BACKGROUND: The optimal management of patients with incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma patients. METHODS: Using data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups. RESULTS: In the unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (P < .001; OR 56.860 [95% CI 26.253-123.150]). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (P = .764; OR 0.890 [95% CI 0.416-1.904]). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (P < .001; OR 94.461 [95% CI 23.082-386.568]). In matched cohorts, new neurological deficits were noted in 2.3% of SRS-treated and 3.2% of conservatively managed patients (P = .475; OR 0.700 [95% CI 0.263-1.863]). CONCLUSIONS: SRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated.

Department of Neurological Surgery University of Virginia Charlottesville Virginia USA

Department of Neurosurgery 2D1 02 Mackenzie Health Sciences Centre University of Alberta Edmonton Alberta Canada

Department of Neurosurgery Ain Shams University Cairo Egypt

Department of Neurosurgery and Radiation Oncology New York University New York NY USA

Department of Neurosurgery and Radiotherapy Nehru Hospital Sector 12 Postgraduate Institute of Medical Education and Research Chandigarh Punjab India

Department of Neurosurgery Benha University Benha Egypt

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery National Yang Ming University Beitou District Taipei City Taiwan

Department of Neurosurgery New York University Cary North Carolina USA

Department of Neurosurgery School of Medicine Neurological Institute Taipei Veteran General Hospital Taipei City Taiwan

Department of Neurosurgery The Walton Centre NHS Foundation Trust Liverpool UK

Department of Neurosurgery University of Miami Miller School of Medicine Miami Florida USA

Department of Neurosurgery University of Pittsburgh Pittsburgh Pennsylvania USA

Department of Radiation and Stereotactic Neurosurgery Na Homolce Hospital Prague Czech Republic

Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt

Department of Radiology Dominican Gamma Knife Center and CEDIMAT Santo Domingo Dominican Republic

Department of Radiosurgery Rúber International Hospital Madrid Spain

Division of Neurosurgery Centre Hospitalier Université de Sherbrooke Sherbrooke Quebec Canada

Gamma Knife Center Cairo Nasser Institute Cairo Egypt

Institute of Systems Molecular and Integrative Biology University of Liverpool Liverpool UK

Neuro Oncol. 2022 Jan 5;24(1):125-126. doi: 10.1093/neuonc/noab222. PubMed

Zobrazit více v PubMed

Bondy M, Lee Ligon B. Epidemiology and etiology of intracranial meningiomas: a review. J Neurooncol. 1996; 29(3):197–205. PubMed

Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet. 2004; 363(9420):1535–1543. PubMed

Hashiba T, Moto NH, Izumoto S, et al. . Serial volumetric assessment of the natural history and growth pattern of incidentally discovered meningiomas: clinical article. J Neurosurg. 2009; 110(4):675–684. PubMed

Kuratsu JI, Kochi M, Ushio Y. Incidence and clinical features of asymptomatic meningiomas. J Neurosurg. 2000; 92(5):766–770. PubMed

Oya S, Kim SH, Sade B, Lee JH. The natural history of intracranial meningiomas: clinical article. J Neurosurg. 2011; 114(5):1250–1256. PubMed

Sughrue ME, Rutkowski MJ, Aranda D, et al. . Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg. 2010; 113(5):1036–1042. PubMed

Jo KW, Kim CH, Kong DS, et al. . Treatment modalities and outcomes for asymptomatic meningiomas. Acta Neurochir (Wien). 2011; 153(1):62–67. PubMed

Nakamura M, Roser F, Michel J, et al. . The natural history of incidental meningiomas. Neurosurgery. 2003; 53(1):62–71. PubMed

Yano S, Kuratsu JI. Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg. 2006; 105(4):538–543. PubMed

Behbahani M, Skeie GO, Eide GE, et al. . A prospective study of the natural history of incidental meningioma – hold your horses! Neurooncol Pract. 2019; 6(6):438–450. PubMed PMC

Islim AI, Mohan M, Moon RDC, et al. . Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes. J Neurooncol. 2019; 142(2):211–221. PubMed PMC

