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Contemporary surgical outcome for skull base meningiomas

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Abstract

Although surgical excision of meningioma and its dural base is the most common primary management, skull base meningiomas are quite different, and contemporary management usually consists of multimodal treatment with the aim of achieving the best possible functional outcome and quality of life (QOL) for these patients. As surgery plays an important role in the treatment of skull base meningiomas, it is crucial for neurosurgeons to appreciate the surgical outcome and QOL after meningioma surgery. Outcome is usually measured for meningiomas in terms of morbidity, mortality, time to recurrence, and QOL. The extent of resection, tumor grade, proliferative markers, and tumor location are significant factors in predicting the surgical outcome. Therefore, we address each of these factors in detail in this review. Advances in recent decades in microsurgical techniques, neuroimaging modalities, neuroanesthesia, and perioperative intensive care have substantially improved the surgical outcome; therefore, most surgical outcomes discussed in this review are cited from contemporary literature (2000 to the present) in order to depict the surgical outcome of contemporary microsurgery.

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References

  1. Abdel-Aziz KM, Froelich SC, Dagnew E, Jean W, Breneman JC, Zuccarello M, van Loveren HR, Tew JM Jr (2004) Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes. Neurosurgery 54(6):1375–1383

    PubMed  Google Scholar 

  2. Adachi K, Kawase T, Yoshida K, Yazaki T, Onozuka S (2009) Abc surgical risk scale for skull base meningioma: a new scoring system for predicting the extent of tumor removal and neurological outcome. Clinical article. J Neurosurg 111(5):1053–1061. doi:10.3171/2007.11.17446

    PubMed  Google Scholar 

  3. Aichholzer M, Bertalanffy A, Dietrich W, Roessler K, Pfisterer W, Ungersboeck K, Heimberger K, Kitz K (2000) Gamma knife radiosurgery of skull base meningiomas. Acta Neurochir (Wien) 142(6):647–652

    CAS  Google Scholar 

  4. Al-Mefty O (1990) Clinoidal meningiomas. J Neurosurg 73(6):840–849. doi:10.3171/jns.1990.73.6.0840

    PubMed  CAS  Google Scholar 

  5. Arai H, Sato K, Okuda MM, Hishii M, Nakanishi H, Ishii H (2000) Transcranial transsphenoidal approach for tuberculum sellae meningiomas. Acta Neurochir (Wien) 142(7):751–756

    CAS  Google Scholar 

  6. Basso A, Carrizo A, Antico J (2006) Sphenoid ridge meningiomas. In: Schmidek HH, Roberts DW (eds) Operative neurosurgical techniques: indications, methods, and results, vol 1, 5. Saunders, Philadelphia, pp 226–237

    Google Scholar 

  7. Arnautovic KI, Al-Mefty O (2002) Primary meningiomas of the jugular fossa. J Neurosurg 97(1):12–20. doi:10.3171/jns.2002.97.1.0012

    PubMed  Google Scholar 

  8. Arnautovic KI, Al-Mefty O, Husain M (2000) Ventral foramen magnum meninigiomas. J Neurosurg 92(1 Suppl):71–80

    PubMed  CAS  Google Scholar 

  9. Bambakidis NC, Kakarla UK, Kim LJ, Nakaji P, Porter RW, Daspit CP, Spetzler RF (2008) Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 62(6 Suppl 3):1182–1191. doi:10.1227/01.neu.0000333784.04435.65

    PubMed  Google Scholar 

  10. Bassiouni H, Asgari S, Stolke D (2006) Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically. Surg Neurol 66(1):37–44. doi:10.1016/j.surneu.2005.11.059

    PubMed  Google Scholar 

  11. Bassiouni H, Hunold A, Asgari S, Stolke D (2004) Meningiomas of the posterior petrous bone: functional outcome after microsurgery. J Neurosurg 100(6):1014–1024. doi:10.3171/jns.2004.100.6.1014

    PubMed  Google Scholar 

  12. Bassiouni H, Hunold A, Asgari S, Stolke D (2004) Tentorial meningiomas: clinical results in 81 patients treated microsurgically. Neurosurgery 55(1):108–116

    PubMed  Google Scholar 

  13. Bassiouni H, Ntoukas V, Asgari S, Sandalcioglu EI, Stolke D, Seifert V (2006) Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach. Neurosurgery 59(6):1177–1185. doi:10.1227/01.NEU.0000245629.77968.37

    PubMed  Google Scholar 

  14. Bertalanffy A, Roessler K, Koperek O, Gelpi E, Prayer D, Neuner M, Knosp E (2006) Intraventricular meningiomas: a report of 16 cases. Neurosurg Rev 29(1):30–35. doi:10.1007/s10143-005-0414-5

    PubMed  Google Scholar 

  15. Bonnal J, Thibaut A, Brotchi J, Born J (1980) Invading meningiomas of the sphenoid ridge. J Neurosurg 53(5):587–599. doi:10.3171/jns.1980.53.5.0587

    PubMed  CAS  Google Scholar 

  16. Borba LA, de Oliveira JG, Giudicissi-Filho M, Colli BO (2009) Surgical management of foramen magnum meningiomas. Neurosurg Rev 32(1):49–58. doi:10.1007/s10143-008-0161-5

    PubMed  Google Scholar 

  17. Borovich B, Doron Y (1986) Recurrence of intracranial meningiomas: the role played by regional multicentricity. J Neurosurg 64(1):58–63. doi:10.3171/jns.1986.64.1.0058

    PubMed  CAS  Google Scholar 

  18. Borovich B, Doron Y, Braun J, Guilburd JN, Zaaroor M, Goldsher D, Lemberger A, Gruszkiewicz J, Feinsod M (1986) Recurrence of intracranial meningiomas: the role played by regional multicentricity. Part 2: clinical and radiological aspects. J Neurosurg 65(2):168–171. doi:10.3171/jns.1986.65.2.0168

    PubMed  CAS  Google Scholar 

  19. Boulton MR, Cusimano MD (2003) Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurg Focus 14(6):e10. doi:10.3171/foc.2003.14.6.10

    PubMed  Google Scholar 

  20. Bret P, Guyotat J, Madarassy G, Ricci AC, Signorelli F (2000) Tentorial meningiomas. Report on twenty-seven cases. Acta Neurochir (Wien) 142(5):513–526

    CAS  Google Scholar 

  21. Bruneau M, George B (2008) Foramen magnum meningiomas: detailed surgical approaches and technical aspects at lariboisiere hospital and review of the literature. Neurosurg Rev 31(1):19–32. doi:10.1007/s10143-007-0097-1

    PubMed  Google Scholar 

  22. Carvalho GA, Matthies C, Tatagiba M, Eghbal R, Samii M (2000) Impact of computed tomographic and magnetic resonance imaging findings on surgical outcome in petroclival meningiomas. Neurosurgery 47(6):1287–1294

    PubMed  CAS  Google Scholar 

  23. Chicani CF, Miller NR (2003) Visual outcome in surgically treated suprasellar meningiomas. J Neuroophthalmol 23(1):3–10

    PubMed  Google Scholar 

  24. Ciric I, Landau B (1993) Tentorial and posterior cranial fossa meningiomas: operative results and long-term follow-up: experience with twenty-six cases. Surg Neurol 39(6):530–537

    PubMed  CAS  Google Scholar 

  25. Colli BO, Assirati JA Jr, Deriggi DJ, Neder L, dos Santos AC, Carlotti CG Jr (2008) Tentorial meningiomas: follow-up review. Neurosurg Rev 31(4):421–430. doi:10.1007/s10143-008-0141-9

    PubMed  Google Scholar 

  26. Condra KS, Buatti JM, Mendenhall WM, Friedman WA, Marcus RB Jr, Rhoton AL (1997) Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 39(2):427–436

    PubMed  CAS  Google Scholar 

  27. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55(3):539–547

    PubMed  Google Scholar 

  28. Cudlip SA, Wilkins PR, Johnston FG, Moore AJ, Marsh HT, Bell BA (1998) Posterior fossa meningiomas: surgical experience in 52 cases. Acta Neurochir (Wien) 140(10):1007–1012

    CAS  Google Scholar 

  29. Cusimano MD, Sekhar LN, Sen CN, Pomonis S, Wright DC, Biglan AW, Jannetta PJ (1995) The results of surgery for benign tumors of the cavernous sinus. Neurosurgery 37(1):1–9

    PubMed  CAS  Google Scholar 

  30. de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O (2008) Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases. Neurosurgery 62(3):556–563. doi:10.1227/01.neu.0000317303.93460.24

    PubMed  Google Scholar 

  31. De Jesus O, Sekhar LN, Parikh HK, Wright DC, Wagner DP (1996) Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 39(5):915–919

    PubMed  Google Scholar 

  32. DeMonte F, Smith HK, al-Mefty O (1994) Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 81(2):245–251. doi:10.3171/jns.1994.81.2.0245

    PubMed  CAS  Google Scholar 

  33. Dijkstra M, van Nieuwenhuizen D, Stalpers LJ, Wumkes M, Waagemans M, Vandertop WP, Heimans JJ, Leenstra S, Dirven CM, Reijneveld JC, Klein M (2009) Late neurocognitive sequelae in patients with who grade I meningioma. J Neurol Neurosurg Psychiatry 80(8):910–915. doi:10.1136/jnnp.2007.138925

    PubMed  CAS  Google Scholar 

  34. Dziuk TW, Woo S, Butler EB, Thornby J, Grossman R, Dennis WS, Lu H, Carpenter LS, Chiu JK (1998) Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. J Neurooncol 37(2):177–188

    PubMed  CAS  Google Scholar 

  35. Eustacchio S, Trummer M, Fuchs I, Schrottner O, Sutter B, Pendl G (2002) Preservation of cranial nerve function following gamma knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years. Acta Neurochir Suppl 84:71–76

    PubMed  CAS  Google Scholar 

  36. Fahlbusch R, Schott W (2002) Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96(2):235–243. doi:10.3171/jns.2002.96.2.0235

    PubMed  Google Scholar 

  37. Gerszten PC (1998) Outcomes research: a review. Neurosurgery 43(5):1146–1156

    PubMed  CAS  Google Scholar 

  38. Gilbert ME, Shelton C, McDonald A, Salzman KL, Harnsberger HR, Sharma PK, Jensen RL (2004) Meningioma of the jugular foramen: glomus jugulare mimic and surgical challenge. Laryngoscope 114(1):25–32. doi:10.1097/00005537-200401000-00004

    PubMed  Google Scholar 

  39. Goel A, Desai K, Muzumdar D (2001) Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases. Neurosurgery 49(1):102–106

    PubMed  CAS  Google Scholar 

  40. Goel A, Muzumdar D, Desai KI (2002) Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery 51(6):1358–1363

    PubMed  Google Scholar 

  41. Gokalp HZ, Arasil E, Erdogan A, Egemen N, Deda H, Cerci A (1995) Tentorial meningiomas. Neurosurgery 36(1):46–51

    PubMed  CAS  Google Scholar 

  42. Guidetti B, Ciappetta P, Domenicucci M (1988) Tentorial meningiomas: surgical experience with 61 cases and long-term results. J Neurosurg 69(2):183–187. doi:10.3171/jns.1988.69.2.0183

    PubMed  CAS  Google Scholar 

  43. Harrison MJ, al-Mefty O (1997) Tentorial meningiomas. Clin Neurosurg 44:451–466

    PubMed  CAS  Google Scholar 

  44. Heim E, Valach L, Schaffner L (1997) Coping and psychosocial adaptation: longitudinal effects over time and stages in breast cancer. Psychosom Med 59(4):408–418

    PubMed  CAS  Google Scholar 

  45. Heimans JJ, Taphoorn MJ (2002) Impact of brain tumour treatment on quality of life. J Neurol 249(8):955–960. doi:10.1007/s00415-002-0839-5

    PubMed  Google Scholar 

  46. Hentschel SJ, DeMonte F (2003) Olfactory groove meningiomas. Neurosurg Focus 14(6):e4. doi:10.3171/foc.2003.14.6.4

    PubMed  Google Scholar 

  47. Henzel M, Gross MW, Hamm K, Surber G, Kleinert G, Failing T, Strassmann G, Engenhart-Cabillic R (2006) Significant tumor volume reduction of meningiomas after stereotactic radiotherapy: results of a prospective multicenter study. Neurosurgery 59(6):1188–1194. doi:10.1227/01.NEU.0000245626.93215.F6

    PubMed  Google Scholar 

  48. Ho DM, Hsu CY, Ting LT, Chiang H (2002) Histopathology and MIB-1 labeling index predicted recurrence of meningiomas: a proposal of diagnostic criteria for patients with atypical meningioma. Cancer 94(5):1538–1547. doi:10.1002/cncr.10351

    PubMed  Google Scholar 

  49. Jallo GI, Benjamin V (2002) Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 51(6):1432–1439

    PubMed  Google Scholar 

  50. Joung H, Lee BS (2008) The novel “class” algorithmic scale for patient selection in meningioma surgery. In: Lee JH (ed) Meningiomas: diagnosis, treatment, and outcome. Springer, Berlin

    Google Scholar 

  51. Jung HW, Yoo H, Paek SH, Choi KS (2000) Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery 46(3):567–574

    PubMed  CAS  Google Scholar 

  52. Kalkanis SN, Quinones-Hinojosa A, Buzney E, Ribaudo HJ, Black PM (2000) Quality of life following surgery for intracranial meningiomas at Brigham and Women's Hospital: a study of 164 patients using a modification of the functional assessment of cancer therapy-brain questionnaire. J Neurooncol 48(3):233–241

    PubMed  CAS  Google Scholar 

  53. Kandenwein JA, Richter HP, Antoniadis G (2009) Foramen magnum meningiomas—experience with the posterior suboccipital approach. Br J Neurosurg 23(1):33–39. doi:10.1080/02688690802545932

    PubMed  CAS  Google Scholar 

  54. Ketter R, Rahnenfuhrer J, Henn W, Kim YJ, Feiden W, Steudel WI, Zang KD, Urbschat S (2008) Correspondence of tumor localization with tumor recurrence and cytogenetic progression in meningiomas. Neurosurgery 62(1):61–69. doi:10.1227/01.NEU.0000311062.72626.D6

    PubMed  Google Scholar 

  55. Kinjo T, al-Mefty O, Kanaan I (1993) Grade zero removal of supratentorial convexity meningiomas. Neurosurgery 33(3):394–399

    PubMed  CAS  Google Scholar 

  56. Kleihues P, Burger PC, Scheithauer BW (1993) The new who classification of brain tumours. Brain Pathol 3(3):255–268

    PubMed  CAS  Google Scholar 

  57. Knosp E, Perneczky A, Koos WT, Fries G, Matula C (1996) Meningiomas of the space of the cavernous sinus. Neurosurgery 38(3):434–442

    PubMed  CAS  Google Scholar 

  58. Kondziolka D, Mathieu D, Lunsford LD, Martin JJ, Madhok R, Niranjan A, Flickinger JC (2008) Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 62(1):53–58. doi:10.1227/01.NEU.0000311061.72626.0D

    PubMed  Google Scholar 

  59. Krupp W, Klein C, Koschny R, Holland H, Seifert V, Meixensberger J (2009) Assessment of neuropsychological parameters and quality of life to evaluate outcome in patients with surgically treated supratentorial meningiomas. Neurosurgery 64(1):40–47. doi:10.1227/01.NEU.0000336330.75381.39

    PubMed  Google Scholar 

  60. Lang DA, Neil-Dwyer G, Garfield J (1999) Outcome after complex neurosurgery: the caregiver's burden is forgotten. J Neurosurg 91(3):359–363. doi:10.3171/jns.1999.91.3.0359

    PubMed  CAS  Google Scholar 

  61. Larson JJ, van Loveren HR, Balko MG, Tew JM Jr (1995) Evidence of meningioma infiltration into cranial nerves: clinical implications for cavernous sinus meningiomas. J Neurosurg 83(4):596–599. doi:10.3171/jns.1995.83.4.0596

    PubMed  CAS  Google Scholar 

  62. Lee JH, Jeun SS, Evans J, Kosmorsky G (2001) Surgical management of clinoidal meningiomas. Neurosurgery 48(5):1012–1019

    PubMed  CAS  Google Scholar 

  63. Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T (2005) Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 56(3):546–559

    PubMed  Google Scholar 

  64. Margalit NS, Lesser JB, Singer M, Sen C (2005) Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure. Neurosurgery 56(2 Suppl):324–336

    PubMed  Google Scholar 

  65. Maruyama K, Shin M, Kurita H, Kawahara N, Morita A, Kirino T (2004) Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery 55(5):1068–1075

    PubMed  Google Scholar 

  66. Mathiesen T, Lindquist C, Kihlstrom L, Karlsson B (1996) Recurrence of cranial base meningiomas. Neurosurgery 39(1):2–7

    PubMed  CAS  Google Scholar 

  67. Mendenhall WM, Morris CG, Amdur RJ, Foote KD, Friedman WA (2003) Radiotherapy alone or after subtotal resection for benign skull base meningiomas. Cancer 98(7):1473–1482. doi:10.1002/cncr.11645

    PubMed  Google Scholar 

  68. Miller E, Crockard HA (1987) Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum. Neurosurgery 20(6):966–968

    PubMed  CAS  Google Scholar 

  69. Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62(1):18–24. doi:10.3171/jns.1985.62.1.0018

    PubMed  CAS  Google Scholar 

  70. Molony TB, Brackmann DE, Lo WW (1992) Meningiomas of the jugular foramen. Otolaryngol Head Neck Surg 106(2):128–136

    PubMed  CAS  Google Scholar 

  71. Nakamura M, Roser F, Dormiani M, Matthies C, Vorkapic P, Samii M (2005) Facial and cochlear nerve function after surgery of cerebellopontine angle meningiomas. Neurosurgery 57(1):77–90

    PubMed  Google Scholar 

  72. Nakamura M, Roser F, Jacobs C, Vorkapic P, Samii M (2006) Medial sphenoid wing meningiomas: clinical outcome and recurrence rate. Neurosurgery 58(4):626–639. doi:10.1227/01.NEU.0000197104.78684.5D

    PubMed  Google Scholar 

  73. Nakamura M, Roser F, Mirzai S, Matthies C, Vorkapic P, Samii M (2004) Meningiomas of the internal auditory canal. Neurosurgery 55(1):119–127

    PubMed  Google Scholar 

  74. Nakamura M, Roser F, Struck M, Vorkapic P, Samii M (2006) Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery 59(5):1019–1028. doi:10.1227/01.NEU.0000245600.92322.06

    PubMed  Google Scholar 

  75. Nakamura M, Struck M, Roser F, Vorkapic P, Samii M (2008) Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery 62(6 Suppl 3):1224–1232. doi:10.1227/01.neu.0000333788.83349.1e

    PubMed  Google Scholar 

  76. Nanda A, Vincent DA, Vannemreddy PS, Baskaya MK, Chanda A (2002) Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. J Neurosurg 96(2):302–309. doi:10.3171/jns.2002.96.2.0302

    PubMed  Google Scholar 

  77. Natarajan SK, Sekhar LN, Schessel D, Morita A (2007) Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up. Neurosurgery 60(6):965–979. doi:10.1227/01.NEU.0000255472.52882.D6

    PubMed  Google Scholar 

  78. Neil-Dwyer G, Lang DA, Davis A (2000) Outcome from complex neurosurgery: an evidence based approach. Acta Neurochir (Wien) 142(4):367–371

    CAS  Google Scholar 

  79. Niranjan A, Lunsford LD, Flickinger JC, Maitz A, Kondziolka D (1999) Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45(4):753–762

    PubMed  CAS  Google Scholar 

  80. Nozaki K, Kikuta K, Takagi Y, Mineharu Y, Takahashi JA, Hashimoto N (2008) Effect of early optic canal unroofing on the outcome of visual functions in surgery for meningiomas of the tuberculum sellae and planum sphenoidale. Neurosurgery 62(4):839–844. doi:10.1227/01.neu.0000318169.75095.cb

    PubMed  Google Scholar 

  81. O'Sullivan MG, van Loveren HR, Tew JM Jr (1997) The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 40(2):238–244

    PubMed  Google Scholar 

  82. Obeid F, Al-Mefty O (2003) Recurrence of olfactory groove meningiomas. Neurosurgery 53(3):534–542

    PubMed  Google Scholar 

  83. Oghalai JS, Leung MK, Jackler RK, McDermott MW (2004) Transjugular craniotomy for the management of jugular foramen tumors with intracranial extension. Otol Neurotol 25(4):570–579

    PubMed  Google Scholar 

  84. Pamir MN, Ozduman K, Belirgen M, Kilic T, Ozek MM (2005) Outcome determinants of pterional surgery for tuberculum sellae meningiomas. Acta Neurochir (Wien) 147(11):1121–1130. doi:10.1007/s00701-005-0625-0

    CAS  Google Scholar 

  85. Park CK, Jung HW, Kim JE, Paek SH, Kim DG (2006) The selection of the optimal therapeutic strategy for petroclival meningiomas. Surg Neurol 66(2):160–165. doi:10.1016/j.surneu.2005.12.024

    PubMed  Google Scholar 

  86. Park CK, Jung HW, Yang SY, Seol HJ, Paek SH, Kim DG (2006) Surgically treated tuberculum sellae and diaphragm sellae meningiomas: the importance of short-term visual outcome. Neurosurgery 59(2):238–243. doi:10.1227/01.NEU.0000223341.08402.C5

    PubMed  Google Scholar 

  87. Perry A, Banerjee R, Lohse CM, Kleinschmidt-DeMasters BK, Scheithauer BW (2002) A role for chromosome 9p21 deletions in the malignant progression of meningiomas and the prognosis of anaplastic meningiomas. Brain Pathol 12(2):183–190

