Artikel
Resection margin infiltration after image-guided dural tail resection – prospective evaluation of the Simpson Grade by neuropathological analysis
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Autoren
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Darius Kalasauskas
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Mirjam Renovanz
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Florian Ringel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Naureen Keric
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Tumor cell infiltration is common but not always present in the dural tail of intracranial meningiomas. Thus, not only a gross total resection but also the removal of up to 2 cm of dura around the tumor has been suggested to reduce recurrence rate. It remains unclear, whether the resection should be guided by the extent of dural tail.
In this prospective study we investigate tumor cell infiltration in the dural tail after image-guided Simpson grade I resection of convexity meningiomas.
Methods: All patients undergoing intended Simpson grade I convexity meningioma resection since January 2016 were included in this prospective analysis. Small pieces of dura were excised separately on the margin of neuronavigated resection (rostral, caudal, medial and lateral) and sent for histology analysis. Screenshots were obtained for comparison with follow-up images. In addition to resection margin infiltration, histology, demographic data, follow-up imaging and postoperative course were assessed.
Results: So far, we included 16 patients, 14 were female (88%) with a mean age of 56 years (±16). Mean follow-up period was 7.3 months (range 0-20.3). There were 68.8% WHO grade I and 31.2% grade II meningiomas. In total, 64 dural tail samples were analysed. In 14 patients the surgeon reported a Simpson grade I resection, while histologically it could only be achieved in 11 cases (68.8%). Two cases (13%) scored as Simpson grade I showed reactive cell infiltration in dura, and the presence of tumor cells could not be excluded. In 1 case (6%), a tumor cell infiltration was detected. In 2 cases, a gross total resection was not performed due to infiltration of the superior sagittal sinus.
Histology and demographic parameters did not correlate with the infiltration of the dural tail. All except 1 patient had at least one follow-up MRI after 3-6 months. Within this period, no residual or recurrent tumor was detected.
Conclusion: Preliminary analysis of this ongoing study revealed that a radiological dural tail is not a reliable marker for tumor cell infiltration in convexity meningiomas. Hence the extent of dural tail resection should not exclusively be guided by preoperative radiological appearance.
