BACKGROUND: As the predictive role of many risk factors for parasagittal meningioma (PM) recurrence remains unclear, the objective of the meta-analysis was to make a comprehensive assessment of the predictive value of selected risk factors in these lesions. METHODS: Studies including data on selected risk factors, such as histology, tumor and sinus resection, sinus invasion, tumor localization, and immediate postoperative radiotherapy for PMs recurrence, were searched in the NCBI/NLM PubMed/MEDLINE, EBM Reviews/Cochrane Central, ProQuest, and Scopus databases, and analyzed using random effects modeling. RESULTS: Thirteen observational studies involving 1243 patients met the criteria for inclusion in the meta-analysis. WHO grading of meningiomas was identified as the most powerful risk factor for recurrence. WHO grade II meningiomas (OR 11.61; 95% CI 4.43-30.43; P < .01; I2 = 31%) or composite group of WHO grades II and III (OR 14.84; 95% CI 5.10-43.19; P < .01; I2 = 48%) had a significantly higher risk of recurrence than benign lesions. Moreover, an advanced sinus involvement (types IV-VI according to the Sindou classification) (OR 3.49; 95% CI 1.30-9.33; P = .01; I2 = 0%) and partial tumor resection (Simpson grades III-V) (OR 2.73; 95% CI 1.41-5.30; P = .03; I2 = 52%) were associated with a significantly higher risk of recurrence than their counterparts. CONCLUSION: Among the selected risk factors, high-grade WHO lesions, advanced sinus invasion, and partial tumor resection were associated with a higher risk of PM recurrence, with WHO grading system being the most powerful risk factor.

Department of Neurosurgery Japanese Red Cross Asahikawa Hospital Asahikawa Hokkaido Japan

Department of Neurosurgery Svet Zdravia Hospital Michalovce Michalovce Slovak Republic

Institute of Molecular and Translational Medicine Faculty of Medicine and Dentistry Palacky University Olomouc Hněvotínská 1333 5 1 P Pavlova 6 779 00 Olomouc Czech Republic

Institute of Neurobiology Slovak Academy of Sciences Kosice Slovak Republic

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Biroli A, Chiocchetta M, Gerosa M, Talacchi A (2012) Surgical treatment of parasagittal and falcine meningiomas of the posterior third. Acta Neurochir 154:1987–1995 DOI

Black PM (1993) Meningiomas. Neurosurgery 32:643–657 DOI

Black PM, Morokoff AP, Zauberman J (2008) Surgery for extra-axial tumors of the cerebral convexity and midline. Neurosurgery 62(6 Suppl 3):1115–1123 PubMed

Bonnal J, Brotchi J (1978) Surgery of the superior sagittal sinus in parasagittal meningiomas. J Neurosurg 48:935–945 DOI

Borovich B, Doron Y (1986) Recurrence of intracranial meningiomas: the role played by regional multicentricity. J Neurosurg 64:58–63 DOI

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. 2: clinical and radiological aspects. J Neurosurg 65:168–171 DOI

Caroli E, Orlando ER, Mastronardi L, Ferrante L (2006) Meningiomas infiltrating the superior sagittal sinus: surgical considerations of 328 cases. Neurosurg Rev 29:236–241 DOI

Chan RC, Thompson GB (1984) Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 60:52–60 DOI

Colli BO, Carlotti CG, Assirati JA, Santos MBM, Neder L, Santos AC (2006) Parasagittal meningiomas: follow-up review. Surg Neurol 66(Suppl 3):S20–S28 DOI

Cushing H, Heisenhardt L (1938) Meningiomas: their classification, regional behavior, life history, and surgical end results. Charles C Thomas, Springfield

DiMeco F, Li KW, Casali C, Ciceri E, Giombini S, Filippini G, Broggi G, Solero CL (2004) Meningiomas invading the superior sagittal sinus: surgical experience in 108 cases. Neurosurgery 55:1263–1274 DOI

Giombini S, Solero CL, Lasio G, Morello G (1984) Immediate and late outcome of operations for parasagittal and falx meningiomas. Report of 342 cases. Surg Neurol 21:427–435 DOI

Han MS, Kim YJ, Moon KS, Lee KH, Yang JI, Kang WD, Lim SH, Jang WY, Jung TY, Kim IY, Jung S (2016) Lessons from surgical outcome for intracranial meningioma involving major venous sinus. Medicine (Baltimore) 95(35):e4705 DOI

Hancq S, Baleriaux D, Brotchi J (2003) Surgical treatment of parasagittal meningiomas. Semin Neurosurg 14:203–210 DOI

Harbord RM, Egger M, Sterne JA (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25:3443–3457 DOI

Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions, vol 4. Wiley, Hoboken

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

Kleihues P, Cavenee WK (eds) (2000) World Health Organization classification of tumours: pathology and genetics of tumours of the nervous system. IARC Press, Lyon

