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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Brain invasion in meningiomas – Does surgical sampling impact specimen characteristics and histology?

Hirninvasion in Meningeomen – Beeinflusst die neurochirurgische Gewebeentnahme die Probencharakteristik und histopathologischen Befunde?

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  • presenting/speaker Maximilian Timme - Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
  • Christian Thomas - Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
  • Dorothee Cäcilia Spille - Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
  • Walter Stummer - Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
  • Heinrich Ebel - St. Barbara-Klinik Hamm, Klinik für Neurochirurgie, Hamm-Heessen, Deutschland
  • Christian Ewelt - St. Barbara-Klinik Hamm, Klinik für Neurochirurgie, Hamm-Heessen, Deutschland
  • Hans-Josef Hans - Paracelsus Klinik Osnabrück, Klinik für Neurochirurgie, Osnabrück, Deutschland
  • Uta Schick - Clemens Hospital Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
  • Maximilian Puchner - Klinikum Vest, Klinik für Neurochirurgie, Recklinghausen, Deutschland
  • Uwe Wildförster - Bergmannsheil und Kinderklinik Buer, Klinik für Neurochirurgie, Gelsenkirchen, Deutschland
  • Rudolf Andreas Kristof - Helios Klinikum Meiningen, Klinik für Neurochirurgie, Meiningen, Deutschland
  • Hans Axel Trost - Klinikum Bayreuth, Klinik für Neurochirurgie, Bayreuth, Deutschland
  • Werner Paulus - Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
  • Katharina Heß - Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
  • presenting/speaker Benjamin Brokinkel - Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP083

doi: 10.3205/19dgnc421, urn:nbn:de:0183-19dgnc4210

Published: May 8, 2019

© 2019 Timme et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Brain invasion (BI) is a stand-alone grading criterion for atypia and therefore impacts both adjuvant treatment and study inclusion. Accordingly, discussion raises if standardized neurosurgical sampling and histopathological analyses might improve the accuracy of the detection of brain invasion. However, the impact of neurosurgical sampling on histopathological analyses and specimen characteristics have not been investigated yet.

Methods: Tumor location, specimen characteristics as well as rates of brain invasion and high-grade histology were compared in meningioma samples obtained from 2938 surgeries in different neurosurgical departments between 2007 and 2017.

Results: High-grade histology was strongly correlated with non-skull base tumor location (OR: 2.91, 95%CI 2.28–3.72; p<.001). Non-skull base location was associated with the presence of brain tissue on microscopic slides, residual specimen not subjected to histopathological analyses and a higher specimen weight (p<.001, each). Similarly, high-grade histology was correlated with higher sample weight, presence of brain tissue on microscopic slides and incomplete neuropathological sampling (p<.001, each). Brain invasion was found in 4% of the meningiomas entirely and in 10% of the tumor incompletely subjected to neuropathological analyses (p<.001). In 406 atypical meningiomas, no correlation was found between brain invasion and the specimen weight (p=.181). In 2570 samples from 8 neurosurgical departments, the portion of skull base meningiomas, the specimen weight, the frequency of brain tissue on the microscopic slides and the rates of brain invasion differed significantly (p<.001, each). However, correlations between brain invasion and the neurosurgical departments were not confirmed (p=.223) when only analyzing specimen with microscopic evidence of brain tissue (N=777). In multivariable analyses, rates of brain invasion were higher in non-skull base meningiomas (OR: 2.08, 95%CI 1.44–3.01; p<.001) and tumors resected in only one of the 8 departments (OR: 2.18, 95%CI 1.40–3.38; p=.001), and tended to be lower in another center (OR: .58, 95%CI .33–1.01; p=.054).

Conclusion: Specimen characteristics are related to histopathological findings and significantly vary among different neurosurgical departments. Surgical nuances might impact the accuracy of the detection of brain invasion and therefore histopathological grading.