Agarwal V, McCutcheon BA, Hughes JD, et al. . Trends in management of intracranial meningiomas: analysis of 49,921 cases from modern cohort. World Neurosurg. 2017; 106:145–151. PubMed

Yoneoka Y, Fujii Y, Tanaka R. Growth of incidental meningiomas. Acta Neurochir (Wien). 2000; 142(5):507–511. PubMed

Jadid KD, Feychting M, Höijer J, et al. . Long-term follow-up of incidentally discovered meningiomas. Acta Neurochir (Wien). 2015; 157(2):225–230. PubMed

Kim KH, Kang SJ, Choi JW, et al. . Clinical and radiological outcomes of proactive Gamma Knife surgery for asymptomatic meningiomas compared with the natural course without intervention. J Neurosurg. 2018. doi:10.3171/2017.12.JNS171943 PubMed DOI

Amelot A, van Effenterre R, Kalamarides M, Cornu P, Boch AL. Natural history of cavernous sinus meningiomas. J Neurosurg. 2018. doi:10.3171/2017.7.JNS17662 PubMed DOI

Romani R, Ryan G, Benner C, Pollock J. Non-operative meningiomas: long-term follow-up of 136 patients. Acta Neurochir (Wien). 2018; 160(8):1547–1553. PubMed

Bunevicius A, Deltuva VP, Tamasauskas A. Association of pre-operative depressive and anxiety symptoms with five-year survival of glioma and meningioma patients: a prospective cohort study. Oncotarget. 2017; 8(34):57543–57551. PubMed PMC

Nassiri F, Price B, Shehab A, et al. . Life after surgical resection of a meningioma: a prospective cross-sectional study evaluating health-related quality of life. Neuro Oncol. 2019; 21(Suppl 1):i32–i43. PubMed PMC

Näslund O, Skoglund T, Farahmand D, Bontell TO, Jakola AS. Indications and outcome in surgically treated asymptomatic meningiomas: a single-center case-control study. Acta Neurochir (Wien). 2020; 162(9):2155–2163. PubMed PMC

Salvetti DJ, Nagaraja TG, Levy C, Xu Z, Sheehan J. Gamma Knife surgery for the treatment of patients with asymptomatic meningiomas. J Neurosurg. 2013; 119(2):487–493. PubMed

Sheehan JP, Starke RM, Kano H, et al. . Gamma Knife radiosurgery for sellar and parasellar meningiomas: a multicenter study: clinical article. J Neurosurg. 2014; 120(6):1268–1277. PubMed

Islim AI, Kolamunnage-Dona R, Mohan M, et al. . A prognostic model to personalize monitoring regimes for patients with incidental asymptomatic meningiomas. Neuro Oncol. 2020; 22(2):278–289. PubMed PMC

Huang RY, Bi WL, Weller M, et al. . Proposed response assessment and endpoints for meningioma clinical trials: report from the Response Assessment in Neuro-Oncology Working Group. Neuro Oncol. 2019; 21(1):26–36. PubMed PMC

Wolf A, Naylor K, Tam M, et al. . Risk of radiation-associated intracranial malignancy after stereotactic radiosurgery: a retrospective, multicentre, cohort study. Lancet Oncol. 2019; 20(1):159–164. PubMed

Kondziolka D, Mathieu D, Lunsford LD, et al. . Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery. 2008; 62(1):53–58. PubMed

Reinert M, Babey M, Curschmann J, et al. . Morbidity in 201 patients with small sized meningioma treated by microsurgery. Acta Neurochir (Wien). 2006; 148(12):1257–1266. PubMed

Kolakshyapati M, Ikawa F, Abiko M, et al. . Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma. Neurosurg Focus. 2018; 44(4):E14. PubMed

Lee EJ, Kim JH, Park ES, et al. . A novel weighted scoring system for estimating the risk of rapid growth in untreated intracranial meningiomas. J Neurosurg. 2017; 127(5):971–980. PubMed

A retrospective comparison of active surveillance to stereotactic radiosurgery for the management of elderly patients with an incidental meningioma

Comparison of Active Surveillance to Stereotactic Radiosurgery for the Management of Patients with an Incidental Frontobasal Meningioma-A Sub-Analysis of the IMPASSE Study