Kleihues P, Louis DN, Scheithauer BW et al (2002) The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61:215–229 DOI

Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) (2007) WHO classification of tumours of the central nervous system. IARC, Lyon

Louis DN, Perry A, Reifenberger G et al (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131:803–820 DOI

Mathiesen T, Pettersson-Segerlind J, Kihlström L, Ulfarsson E (2014) Meningiomas engaging major venous sinuses. World Neurosurg 81:116–124 DOI

Mesa JAE, Morillejo EA, Carreño TP, Allut AH, Donate JMN, Roman PM, Jimenez AC, Garcia FP, Gonzalez JM (2018) Risk of recurrence in operated parasagittal meningiomas: a logistic binary regression model. World Neurosurg 110:e112–e118 DOI

Mirian C, Duun-Henriksen AK, Juratli T, Sahm F, Spiegl-Kreinecker S, Peyre M, Biczok A, Tonn JC, Goutagny S, Bertero L, Maier AD, Møller Pedersen M, Law I, Broholm H, Cahill DP, Brastianos P, Poulsgaard L, Fugleholm K, Ziebell M, Munch T, Mathiesen T (2020) Poor prognosis associated with TERT gene alterations in meningioma is independent of the WHO classification: an individual patient data meta-analysis. J Neurol Neurosurg Psychiatry 91:378–387 DOI

Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62:18–24 DOI

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoSMed 6:e1000097

Nowak A, Dziedzic T, Czernicki T, Kunert P, Marchel A (2014) Surgical treatment of parasagittal and falcine meningiomas invading the superior sagittal sinus. Neurol Neurochir Pol 48:174–180 DOI

Nowak A, Marchel A (2007) Surgical treatment of parasagittal and falx meningiomas. Neurol Neurochir Pol 41:306–314 PubMed

Pettersson-Segerlind J, Orrego A, Lönn S, Mathiesen T (2011) Long-term 25-year follow-up of surgically treated parasagittal meningiomas. World Neurosurg 76:564–571 DOI

Raza SM, Gallia GL, Brem H, Weingart JD, Long DM, Olivi A (2010) Perioperative and long-term outcomes from the management of parasagittal meningiomas invading the superior sagittal sinus. Neurosurgery 67:885–893 DOI

Ricci A, Di Vitantonio H, De Paulis D, Del Maestro M, Gallieni M, Dechcordi SR, Marzi S, Galzio RJ (2017) Parasagittal meningiomas: our surgical experience and the reconstruction technique of the superior sagittal sinus. Surg Neurol Int 8:1 PubMed PMC

Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S et al (2017) DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 18:682–694 DOI

Samii M (1997) Radical resection of meningiomas and arteriovenous fistulas involving critical dural sinus segments: experience with intraoperative sinus pressure monitoring and elective sinus reconstruction in 10 patients. Neurosurgery 41:1018 (comment) DOI

Schunemann H, Brozek J, Guyatt G, Oxman A, eds GRADE handbook. Updated October 2013. Available at: https://gdt.gradepro.org/app/handbook/handbook.html . Accessed [June 13, 2019]

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

Sindou MP, Alvernia JE (2006) Results of attempted radical tumor removal and venous repair in 100 consecutive meningiomas involving the major dural sinuses. J Neurosurg 105:514–525 DOI

Sindou M, Auque J (2000) The intracranial venous system as a neurosurgeon’s perspective. Adv Tech Stand Neurosurg 26:131–216 DOI

Slavik H, Balik V, Vrbkova J, Rehulkova A, Vaverka M, Hrabalek L, Ehrmann J, Vidlarova M, Gurska S, Hajduch M, Srovnal J (2020) Identification of meningioma patients at high risk of tumor recurrence using microRNA profiling. Neurosurgery. https://doi.org/10.1093/neuros/nyaa009

Sterne JAC, Higgins JPT, Reeves BC, on behalf of the development group for ACROBAT-NRSI A Cochrane Risk Of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI), Version 1.0.0, 24 September 2014. Available at: http://www.riskofbias.info . Accessed [June 13, 2019]

Sughrue ME, Rutkowski MJ, Shangari G, Parsa AT, Berger MS, McDermott MW (2011) Results with judicious modern neurosurgical management of parasagittal and falcine meningiomas. Clinical article. J Neurosurg 114:731–737 DOI

Tomasello F, Conti A, Cardali S, Angileri FF (2013) Venous preservation-guided resection: a changing paradigm in parasagittal meningioma surgery. J Neurosurg 119:74–81 DOI

Wells GA, Shea B, O’Connell D et al The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Accessed [June 13, 2019]

Zülch KJ (ed) (1979) Histologic typing of tumours of the central nervous system. World Health Organization, Geneva