    PubMed  CAS  Google Scholar 

  88. Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC (1999) “Malignancy” in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 85(9):2046–2056. doi:10.1002/(SICI)1097-0142(19990501)85:9<2046::AID-CNCR23>3.0.CO;2-M

    PubMed  CAS  Google Scholar 

  89. Perry A, Stafford SL, Scheithauer BW, Suman VJ, Lohse CM (1997) Meningioma grading: an analysis of histologic parameters. Am J Surg Pathol 21(12):1455–1465

    PubMed  CAS  Google Scholar 

  90. Pichierri A, Santoro A, Raco A, Paolini S, Cantore G, Delfini R (2009) Cavernous sinus meningiomas: retrospective analysis and proposal of a treatment algorithm. Neurosurgery 64(6):1090–1099. doi:10.1227/01.NEU.0000346023.52541.0A

    PubMed  Google Scholar 

  91. Pollock BE, Stafford SL, Link MJ (2000) Gamma knife radiosurgery for skull base meningiomas. Neurosurg Clin N Am 11(4):659–666

    PubMed  CAS  Google Scholar 

  92. Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA (2003) Stereotactic radiosurgery provides equivalent tumor control to simpson grade 1 resection for patients with small- to medium-size meningiomas. Int J Radiat Oncol Biol Phys 55(4):1000–1005. doi:10.1016/S0360-3016(02)04356-0

    PubMed  Google Scholar 

  93. Puzzilli F, Ruggeri A, Mastronardi L, Agrillo A, Ferrante L (1999) Anterior clinoidal meningiomas: report of a series of 33 patients operated on through the pterional approach. Neuro Oncol 1(3):188–195

    PubMed  CAS  Google Scholar 

  94. Quinones-Hinojosa A, Chang EF, McDermott MW (2003) Falcotentorial meningiomas: clinical, neuroimaging, and surgical features in six patients. Neurosurg Focus 14(6):e11. doi:10.3171/foc.2003.14.6.11

    PubMed  Google Scholar 

  95. Ramina R, Neto MC, Fernandes YB, Aguiar PH, de Meneses MS, Torres LF (2006) Meningiomas of the jugular foramen. Neurosurg Rev 29(1):55–60. doi:10.1007/s10143-005-0415-4

    PubMed  Google Scholar 

  96. Reijneveld JC, Sitskoorn MM, Klein M, Nuyen J, Taphoorn MJ (2001) Cognitive status and quality of life in patients with suspected versus proven low-grade gliomas. Neurology 56(5):618–623

    PubMed  CAS  Google Scholar 

  97. Roberti F, Sekhar LN, Kalavakonda C, Wright DC (2001) Posterior fossa meningiomas: surgical experience in 161 cases. Surg Neurol 56(1):8–20. doi:10.1016/S0090-3019(01)00479-7

    PubMed  CAS  Google Scholar 

  98. Roser F, Nakamura M, Dormiani M, Matthies C, Vorkapic P, Samii M (2005) Meningiomas of the cerebellopontine angle with extension into the internal auditory canal. J Neurosurg 102(1):17–23. doi:10.3171.jns.2005.102.1.0017

    PubMed  Google Scholar 

  99. Roser F, Nakamura M, Jacobs C, Vorkapic P, Samii M (2005) Sphenoid wing meningiomas with osseous involvement. Surg Neurol 64(1):37–43. doi:10.1016/j.surneu.2004.08.092

    PubMed  Google Scholar 

  100. Russell SM, Benjamin V (2008) Medial sphenoid ridge meningiomas: classification, microsurgical anatomy, operative nuances, and long-term surgical outcome in 35 consecutive patients. Neurosurgery 62(6 Suppl 3):1169–1181. doi:10.1227/01.neu.0000333783.96810.58

    PubMed  Google Scholar 

  101. Sachsenheimer W, Bimmler T (1992) Assessment of quality of survival in patients with surgically treated meningioma. Neurochirurgia (Stuttg) 35(5):133–136

    CAS  Google Scholar 

  102. Sachsenheimer W, Piotrowski W, Bimmler T (1992) Quality of life in patients with intracranial tumors on the basis of Karnofsky's performance status. J Neurooncol 13(2):177–181

    PubMed  CAS  Google Scholar 

  103. Samii M, Carvalho GA, Tatagiba M, Matthies C, Vorkapic P (1996) Meningiomas of the tentorial notch: surgical anatomy and management. J Neurosurg 84(3):375–381. doi:10.3171/jns.1996.84.3.0375

    PubMed  CAS  Google Scholar 

  104. Sanna M, Bacciu A, Falcioni M, Taibah A, Piazza P (2007) Surgical management of jugular foramen meningiomas: a series of 13 cases and review of the literature. Laryngoscope 117(10):1710–1719. doi:10.1097/MLG.0b013e3180cc20a3

    PubMed  Google Scholar 

  105. Schick U, Hassler W (2005) Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry 76(7):977–983. doi:10.1136/jnnp.2004.039974

    PubMed  CAS  Google Scholar 

  106. Seifert V, Raabe A, Zimmermann M (2003) Conservative (labyrinth-preserving) transpetrosal approach to the clivus and petroclival region—indications, complications, results and lessons learned. Acta Neurochir (Wien) 145(8):631–642. doi:10.1007/s00701-003-0086-2

    CAS  Google Scholar 

  107. Sekhar LN, Jannetta PJ, Maroon JC (1984) Tentorial meningiomas: surgical management and results. Neurosurgery 14(3):268–275

