Despite the importance of functional outcome, only a few scoring systems exist to predict neurologic outcome in meningioma surgery. Therefore, our study aims to identify preoperative risk factors and develop the receiver operating characteristics (ROC) models estimating the risk of a new postoperative neurologic deficit and a decrease in Karnofsky performance status (KPS). A multicentric study was conducted in a cohort of 552 consecutive patients with skull base meningiomas who underwent surgical resection from 2014 to 2019. Data were gathered from clinical, surgical, and pathology records as well as radiological diagnostics. The preoperative predictive factors of functional outcome (neurologic deficit, decrease in KPS) were analyzed in univariate and multivariate stepwise selection analyses. Permanent neurologic deficits were present in 73 (13.2%) patients and a postoperative decrease in KPS in 84 (15.2%). Surgery-related mortality was 1.3%. A ROC model was developed to estimate the probability of a new neurologic deficit (area 0.74; SE 0.0284; 95% Wald confidence limits (0.69; 0.80)) based on meningioma location and diameter. Consequently, a ROC model was developed to predict the probability of a postoperative decrease in KPS (area 0.80; SE 0.0289; 95% Wald confidence limits (0.74; 0.85)) based on the patient's age, meningioma location, diameter, presence of hyperostosis, and dural tail. To ensure an evidence-based therapeutic approach, treatment should be founded on known risk factors, scoring systems, and predictive models. We propose ROC models predicting the functional outcome of skull base meningioma resection based on the age of the patient, meningioma size, and location and the presence of hyperostosis and dural tail.

1st Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital U Vojenske nemocnice 1200 16902 Prague Czech Republic

Department of Neurosurgery Ceske Budejovice Hospital Ceske Budejovice Czech Republic

Department of Neurosurgery Liberec Hospital Liberec Czech Republic

Department of Neurosurgery Pilsen University Hospital Pilsen Czech Republic

Department of Neurosurgery University Hospital Olomouc Olomouc Czech Republic

Department of Neurosurgery University Hospital Ostrava Ostrava Czech Republic

Department of Radiology Military University Hospital Prague Czech Republic

Institute of Computer Science The Czech Academy of Sciences Prague Czech Republic

Zobrazit více v PubMed

Ostrom QT, Gittleman H, Liao P, Rouse C, Chen Y, Dowling J, Wolinsky Y, Kruchko C, Barnholtz-Sloan J. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. Neuro-Oncology. 2014;16:iv1–iv63. doi: 10.1093/neuonc/nou223. PubMed DOI PMC

Goldbrunner R, Stavrinou P, Jenkinson MD, Sahm F, Mawrin C, Weber DC, Preusser M, Minniti G, Lund-Johansen M, Lefranc F, Houdart E, Sallabanda K, Le Rhun E, Nieuwenhuizen D, Tabatabai G, Soffietti R, Weller M. EANO guideline on the diagnosis and management of meningiomas. Neuro-Oncol. 2021;23:1821–1834. doi: 10.1093/neuonc/noab150. PubMed DOI PMC

Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S, Okonechnikov K, Koelsche C, Reuss DE, Capper D, Sturm D, Wirsching H-G, Berghoff AS, Baumgarten P, Kratz A, Huang K, Wefers AK, Hovestadt V, Sill M, Ellis HP, Kurian KM, Okuducu AF, Jungk C, Drueschler K, Schick M, Bewerunge-Hudler M, Mawrin C, Seiz-Rosenhagen M, Ketter R, Simon M, Westphal M, Lamszus K, Becker A, Koch A, Schittenhelm J, Rushing EJ, Collins VP, Brehmer S, Chavez L, Platten M, Hänggi D, Unterberg A, Paulus W, Wick W, Pfister SM, Mittelbronn M, Preusser M, Herold-Mende C, Weller M, von Deimling A. DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol. 2017;18:682–694. doi: 10.1016/S1470-2045(17)30155-9. PubMed DOI

Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, Hawkins C, Ng HK, Pfister SM, Reifenberger G, Soffietti R, von Deimling A, Ellison DW. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro-Oncology. 2021;23:1231–1251. doi: 10.1093/neuonc/noab106. PubMed DOI PMC

Jenkins FS, Vasella F, Padevit L, Mutschler V, Akeret K, Velz J, Regli L, Sarnthein J, Neidert MC. Preoperative risk factors associated with new focal neurological deficit and other major adverse events in first-time intracranial meningioma neurosurgery. