Convexity meningioma recurrence

Convexity meningiomas had about half the risk of recurrence compared to other localizations (odds ratio 0.4 [95% CI 0.27 to 0.67], P-value = 0.0002) ¹⁾.

This having a Simpson Grading System 1 complete excision have a very low recurrence rate. The recurrence rates of atypical meningioma and malignant meningiomas are significantly higher, and borderline atypical tumors should be considered to behave more like atypical rather than benign lesions ²⁾.

With the conservative recommendations for surgery for asymptomatic meningiomas and the advent of radiosurgery, microsurgically treated convexity meningiomas are typically large in size. Nevertheless, the patient's clinical course following microsurgical removal of these lesions is expected to be uncomplicated ³⁾.

In spite of these important aspects and results, other authors observed consistent relation between radical removal (Simpson 1) and the retreatment-free survival rates in WHO grade I convexity meningiomas ⁴⁾.

Other authors extended the area of dura resection, in order to obtain a grade zero resection. It is a clear consideration of the importance of radical removal for control of the recurrence in meningiomas ⁵⁾.

AD use was an independent predictor of meningioma recurrence. This association may be due to mood or affective changes caused by tumor location in convexity, parasagittal, or falcine areas regions that may be a sign of early recurrence. The finding calls attention to AD use in the management of patients with meningioma and warrants further exploration of an underlying relationship ⁶⁾.

Replacing the skull defect with synthetic materials for hyperostotic bone secondary to meningioma is recommended owing to the possibility of tumor invasion. In the Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Malaysia, neurosurgeons have been putting back the refashioned hyperostotic bone flap after meningioma excision because of budget constraints. The aim of this study was to review the long-term meningioma recurrence rate in these patients.

This was a nonrandomized, prospective observational study conducted from September 2011 to January 2015 on patients with intracranial convexity and parasagittal meningiomas. Preoperative computed tomography brain scans were obtained in all patients to confirm bony hyperostosis. Intraoperatively, part of the hyperostotic bone was sent for histopathologic examination. The rest of the bone flap was refashioned by drilling off the hyperostotic part. The bone flap was put back over the craniotomy site after soaking in distilled water. All patients were followed up for tumor recurrence.

The study included 34 patients with convexity or parasagittal meningioma World Health Organization grade I-II who underwent Simpson grade Ia and IIa excision. Median follow-up was 63.5 months (mean 64.9 ± 9.4 months). The hyperostotic bone flap showed presence of tumor in 35% of patients. There were 2 patients with parasagittal meningiomas after Simpson grade IIa resections who developed tumor recurrences.

This study found that meningioma recurrence was unlikely when autologous cranioplasty was done with refashioned hyperostotic bone. This could be done in the same setting with meningioma excision. There was no recurrence in convexity meningiomas at mean 5-year follow-up ⁷⁾.

Alvernia et al. reviewed 100 cases of convexity meningiomas surgically treated between 1987 and 2001 with a median follow-up of 86 months (range 2-16 years). Preoperative and postoperative functional status, Simpson resection grade, histological type, and intraoperative surgical plane with pial vessel invasion were studied and correlated with the recurrence rate.

The average tumor size was 3.6 ± 0.4 cm. The pre- and postoperative Karnofsky Performance Scale scores were 92.6 ± 4.6 and 97.9 ± 2.2, respectively. Ninety-five lesions were benign (WHO Grade I) and 5 were atypical (WHO Grade II). Ninety-one and 9 tumors were subjected to Simpson Grade 1 and 3 resections (three Grade 3a and six Grade 3b), respectively. Surgical deaths did not occur. After a mean follow-up of 7.2 years, 4 meningiomas recurred; 2 (2.2%) after Simpson Grade 1 resections and 2 after Simpson Grade 3 (3a and 3b) resections (22.2%; p = 0.0034). When just the subgroup of Simpson Grade 1/WHO Grade I was studied, the recurrence rate decreased to 1.2% (1 of 86 cases). The recurrence of WHO Grade I tumors was higher in the subpial group than in the extrapial group (p = 0.025). No difference in recurrence according to the cleavage plane was seen in the WHO Grade II subgroup (p = 0.361). As for the subpial group, no difference in recurrence was noted between the WHO Grade I and II subgroups (p = 0.608). Importantly, however, the extrapial subgroup of WHO Grade II lesions had a higher recurrence rate compared with its counterpart in the WHO Grade I subgroup (p = 0.005).

Pial and vascular invasion affect the recurrence rate in convexity meningioma surgery. The recurrence rate of WHO Grade I tumors was higher among those with a subpial plane of dissection than among those with an extrapial one. Histological type did not determine the degree of pial invasion in World Health Organization grade 1 meningioma and World Health Organization grade 2 meningioma ⁸⁾.

Clinical and radiologic information on 112 patients with WHO grade I convexity meningiomas who underwent surgery over the past 20 years was retrospectively reviewed.

The recurrence rate in the grade 0-I resection group was 2.9%, whereas in the grade II-IV resection group, the recurrence rate was 31% (P = 0.0001). In Cox regression analysis, Simpson grade 0-I resection was revealed as a significant predictor of recurrence-free survival (P = 0.021). The hazard ratio for recurrence after II-IV resection was 10.98 times higher than grade 0-I. Like the Simpson grading of resection, a similar trend of recurrence (grade I, 1.6% vs. grade II-IV, 28%, P = 0.0001) was observed in the Shinshu grade of resection. In univariate analysis, female gender and use of neuronavigation were also identified as independent predictors of recurrence-free survival after resection of WHO grade I meningiomas. Six months after surgery, use of antiepileptic medication was less in grade 0-I compared with other grades.

When histologic grade is fixed, the Simpson grading system is the prime predictor for recurrence of meningioma after resection. Grade 0-I resection is also beneficial in cutting off antiepileptic medication in patients with convexity meningiomas. Although complete tumor resection (grade 0-I) is the goal, the surgical approach should be tailored to each patient depending on the risks and surgical morbidity ⁹⁾.

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