Pre-operative factors affecting resectability of giant intracranial meningiomas

Alfredo Quiñones-Hinojosa, Tania Kaprealian, Kaisorn L. Chaichana, Nader Sanai, Andrew T. Parsa, Mitchel S. Berger, Michael W. McDermott

Research output: Contribution to journalArticle

Abstract

Objective: Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas ≥5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability. Methods: Sixty-seven patients undergoing surgery for a large intracranial meningioma (≥5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis. Results: Thirty-nine (58%) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58%) patients, remained unchanged in 20 (30%), and were aggravated in 8 (12%). In the multivariate model for all large meningiomas, age>45 years [OR(95%CI);0.127 (0.026-0.616),p=0.01] and superior sagittal sinus involvement [OR(95%CI);0.160 (0.026-0.976),p=0.05] were negative predictors of GTR, while preoperative embolization [OR(95%CI);8.087(1.719-38. 044),p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95%CI);0.077 (0.010-0.571),p=0.01] and preoperative embolization [OR(95%CI);10.492(1.961-56. 135),p=0.006] were independently associated with GTR. Conclusions: This study evaluated a subset of large intracranial meningiomas ≥5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.

Original languageEnglish (US)
Pages (from-to)623-630
Number of pages8
JournalCanadian Journal of Neurological Sciences
Volume36
Issue number5
StatePublished - Sep 1 2009

Fingerprint

Meningioma
Superior Sagittal Sinus
San Francisco
Mortality
Regression Analysis
Morbidity
Recurrence
Neoplasms

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Quiñones-Hinojosa, A., Kaprealian, T., Chaichana, K. L., Sanai, N., Parsa, A. T., Berger, M. S., & McDermott, M. W. (2009). Pre-operative factors affecting resectability of giant intracranial meningiomas. Canadian Journal of Neurological Sciences, 36(5), 623-630.

Pre-operative factors affecting resectability of giant intracranial meningiomas. / Quiñones-Hinojosa, Alfredo; Kaprealian, Tania; Chaichana, Kaisorn L.; Sanai, Nader; Parsa, Andrew T.; Berger, Mitchel S.; McDermott, Michael W.

In: Canadian Journal of Neurological Sciences, Vol. 36, No. 5, 01.09.2009, p. 623-630.

Research output: Contribution to journalArticle

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', Canadian Journal of Neurological Sciences, vol. 36, no. 5, pp. 623-630.
Quiñones-Hinojosa A, Kaprealian T, Chaichana KL, Sanai N, Parsa AT, Berger MS et al. Pre-operative factors affecting resectability of giant intracranial meningiomas. Canadian Journal of Neurological Sciences. 2009 Sep 1;36(5):623-630.
Quiñones-Hinojosa, Alfredo ; Kaprealian, Tania ; Chaichana, Kaisorn L. ; Sanai, Nader ; Parsa, Andrew T. ; Berger, Mitchel S. ; McDermott, Michael W. / Pre-operative factors affecting resectability of giant intracranial meningiomas. In: Canadian Journal of Neurological Sciences. 2009 ; Vol. 36, No. 5. pp. 623-630.
@article{d1a40784a8644140aa08bc48feecff91,
title = "Pre-operative factors affecting resectability of giant intracranial meningiomas",
abstract = "Objective: Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas ≥5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability. Methods: Sixty-seven patients undergoing surgery for a large intracranial meningioma (≥5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis. Results: Thirty-nine (58{\%}) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58{\%}) patients, remained unchanged in 20 (30{\%}), and were aggravated in 8 (12{\%}). In the multivariate model for all large meningiomas, age>45 years [OR(95{\%}CI);0.127 (0.026-0.616),p=0.01] and superior sagittal sinus involvement [OR(95{\%}CI);0.160 (0.026-0.976),p=0.05] were negative predictors of GTR, while preoperative embolization [OR(95{\%}CI);8.087(1.719-38. 044),p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95{\%}CI);0.077 (0.010-0.571),p=0.01] and preoperative embolization [OR(95{\%}CI);10.492(1.961-56. 135),p=0.006] were independently associated with GTR. Conclusions: This study evaluated a subset of large intracranial meningiomas ≥5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.",
author = "Alfredo Qui{\~n}ones-Hinojosa and Tania Kaprealian and Chaichana, {Kaisorn L.} and Nader Sanai and Parsa, {Andrew T.} and Berger, {Mitchel S.} and McDermott, {Michael W.}",
year = "2009",
month = "9",
day = "1",
language = "English (US)",
volume = "36",
pages = "623--630",
journal = "Canadian Journal of Neurological Sciences",
issn = "0317-1671",
publisher = "Canadian Journal of Neurological Sciences",
number = "5",

}

TY - JOUR

T1 - Pre-operative factors affecting resectability of giant intracranial meningiomas

AU - Quiñones-Hinojosa, Alfredo

AU - Kaprealian, Tania

AU - Chaichana, Kaisorn L.

AU - Sanai, Nader

AU - Parsa, Andrew T.

AU - Berger, Mitchel S.

AU - McDermott, Michael W.

PY - 2009/9/1

Y1 - 2009/9/1

N2 - Objective: Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas ≥5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability. Methods: Sixty-seven patients undergoing surgery for a large intracranial meningioma (≥5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis. Results: Thirty-nine (58%) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58%) patients, remained unchanged in 20 (30%), and were aggravated in 8 (12%). In the multivariate model for all large meningiomas, age>45 years [OR(95%CI);0.127 (0.026-0.616),p=0.01] and superior sagittal sinus involvement [OR(95%CI);0.160 (0.026-0.976),p=0.05] were negative predictors of GTR, while preoperative embolization [OR(95%CI);8.087(1.719-38. 044),p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95%CI);0.077 (0.010-0.571),p=0.01] and preoperative embolization [OR(95%CI);10.492(1.961-56. 135),p=0.006] were independently associated with GTR. Conclusions: This study evaluated a subset of large intracranial meningiomas ≥5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.

AB - Objective: Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas ≥5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability. Methods: Sixty-seven patients undergoing surgery for a large intracranial meningioma (≥5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis. Results: Thirty-nine (58%) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58%) patients, remained unchanged in 20 (30%), and were aggravated in 8 (12%). In the multivariate model for all large meningiomas, age>45 years [OR(95%CI);0.127 (0.026-0.616),p=0.01] and superior sagittal sinus involvement [OR(95%CI);0.160 (0.026-0.976),p=0.05] were negative predictors of GTR, while preoperative embolization [OR(95%CI);8.087(1.719-38. 044),p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95%CI);0.077 (0.010-0.571),p=0.01] and preoperative embolization [OR(95%CI);10.492(1.961-56. 135),p=0.006] were independently associated with GTR. Conclusions: This study evaluated a subset of large intracranial meningiomas ≥5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.

UR - http://www.scopus.com/inward/record.url?scp=69549135465&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=69549135465&partnerID=8YFLogxK

M3 - Article

VL - 36

SP - 623

EP - 630

JO - Canadian Journal of Neurological Sciences

JF - Canadian Journal of Neurological Sciences

SN - 0317-1671

IS - 5

ER -