor-related death.

Conclusion: Microsurgical resection conveys significant functional recovery, however improvement rates are heterogeneous. Although higher WHO grade is associated with risk for recurrence and tumor-related death, benign tumors can also display highly aggressive behavior.