    PubMed  CAS  Google Scholar 

  108. Sekhar LN, Wright DC, Richardson R, Monacci W (1996) Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls. J Neurooncol 29(3):249–259

    PubMed  CAS  Google Scholar 

  109. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20(1):22–39

    PubMed  CAS  Google Scholar 

  110. Spektor S, Valarezo J, Fliss DM, Gil Z, Cohen J, Goldman J, Umansky F (2005) Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes. Neurosurgery 57(4 Suppl):268–280. doi:10.1227/01.NEU.0000176409.70668.EB

    PubMed  Google Scholar 

  111. Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, Leavitt JA (2001) Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients. Neurosurgery 49(5):1029–1037

    PubMed  CAS  Google Scholar 

  112. Tobias S, Kim CH, Kosmorsky G, Lee JH (2003) Management of surgical clinoidal meningiomas. Neurosurg Focus 14(6):e5. doi:10.3171/foc.2003.14.6.5

    PubMed  Google Scholar 

  113. Tuniz F, Soltys SG, Choi CY, Chang SD, Gibbs IC, Fischbein NJ, Adler JR Jr (2009) Multisession cyberknife stereotactic radiosurgery of large, benign cranial base tumors: preliminary study. Neurosurgery 65(5):898–907. doi:10.1227/01.NEU.0000359316.34041.A8

    PubMed  Google Scholar 

  114. Voss NF, Vrionis FD, Heilman CB, Robertson JH (2000) Meningiomas of the cerebellopontine angle. Surg Neurol 53(5):439–446. doi:10.1016/S0090-3019(00)00195-6

    PubMed  CAS  Google Scholar 

  115. Walsh MT, Couldwell WT (2009) Management options for cavernous sinus meningiomas. J Neurooncol 92(3):307–316. doi:10.1007/s11060-009-9824-5

    PubMed  Google Scholar 

  116. Welge-Luessen A, Temmel A, Quint C, Moll B, Wolf S, Hummel T (2001) Olfactory function in patients with olfactory groove meningioma. J Neurol Neurosurg Psychiatry 70(2):218–221

    PubMed  CAS  Google Scholar 

  117. Wu ZB, Yu CJ, Guan SS (2005) Posterior petrous meningiomas: 82 cases. J Neurosurg 102(2):284–289. doi:10.3171/jns.2005.102.2.0284

    PubMed  Google Scholar 

  118. Wyrwich KW, Bullinger M, Aaronson N, Hays RD, Patrick DL, Symonds T (2005) Estimating clinically significant differences in quality of life outcomes. Qual Life Res 14(2):285–295

    PubMed  Google Scholar 

  119. Zachenhofer I, Wolfsberger S, Aichholzer M, Bertalanffy A, Roessler K, Kitz K, Knosp E (2006) Gamma-knife radiosurgery for cranial base meningiomas: experience of tumor control, clinical course, and morbidity in a follow-up of more than 8 years. Neurosurgery 58(1):28–36

    PubMed  Google Scholar 

  120. Zevgaridis D, Medele RJ, Muller A, Hischa AC, Steiger HJ (2001) Meningiomas of the sellar region presenting with visual impairment: impact of various prognostic factors on surgical outcome in 62 patients. Acta Neurochir (Wien) 143(5):471–476

    CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

    Chien-Min Chen

  2. Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan

    Abel Po-Hao Huang & Lu-Ting Kuo

  3. Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

    Yong-Kwang Tu

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  1. Chien-Min Chen
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  2. Abel Po-Hao Huang
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  3. Lu-Ting Kuo
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  4. Yong-Kwang Tu
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Correspondence to Abel Po-Hao Huang.

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Michael W. McDermott, San Francisco, USA

The authors have provided a very nice review of the literature since 2000, indicating that challenges remain in the management of the most common primary brain tumor in adults, a meningioma. Not since Cushing first wrote about the significant difficulties these tumors present to the surgeon in 1939 have we been able to provide patients with a definitive surgical cure and acceptable morbidity for our efforts. At our institution, we have published on our own series to document, like the authors here, what the current status of surgical and radiosurgical treatment is (see attached references below; none include in the current paper). Still, many of our efforts are associated with not insignificant morbidity and residual chance for recurrence. Compared to 20 years ago, the neurosurgical community has for the most part accepted that the maximal “safe” resection, followed by observation or adjuvant therapy, provides patients with a better quality of life than attempting complete tumor removal. Soon I suspect that not only the patients, but medical insurers, medical review boards, and government-run health systems will dictate some of the options for treatment for our patients. If we can prove with quality of life follow-up studies and not just freedom from progression or overall survival data that our surgical treatment leaves the patients able to live a nearly normal life postoperatively, then our future surgical endeavors will continue to advance.

