Surgical Outcomes and Complications after Reoperation for Recurrent Skull Base Meningiomas

Background: Skull base meningiomas are surgically challenging due to the intricate skull base anatomy and the proximity to cranial nerves and cerebral vasculature. A great deal is known about the primary treatment of skull base meningiomas, however, little is known about outcomes after reoperation for recurrent skull base meningiomas.

Methods: A retrospective review of 2,120 patients who underwent surgery for resection of meningioma from 1985–2015 meningiomas was conducted. Clinical information was extracted from the medical records, radiology data, and pathology data. All records of patients with recurrent skull base meningioma were reviewed. Demographic data, presenting symptoms, surgical management, outcomes and complications data were collected. Kaplan-Meier analysis was used to evaluate survival after reoperation. Logistic regression was used to evaluate for risk factors associated with complications.

Results: Seventy-eight patients underwent 100 reoperations for recurrent skull base meningioma. Seventeen patients had a second reoperation, three patients had a third reoperation, and two had four or more reoperations. Average age at diagnosis was 52 years, and 64% were female. Median follow up was 8.5 years. Presenting symptoms included cranial neuropathy, headache, seizure, proptosis and weakness. Median time from initial resection to first reoperation was 4.4 years and 4.1 years from first to second reoperation. Seventy-two percent of tumors were WHO Grade I, 21% were WHO Grade II, and 7% were WHO Grade III tumors. The sphenoid wing was the most common location (31%), followed by cavernous sinus (13%), olfactory groove (12%), cerebellopontine angle (11%), tuberculum (11%), middle fossa floor (5%), and other (17%). Forty-four tumors were greater than 3 cm in maximum diameter at the time of the first reoperation. There were 65 complications that occurred in 30 patients (38%). Nineteen of the 65 complications required surgical intervention (29%). Surgical complications included hydrocephalus (12), cerebral spinal fluid leak/pseudomeningocele (11), wound infection (9), post-op hematoma (4), venous infarct (1) and pneumocephalus (1). Post-operative neurological deficits included new or worsened cranial nerve deficits (16) and hemiparesis (3). There were (9) medical complications. Logistic regression of age, gender, tumor grade, size, location, interval treatment, and presenting symptoms identified tumor size greater than 3 cm as a significant risk factor for complication (p = 0.04). Tumor location in the cavernous sinus or cerebellopontine angle trended toward significance (p = 0.08). Median survival after reoperation was 17 years.

Conclusion: Recurrent skull base meningiomas are surgically challenging tumors and reoperation is associated with high morbidity and complication rates, however, continued resection of recurrent tumors provides excellent long-term survival.