Growth Analysis of Untreated Meningiomas under Observation

Charles F. Opalak; Adam P. Sima; Matthew Thomas Carr; Andrew Rock; Aravind Somasundaram; Kathryn G. Workman; Alper Dincer; Vyshak Chandra; Rafael A. Vega; William C. Broaddus

doi:10.1055/s-0041-1739216

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2023; 84(02): 109-115
DOI: 10.1055/s-0041-1739216

Original Article

Growth Analysis of Untreated Meningiomas under Observation

Charles F. Opalak

¹Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, United States

,

Adam P. Sima

²Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States

,

Matthew Thomas Carr

¹Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, United States

,

Andrew Rock

¹Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, United States

,

Aravind Somasundaram

¹Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, United States

,

Kathryn G. Workman

¹Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, United States

,

Alper Dincer

¹Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, United States

,

Vyshak Chandra

³Department of Neurosurgery, University of Florida, Gainesville, Florida, United States

,

Rafael A. Vega

⁴Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

,

William C. Broaddus

¹Department of Neurosurgery, Virginia Commonwealth University Health System, Richmond, Virginia, United States

› Author Affiliations

Abstract

Background When meningiomas are small or asymptomatic, the decision to observe rather than treat requires balancing the growth potential of the lesion with the outcome and side effects of treatment. The aim of this study is to characterize the growth patterns of untreated meningiomas to better inform the clinical decision-making process.

Methods Patients with meningiomas were identified from 2005 to 2015. Those without treatment who had been followed for 1.5 years, with three magnetic resonance imaging (MRI) scans, were identified. Scans were measured with orthogonal diameters, geometric mean diameters, and volumes using the ABC/2 method. Regression modeling determined what growth pattern these parameters best approximated.

Results Two hundred and fifteen MRI scans for 34 female (82.9%) and 7 male (17%) patients with 43 tumors were evaluated. Initial tumor volumes ranged from 0.13 to 9.98 mL. The mean and median initial volumes were 2.44 and 1.52 mL, respectively. Follow-up times ranged from 21 to 144 months, with a median of 70 months. There were 12 tumors (28%) whose growth rates were significantly greater than zero. For all tumors, use of a linear regression model allowed accurate prediction of the future size using prior data.

Conclusion Three-quarters of presumptive meningiomas managed conservatively do not grow significantly. The remainder have significant growth over time, and the behavior could be approximated with linear regression models.

Keywords

meningioma - conservative treatment - prognosis - growth - disease management

Full Text

References

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