Surgical approach for convexity meningiomas: An analysis of the preoperative clinical signs, radiological features and surgical outcomes of these tumors

Hajrullah Ahmeti; Amke Caliebe; Nourane Trigui; Ilay Alati; Christoph Röcken; Olav Jansen; Michael Synowitz; Maximilian H Mehdorn

doi:10.1016/j.clineuro.2023.107914

Surgical approach for convexity meningiomas: An analysis of the preoperative clinical signs, radiological features and surgical outcomes of these tumors

Clin Neurol Neurosurg. 2023 Oct:233:107914. doi: 10.1016/j.clineuro.2023.107914. Epub 2023 Jul 27.

Authors

Hajrullah Ahmeti¹, Amke Caliebe², Nourane Trigui², Ilay Alati³, Christoph Röcken⁴, Olav Jansen⁵, Michael Synowitz³, Maximilian H Mehdorn³

Affiliations

¹ Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany. Electronic address: Hajrullah.Ahmeti@uksh.de.
² Institute of Medical Informatics und Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany.
³ Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
⁴ Department of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
⁵ Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.

PMID: 37531753
DOI: 10.1016/j.clineuro.2023.107914

Abstract

Background: Convexity meningiomas (CM) can be successfully treated with neurosurgery. However, clinical complications due to CM have been reported. Moreover, systematic investigations of CM with respect to all relevant clinical factors are currently lacking.

Methods: We performed a systematic investigation in 210 patients with supratentorial CM considering all relevant clinical and radiological factors, with a follow-up time of 19.5 years.

Results: Among 812 patients with intracranial meningiomas treated in our department (2003-2020), 28.2 % of intracranial meningiomas were located over the supratentorial convexity, and the patients had a median age of 62 years (95 % CI:59-64). The median follow-up was 30.4 months (95 % CI:21.6-37.1). Tumor-related symptoms were observed in 88.1 % of patients. The most common preoperative symptom was headache (28.1 %), followed by seizure (19.5 %). Symptomatic patients had significantly higher tumor volumes than asymptomatic patients (p = 0.0003; 24.5 cm³ and 6.98 cm³, respectively). Complete tumor resection was achieved in 92.9 % of patients. The most common postoperative complication was bleeding (7.1 %) in the approach area. Of all bleedings, only three were intracerebral hemorrhages and did not require surgical intervention. The second most common complication was postoperative seizure (4.7 %). The multiple logistic regression analyses showed that tumor volume (OR:1.007; 95 % CI:1.001-1.013; p = 0.02) and brain infiltration by the tumor (OR:1.961; 95 % CI:1.028-3.741; p = 0.04) had a significant impact on postoperative complications. The postoperative and final KPS scores significantly improved (p < 0.001). The tumor recurrence rate was 6.2 %, with a median time of 38 months. No surgery-related deaths occurred.

Conclusion: A large tumor volume and brain infiltration by the tumor were significant factors for postoperative complications. The clinical conditions significantly improved postoperatively and further during the follow-up period.

Keywords: Convexity meningiomas; Intracranial meningiomas; Long term outcomes; Neurological conditions; Surgery.

MeSH terms

Humans
Meningeal Neoplasms* / complications
Meningeal Neoplasms* / diagnostic imaging
Meningeal Neoplasms* / surgery
Meningioma* / complications
Meningioma* / diagnostic imaging
Meningioma* / surgery
Middle Aged
Neoplasm Recurrence, Local
Postoperative Complications / epidemiology
Retrospective Studies
Seizures / complications
Treatment Outcome