References

1. Kane AJ, Sughrue ME, Rutkowski MJ, Shangari G, Fang S, McDermott MW, Berger MS, Parsa AT (2001) Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer 117(6):1272–1278 (Mar 15). doi:10.1002/cncr.25591. Epub 2010 Nov 8. PMID: 21381014 [PubMed—in process]. Related citations

2. Sughrue ME, Rutkowski MJ, Shangari G, Fang S, Parsa AT, Berger MS, McDermott MW (2011) Incidence, risk factors, and outcome of venous infarction after meningioma surgery in 705 patients. J Clin Neurosci 18(5):628–632 (May). Epub 2011 Feb 23. PMID: 21349725 [PubMed—in process]. Related citations

3. Kane AJ, Sughrue ME, Rutkowski MJ, Shangari G, Fang S, McDermott MW, Berger MS, Parsa AT (2010) Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer (Nov 8). [Epub ahead of print]. PMID: 21061397 [PubMed—as supplied by publisher]. Related citations

4. Zlotnick D, Kalkanis SN, Quinones-Hinojosa A, Chung K, Linskey ME, Jensen RL, DeMonte F, Barker FG, Racine CA, Berger MS, Black PM, Cusimano M, Sekhar LN, Parsa A, Aghi M, McDermott MW (2010) FACT-MNG: tumor site specific web-based outcome instrument for meningioma patients. J Neurooncol 99(3):423–431 (Sep). Epub 2010 Sep 18. Review. PMID: 20853019 [PubMed—indexed for MEDLINE] Free PMC Article. Free full text. Related citations

5. Sughrue ME, Rutkowski MJ, Shangari G, Chang HQ, Parsa AT, Berger MS, McDermott MW (2011) Risk factors for the development of serious medical complications after resection of meningiomas. J Neurosurg 114(3):697–704 (Mar). Epub 2010 Jul 23. PMID: 20653395 [PubMed—in process]. Related citations

6. Sughrue ME, Rutkowski MJ, Chang EF, Shangari G, Kane AJ, McDermott MW, Berger MS, Parsa AT (2011) Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? J Neurosurg 114(3):705–709 (Mar). Epub 2010 Jun 25. PMID: 20578801 [PubMed—in process]. Related citations

7. Sughrue ME, Cage T, Shangari G, Parsa AT, McDermott MW (2010) Clinical characteristics and surgical outcomes of patients presenting with meningiomas arising predominantly from the floor of the middle fossa. Neurosurgery 67(1):80–86; discussion 86 (Jul). PMID: 20559094 [PubMed—in process]. Related citations

8. Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT (2010) Factors affecting outcome following treatment of patients with cavernous sinus meningiomas. J Neurosurg 113(5):1087–1092 (Nov). Epub 2010 May 7. PMID: 20450274 [PubMed—indexed for MEDLINE]. Related citations

9. Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT (2010) Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg 113(5):1036–1042 (Nov). Epub 2010 Apr 30. Review. PMID: 20433281 [PubMed—indexed for MEDLINE]. Related citations

10. Sughrue ME, Kane AJ, Shangari G, Parsa AT, Berger MS, McDermott MW (2010) Prevalence of previous extracranial malignancies in a series of 1228 patients presenting with meningioma. J Neurosurg 113(5):1115–1121 (Nov). Epub 2010 Apr 30. PMID: 20433279 [PubMed—indexed for MEDLINE]. Related citations

11. Sughrue ME, Kane AJ, Shangari G, Rutkowski MJ, McDermott MW, Berger MS, Parsa AT (2010) The relevance of Simpson grade I and II resection in modern neurosurgical treatment of World Health Organization grade I meningiomas. J Neurosurg 113(5):1029–1035 (Nov). Epub 2010 Apr 9. PMID: 20380529 [PubMed—indexed for MEDLINE]. Related citations

12. Sughrue ME, Sanai N, Shangari G, Parsa AT, Berger MS, McDermott MW (2010) Outcome and survival following primary and repeat surgery for World Health Organization grade III meningiomas. J Neurosurg 113(2):202–209 (Aug). PMID: 20225922 [PubMed—indexed for MEDLINE]. Related citations

13. Sanai N, McDermott MW (2010) A modified far-lateral approach for large or giant meningiomas of the posterior fossa. J Neurosurg 112(5):907–912 (May). PMID: 19877805 [PubMed—indexed for MEDLINE]. Related citations

14. Quiñones-Hinojosa A, Kaprealian T, Chaichana KL, Sanai N, Parsa AT, Berger MS, McDermott MW (2009) Pre-operative factors affecting resectability of giant intracranial meningiomas. Can J Neurol Sci 36(5):623–630 (Sep). PMID: 19831133 [PubMed—indexed for MEDLINE]. Related citations

15. Sanai N, Sughrue ME, Shangari G, Chung K, Berger MS, McDermott MW (2010) Risk profile associated with convexity meningioma resection in the modern neurosurgical era. J Neurosurg 112(5):913–919 (May). PMID: 19645533 [PubMed—indexed for MEDLINE]. Related citations

16. Cage TA, Lamborn KR, Ware ML, Frankfurt A, Chakalian L, Berger MS, McDermott MW (2009) Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas. J Neurooncol 93(1):151–156 (May). Epub 2009 May 9. PMID: 19430892 [PubMed—indexed for MEDLINE]. Related citations

17. Quiñones-Hinojosa A, Chang EF, Chaichana KL, McDermott MW (2009) Surgical considerations in the management of falcotentorial meningiomas: advantages of the bilateral occipital transtentorial/transfalcine craniotomy for large tumors. Neurosurgery 64(5 Suppl 2):260–268; discussion 268 (May). PMID: 19287325 [PubMed—indexed for MEDLINE]. Related citations

18. Smith JS, Lal A, Harmon-Smith M, Bollen AW, McDermott MW (2007) Association between absence of epidermal growth factor receptor immunoreactivity and poor prognosis in patients with atypical meningioma. J Neurosurg 106(6):1034–1040 (Jun). PMID: 17564176 [PubMed—indexed for MEDLINE]. Related citations

19. Chi JH, Parsa AT, Berger MS, Kunwar S, McDermott MW (2006) Extended bifrontal craniotomy for midline anterior fossa meningiomas: minimization of retraction-related edema and surgical outcomes. Neurosurgery 59(4 Suppl 2):ONS426–ONS433; discussion ONS433–ONS434 (Oct). PMID: 17041513 [PubMed—indexed for MEDLINE]. Related citations

