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. 2022 Sep 21:12:967420.
doi: 10.3389/fonc.2022.967420. eCollection 2022.

Symptom burden and surgical outcome in non-skull base meningiomas

Tobias Mederer  1   2 , Sebastian Schachinger  1   2 , Katharina Rosengarth  1   2 , Anja Brosig  3 , Karl-Michael Schebesch  1   2 , Christian Doenitz  1   2 , Nils-Ole Schmidt  1   2 , Martin Andreas Proescholdt  1   2
Affiliations

Symptom burden and surgical outcome in non-skull base meningiomas

Tobias Mederer et al. Front Oncol. .

Abstract

Purpose: Non-skull base meningiomas (NSBM) are a distinct entity and frequently present with focal neurological deficits. This study was designed to analyze functional and oncological outcome following microsurgical tumor resection in patients with NSBM.

Patients and methods: An analysis of 300 patients that underwent NSBM resection between 2003 and 2013 was performed. Assessment measures for functional outcome were Karnofsky Performance Scale (KPS), Medical Research Council - Neurological Performance Scale (MRC-NPS), and improvement rates of focal deficits and seizures. The extent of resection; recurrence-free survival (RFS) and tumor-specific survival (TSS) were also determined.

Results: Impaired KPS and MRC-NPS were present in 73.3% and 45.7%, respectively. Focal neurological deficits were recorded in 123 patients (41.0%), with hemiparesis (21.7%) and aphasia (9.3%) the most prevalent form of impairment. Most meningiomas were localized at the convexity (64.0%), followed by falcine tumors (20.3%). Both KPI and MRC-NPS scores were significantly improved by surgical resection. Postoperative improvement rates of 96.6%, 89.3%, 72.3%, 57.9%, and 27.3% were observed for aphasia, epilepsy, hemiparesis, cranial nerve, and visual field deficits, respectively. Long-term improvement was achieved in 83.2%, 89.3%, 80.0%, 68.4% and 54.6% of patients, respectively. Gross total resection (GTR) over subtotal resection (STR) significantly improved preoperative seizures and visual field deficits and correlated with reduced risk of new postoperative hemiparesis. Poor Simpson grade was the only significant prognostic factor in multivariate analysis for long-term functional deficit, which occurred in 7.3%. Median RFS was 45.9 months (6.0 - 151.5 months), while median TSS was 53.7 months (3.1 - 153.2 months). Both WHO grade (p= 0.001) and Simpson classification (p= 0.014 and p= 0.031) were independent significant prognostic factors for decreased RFS and TSS by multivariate analysis, respectively. Furthermore, tumor diameter > 50 mm (p= 0.039) significantly correlated with decreased TSS in multivariate analysis.

Conclusion: Surgical resection significantly and stably improves neurological deficits in patients with NSBM.

Keywords: meningioma; neurological deficit; outcome; recurrence; resection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Illustration of two cases with large NSBM; T1-weighted, contrast-enhanced MRI scans in coronal orientation are shown. (A) Convexity meningioma receiving a grade Simpson I resection (B), (C) a parasagittal lesion with a Simpson IV resection (D).
Figure 2
Figure 2
Violin plots show the distribution of preoperative (preop, yellow), postoperative (postop, blue) long-term (last follow-up, green) (A) Karnofsky Performance Scale (KPS) scores and (B) Medical Research Council - Neurological Performance Scale scores of the analyzed patients (n=300). Boxplots are shown within violin plots depicting median with lower and upper quartiles. Whiskers represent 1.5 interquartile range. Outliers are depicted as points. One-way repeated measure ANOVA was calculated to analyze the difference between preop, postop and long-term performance, the p – values are noted on top of the graph. Below the plots mean scores with standard deviations (SD) are shown.
Figure 3
Figure 3
Graphical representation (Sankey plots) of the neurological outcome of patients with preoperative (preop) (A) epilepsy, (B) aphasia, (C) hemiparesis, (D) cranial nerve deficit or (E) visual field deficit within 30 days after surgery (postop) and at last follow-up (long-term). Symptom improvement and recovery is represented in light and dark green respectively while worsening of symptoms is depicted in red. No change in deficits is marked yellow. Numbers in parenthesis indicate number of patients of each branch.
Figure 4
Figure 4
Kaplan-Meier plots show the (A) recurrence-free survival and (B) overall survival of patients with NSBM following tumor resection based on WHO grading (n=300). P-values (log rank test) are shown.
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