gms | German Medical Science

Objective: To elucidate the development of diagnostics, treatment, and clinical outcome of primarily diagnosed cranial meningiomas resected during a 25-years period.

Methods: Clinical and radiological data, surgical procedures, and complications as well as clinical outcome of 817 patients who underwent surgery for cranial meningioma between 1991 and 2015 were reviewed and analyzed in uni- and multivariate analyses.

Results: Median age at diagnosis rose from 56 (1991-95) to 59 years (2011-15, p=.042), while gender relation, tumor location and preoperative Karnofsky Performance Status did not change during the inclusion period. In the same time, availability of preoperative magnet resonance imaging increased, and rates of angiography and tumor embolization decreased (p<.001, each). Median duration of total, pre- and postoperative stay was 13 (range: 3-65), 2 (0-28) and 9 days (range: 2-59), respectively, and decreased between 1991 and 2015 (p<.001, each). Annual median incision-suture time varied but without a clear trend during observation period (p<.001). The portion of Simpson grade II and IV resections increased, while Simpson grades I and III surgeries decreased (p<.001). Use of intraoperative neuronavigation and neuromonitoring increased between 1991 and 2015 (p<.001, each), and rates of grade II/III meningiomas rose from 2% to 8% (p=.019). Within short-term follow-up (median: 3 months), Glasgow outcome scores (p=.466), rates of postoperative hemorrhage (p=.997), hydrocephalus (p=.632) and wound infection (p=.126) did not change, while the frequency of new postoperative neurological deficits decreased from 21% to 13% (p=.003). In contrast, the rate of cerebrospinal fluid fistulas slightly increased from 2% to 3% (p=.049) during observation period. Within a median long-term follow-up of 62 months, overall (p=.308) and progression free survival (p=.196) were independent of the year of surgery. Similarly, in subgroup analyses of all patients with a follow-up of at least 5 years, both progression free survival (p=.126) and recurrence rates (p=.587) did not significantly change during inclusion period. Age-, sex-, tumor location- and WHO grade-adjusted multivariate analyses confirmed the lack of correlation between years of surgery and tumor relapse (HR: 1.1, 95%CI .93-1.3, p=.268).

Conclusion: Cranial meningioma surgery has been substantially evolved within 25 years. Although neurological outcome has improved, long-term prognosis remains unchanged.