J Neurol Surg A Cent Eur Neurosurg 2022; 83(06): 516-522
DOI: 10.1055/s-0041-1739204
Original Article

Skull Base Meningiomas: Is Surgical Resection Enough? Outcome Evaluation and Prognostic Factors Analysis in a Single-Center Cohort

Federico Pessina
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
2   Department of Neurosurgery, IRCCS Humanitas Research Hospital, Lombardia, Italy
,
Pierina Navarria
3   Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Lombardia, Italy
,
Zefferino Rossini
2   Department of Neurosurgery, IRCCS Humanitas Research Hospital, Lombardia, Italy
,
Elena Clerici
3   Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Lombardia, Italy
,
Maurizio Fornari
2   Department of Neurosurgery, IRCCS Humanitas Research Hospital, Lombardia, Italy
,
Letterio S. Politi
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
4   Department of Neuroradiology, IRCCS Humanitas Research Hospital, Lombardia, Italy
,
Marta Scorsetti
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
3   Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Lombardia, Italy
,
Franco Servadei
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
2   Department of Neurosurgery, IRCCS Humanitas Research Hospital, Lombardia, Italy
› Author Affiliations
Funding None.

Abstract

Background Surgical resection represents the mainstay of treatment in skull base meningiomas (SBMs). Considering the high recurrence rate reported, an adjuvant radiation therapy (RT) treatment should be considered. The aim of this study was to evaluate the progression-free survival (PFS), overall survival (OS), and prognostic factors conditioning outcome.

Methods Patients receiving surgical resection for grade I SBMs were included. The extent of resection (EOR) was dichotomized as gross total resection (GTR) and subtotal resection (STR). RT was administered only in patients receiving STR. Clinical outcome was evaluated by brain magnetic resonance imaging (MRI) performed every 6 months for the first year and yearly thereafter.

Results From January 2000 to December 2015, 123 patients were treated. The majority were females (70.7%), with a Karnofsky Performance Score (KPS) ≥80 (95%), and symptoms at diagnosis (91%). GTR was performed in 30% of cases and STR in 70%. RT was performed in 18 (20.9%) patients at diagnosis and in 29 (33.7%) patients at progression. Improvement or stability of neurologic status was obtained in 78.9% of patients. The median follow-up time was 91 months (range: 40–230 months). Local recurrence occurred in 34 (27.6%) patients at a median time of 45 months (range: 6–214 months). The median, 2-, 5-, and 10-year PFS were 193 months, 89.3, 81.8, and 72.5%, respectively. On univariate and multivariate analyses, factors impacting on PFS were EOR, tumor location, neurologic postoperative status, and adjuvant RT in STR.

Conclusions A safe surgical resection followed by RT adjuvant treatment could represent the better choice to obtain local control maintaining neurologic integrity. Our data underlined the value of adjuvant RT in incompletely resected meningiomas.

Author Contribution

FP and PN performed most of the study and drafted the manuscript. FS and MS contributed to the conception of this study. ZF, EC, and MS participated in the acquisition of the data, and LP and MF assisted in the interpretation of the results.




Publication History

Received: 01 July 2020

Accepted: 23 April 2021

Article published online:
12 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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