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Meling TR, Da Broi M, Scheie D, Helseth E. Skull base versus non-skull base meningioma surgery in the elderly. Neurosurg Rev 2018; 42:961-972. [PMID: 29978438 DOI: 10.1007/s10143-018-1005-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/17/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
To compare outcomes after surgery for skull base meningiomas (SBMs) with non-skull base meningiomas (NSBMs) in the elderly. Overall, 128 consecutive patients ≥ 70 years of age with intracranial SBMs operated between 1990 and 2010 were compared to 193 consecutive patients ≥ 70 years of age with NSBMs operated within the same time period. Median age at surgery was 75.0 years (mean 75.7, range 70.0-92.4). Follow-up was complete with median 4.7 years (mean 5.5, range 0-19). The female-to-male ratio was 2.8 for SBMs and 1.3 for NSBMs (p < 0.005). The groups had similar preoperative KPS (median 80, range 20-100), but SBMs presented significantly more frequently with raised ICP (RR = 2.2, p < 0.005) and less frequently with seizures (RR = 0.6, p < 0.05). WHO I was significantly more frequent in SBMs (p < 0.005). Gross-total resection (GTR) was less frequent in SBMs (63 vs 82%) (RR = 2.1, p < 0.0001). SBMs were similar to NSBMs with respect to neurological outcome at 6-12 months, reoperations for hematomas, postoperative infections, and 30-day mortality. Retreatment rates and time to retreatments were also similar. There were no differences between the two groups with respect to risk of retreatment and overall survival (OS) at 5, 10, 15, and 20 years. In elderly patients with SBMs selected to surgical treatment, the risks of surgery, risk of retreatment, and OS were similar to NBSMs. Therefore, surgery for SBMs may be considered as safe as NSBMs in the elderly population.
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Affiliation(s)
- Torstein R Meling
- Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Neurosurgery, Oslo University Hospital, N-0027, Oslo, Norway.
| | | | - David Scheie
- Section of Neuropathology, Rigshospitalet, Copenhagen, Denmark
| | - Eirik Helseth
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, N-0027, Oslo, Norway
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Islim AI, Ali A, Bagchi A, Ahmad MU, Mills SJ, Chavredakis E, Brodbelt AR, Jenkinson MD. Postoperative seizures in meningioma patients: improving patient selection for antiepileptic drug therapy. J Neurooncol 2018; 140:123-134. [PMID: 29959695 PMCID: PMC6182382 DOI: 10.1007/s11060-018-2941-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
Background Epilepsy is a major cause of morbidity and mortality in meningioma patients. The aims of this study were to determine which factors predispose meningioma patients to developing perioperative seizures and to understand the impact of antiepileptic drugs. Methods Patients treated for a histologically-confirmed intracranial meningioma at the authors’ institution between 2010 and 2015 were retrospectively examined. Clinical and imaging data were assessed. Multivariate analysis was performed using binary logistic regression. The effect of antiepileptic treatment was assessed using survival analysis. Results Two hundred and eighty-three patients met the selection criteria; seizures were present in 68 preoperatively (24%) and in 48 patients (17%) following surgery. Of the 68 with preoperative seizures, 19 continued to have them, whereas de-novo seizures arose postoperatively in 29 seizure-naïve patients. Risk factors of postoperative seizures were convexity location (OR 2.05 [95% CI 1.07–3.98], p = 0.030), fronto-parietal location (OR 4.42 [95% CI 1.49–13.16], p = 0.007) and preoperative seizures (OR 2.65 [95% CI 1.37–5.24], p = 0.005). The two locations, in addition to the presence of midline shift on preoperative imaging (OR 4.15 [95% CI 1.54–11.24], p = 0.005), were significantly correlated with postoperative seizures in seizure-naïve patients. Antiepileptic treatment in patients with those risk factors reduced the possibility of seizures at any time point within the 1st year postoperatively by approximately 40%, although this did not meet statistical significance. Conclusion Prophylactic antiepileptic treatment might be warranted in seizure-naïve meningioma patients with ≥ 1 risk factor. High-quality randomised controlled trials are required to verify those factors and to define the role of antiepileptics in meningioma practice.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK. .,School of Medicine, University of Liverpool, Liverpool, UK. .,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - Arousa Ali
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Ananyo Bagchi
- School of Medicine, University of Liverpool, Liverpool, UK.,Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emmanuel Chavredakis
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Meningiomas: skull base versus non-skull base. Neurosurg Rev 2018; 42:163-173. [PMID: 29627874 DOI: 10.1007/s10143-018-0976-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 01/31/2018] [Accepted: 03/28/2018] [Indexed: 11/27/2022]
Abstract
To identify differences between skull base meningiomas (SBM) and non-skull base meningiomas (NSBM). All adult patients (18.0-69.9 years) operated for intracranial meningiomas between 1990 and 2010 at our institution were investigated. Al-Mefty's definition was used to dichotomize tumors into SBM and NSBM. Overall, 1148 consecutive patients were identified. Median age at surgery was 54.2 years [18.1-69.9]. Median follow-up was 7.4 years [0.0-20.9]. There were 562 patients (49%) with SBM and 586 (51%) with NSBM. The two groups were similar with respect to patient age, follow-up time, and number of patients. Overall female-to-male ratio was 2.6:1, but 3.2:1 in SBM and 2.2:1 in NSBM (p < 0.005). With respect to presenting symptoms, SBMs had more often neurological deficits (risk ratio (RR) 1.4; p < 0.0001) and less often seizures (RR 0.4; p < 0.0001). Gross total resections were less frequent in SBM than NSBM (62 vs 84%) (RR 1.3; p < 0.0001). SBMs had a lower risk of WHO grades II and III histology (4.5 vs 9.5%) (RR 0.5; p < 0.001). Worsening of neurological function was more frequent in SBM (21 vs 121%) (RR 1.8; p < 0.001). Retreatment-free survival at 5, 10, and 15 years, respectively, was 80, 70, and 62% for SBM versus 90, 82, and 74% for NSBM (p < 0.0001). Overall survival at 5, 10, and 15 years, respectively, was 93, 85, and 78% for SBM and 96, 91, and 79% for NSBM (p = 0.14). Patients with SBMs had more new-onset neurological deficits and significantly shorter retreatment-free survivals, but this did not adversely affect the overall survival.
