Operative Complications of Incidental Meningiomas

Introduction: Incidental meningiomas pose a significant management dilemma in all age groups. This study aims to assess the risk of postoperative complications in these patients and factors associated with their surgical outcome.

Methods: Records of 600 consecutive patients were reviewed retrospectively. Of these, 208 (34.6%) had incidental meningiomas. Patients were stratified according to age, medical comorbidity, tumor size, location, and history of previous surgery. Surgical complications (SC) were grouped as major neurological, minor neurological, and nonneurological. Operative outcome was assessed at 6 weeks and 1 year using the Glasgow Outcome Score (GOS).

Results: SC were encountered in 13% of asymptomatic patients (AP)(22/208), and 22.2% of symptomatic patients (SP)(87/392). Of the 22 patients, 3.8% had major, 6.3% minor, and 2.9% nonneurological SC. Cranial nerve deficit, new-onset seizure and infectious/inflammatory conditions were encountered most frequently (5.8%, 3.4%, 3.4%, respectively). Age, size, comorbidity were not significant factors, whereas tumor location was. Medical complications were seen in 3.4% of AP and 12.2% of SP. GOS 5 outcome was 95.7% versus 78.1% at 6 weeks, and 98.2% versus 90.1% at 1 year, for AP and SP, respectively. Mortality was 1.8% at 1 year for AP.

Conclusions: In AP with meningiomas, both surgical and medical complications occur less frequently compared to SP. Although most patients (98.2%) have excellent outcome (GOS 5) by 1 year after surgery, the overall 13% incidence of SC must be considered in AP with meningiomas, when evaluating surgical management.