20. Chi JH, McDermott MW (2003) Tuberculum sellae meningiomas. Neurosurg Focus 14(6):e6 (Jun 15). PMID: 15669791 [PubMed—indexed for MEDLINE]. Related citations

21. Quinones-Hinojosa A, Chang EF, McDermott MW (2003) Falcotentorial meningiomas: clinical, neuroimaging, and surgical features in six patients. Neurosurg Focus 14(6):e11 (Jun 15). Review. PMID: 15669786 [PubMed—indexed for MEDLINE]. Related citations

22. McDermott MW (2003) Intraventricular meningiomas. Neurosurg Clin N Am 14(4):559–569 (Oct). Review. PMID: 15024801 [PubMed—indexed for MEDLINE]. Related citations

23. Ware ML, Larson DA, Sneed PK, Wara WW, McDermott MW (2004) Surgical resection and permanent brachytherapy for recurrent atypical and malignant meningioma. Neurosurgery 54(1):55–63; discussion 63–64 (Jan). PMID: 14683541 [PubMed—indexed for MEDLINE]. Related citations

24. Chun JY, McDermott MW, Lamborn KR, Wilson CB, Higashida R, Berger MS (2002) Delayed surgical resection reduces intraoperative blood loss for embolized meningiomas. Neurosurgery 50(6):1231–1235; discussion 1235–1237 (Jun). PMID: 12015840 [PubMed—indexed for MEDLINE]. Related citations

25. Ojemann SG, Sneed PK, Larson DA, Gutin PH, Berger MS, Verhey L, Smith V, Petti P, Wara W, Park E, McDermott MW (2000) Radiosurgery for malignant meningioma: results in 22 patients. J Neurosurg 93(Suppl 3):62–67 (Dec). PMID: 11143265 [PubMed—indexed for MEDLINE]. Related citations

Kenji Ohata, Osaka, Japan

The authors reviewed the contemporary literature regarding the surgical outcome and quality of life after the surgery of skull base meningiomas in different locations. Their endeavor of reviewing 120 articles is worthy of praise and very informative. In the history of the treatment of skull base meningioma, the advancement of skull base surgery in the 1980s greatly contributed to the surgical resectability of the basal meningioma even from the complex area including cavernous sinus and petroclival region, whereas the surgical mortality after the radical resection became the issue of discussion for QOL. In the 1990s, stereotactic radiosurgery provided a resolution of this problem and multimodal treatment is now commonly applied in order to achieve a satisfactory functional outcome and control the tumor. However, I am concerned that the role of stereotactic radiosurgery has been overestimated and the role of radical resection has a tendency of underestimation. As the radiation technology is advanced, the surgical techniques also could be advanced for the cure of this disease. We need the long-term follow-up results over 10 or 20 years in order to obtain the truth of the treatment philosophy. Our recent analysis of this particular tumor in the long-term follow-up periods showed that radical resection could provide a satisfactory outcome with 91.5% recurrence-free survival rate at 20 years [1]. As a result, I advocate that radical resection has the most important role even in the era of multimodal treatment. Additionally, I completely agree with the authors’ comment that the most important factors are the experience, philosophy, and techniques of the surgeon.

References

1. Ichinose T, Goto T, Ishibashi K, Takami T, Ohata K (2010) The role of radical microsurgical resection in multimodal treatment for skull base meningioma. J Neurosurg 113:1072–1078

Madjid Samii, Venelin Miroslav Gerganov, Hannover, Germany

The authors present a comprehensive review of the current management of skull base meningiomas with a special emphasize on the role of surgery. The significance of extent of resection, of tumor grade, and of various proliferative markers as predictors of the outcome and of the risk of recurrence is presented in detail. The surgical outcome in regards to tumor location is discussed, summarizing the results published by recognized expert groups in the last 10 years.

Some areas of future research are suggested in the manuscript. The current grading system of meningiomas is based on histopathological criteria, which do not account for the many individual tumor differences that are of paramount importance for the outcome. We believe that meningiomas, regardless of their histopathological grade, are two types: encapsulated or infiltrating. Encapsulated meningiomas can be removed completely without or with minimal morbidity. Infiltrating meningiomas, which frequently but not always, are microcystic, atypical, or anaplastic, tend to infiltrate the pial covering and even the neural tissue. In such cases, the attempt to remove the tumor completely may have dramatic consequences. The infiltration of the pia is not restricted to the aforementioned tumor categories and does not necessarily indicate malignant tumor: it may occur also in WHO grade I meningiomas. The possibility to predict these relationships of the meningioma to surrounding structures reliably before surgery would be of great value for the selection of appropriate management in each individual patient. In the future, meningioma grading will be certainly refined by inclusion of molecular and genetic criteria.

The goal of surgery in skull base meningiomas, according to the authors, is to “achieve as extensive resection as possible while minimizing neurological morbidity”—a statement that should be generally accepted. Radiosurgery has a certain place in the management of patients with meningiomas that are not amenable to complete removal due to the aforementioned tumor characteristics, due to tumor critical location (e.g., cavernous sinus), or in case the patient’s general condition precludes open surgery.

Chien-Min Chen and Abel Po-Hao Huang contributed equally to this study.

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Chen, CM., Huang, A.PH., Kuo, LT. et al. Contemporary surgical outcome for skull base meningiomas. Neurosurg Rev 34, 281–296 (2011). https://doi.org/10.1007/s10143-011-0321-x

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