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Seyedi JF, Pedersen CB, Poulsen FR. Risk of seizures before and after neurosurgical treatment of intracranial meningiomas. Clin Neurol Neurosurg 2018; 165:60-66. [PMID: 29316494 DOI: 10.1016/j.clineuro.2018.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/11/2017] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify variables associated with the development of pre- and postoperative seizures in patients who underwent surgical resection of intracranial meningiomas, in a patient cohort not routinely treated prophylactically with antiepileptic drugs (AED). PATIENTS AND METHODS Retrospective cohort study of 295 patients that underwent resection of a supratentorial meningioma at Odense University Hospital in between 2007-2015. Multivariate logistic regression was used to identify variables significantly correlating with pre- and postoperative seizures. Retrospective chart review was used to identify the rates of seizure incidence in patients, and the effect of AED on them. RESULTS The presence of peritumoral edema (OR:18.00, 7.44-43.58) was identified as predictor of preoperative seizure, while headache (OR:0.43, 0.22-0.84) and neurological deficit (OR:0.18, 0.09-0.39) were associated with a reduced incidence of preoperative seizures. The rates of postoperative seizure were increased in meningiomas in the left side (OR:1.91, 1.11-3.29), and reduced for tumor location in the convexity/parasagittal/falx (OR:0.72, 0.59-0.88) as well as in the absence of postoperative complications (OR:0.19, 0.10-0.36). 24.4% of the patients experienced seizures preoperatively, and a complete seizure freedom was achieved in 63.9% of them. 75.6% of the patients did not experience seizures preoperatively, but 15.2% of them then developed seizures postoperatively. A total of 20.3% of the patients experienced seizures after surgery. Time to first seizure in patients that did not experience seizures preoperatively but developed seizures after surgery, was one week (47%). However, first time postoperative seizures were also observed within one month postoperative (21%) and three months after surgery (32%). AED had a treatment success rate of 98.2% in preoperative seizures, and 98.0% in postoperative seizures. CONCLUSION Seizures after supratentorial meningioma surgery is common also in patients with no seizures preoperatively and mainly occurs within the first three postoperative months. AED are effective in controlling seizures.
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Affiliation(s)
- Jian Fernandes Seyedi
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark; OPEN Odense Patient Data Explorative Network, J. B. Winsløws Vej 9 a, Odense Denmark
| | - Christian Bonde Pedersen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark; OPEN Odense Patient Data Explorative Network, J. B. Winsløws Vej 9 a, Odense Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark; OPEN Odense Patient Data Explorative Network, J. B. Winsløws Vej 9 a, Odense Denmark.
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Wu A, Garcia MA, Magill ST, Chen W, Vasudevan HN, Perry A, Theodosopoulos PV, McDermott MW, Braunstein SE, Raleigh DR. Presenting Symptoms and Prognostic Factors for Symptomatic Outcomes Following Resection of Meningioma. World Neurosurg 2017; 111:e149-e159. [PMID: 29248774 DOI: 10.1016/j.wneu.2017.12.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Meningioma is the most common primary intracranial tumor and patients present with diverse neurologic symptoms related to meningioma location. This study aimed to systematically quantify the presenting symptoms of meningioma and identify prognostic factors for symptomatic outcome following resection. METHODS test and multivariate regression were used to compare groups. RESULTS Patients presented primarily with headaches (48.2%) and either cerebral dysfunctions (48.5%) with convexity meningiomas or cranial nerve deficits (38.9%) with skull base meningiomas. Symptomatic improvement in the acute postoperative period was significantly correlated with long term symptomatic improvement (P ≤ 0.01). Headaches and seizures had the greatest rates of symptomatic improvement after surgery (78%), and the vast majority of patients with symptom improvement experienced complete resolution (86%). In contrast, symptoms persisted in >60% of patients with anosmia, sensory changes, or frontal, temporal, or cerebellar symptoms. Multivariate regression identified subtotal resection as a prognostic factor for persistent symptoms (odds ratio, 0.62; 95% confidence interval, 0.03-1.21; P = 0.041). CONCLUSIONS Symptoms improve in the majority of patients after resection of meningioma, with the rate of improvement varying according to symptom type and extent of resection. These data may be a useful when counseling patients about symptoms after resection of meningiomas.
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Affiliation(s)
- Ashley Wu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Michael A Garcia
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Stephen T Magill
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - William Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Harish N Vasudevan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Arie Perry
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Philip V Theodosopoulos
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Michael W McDermott
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
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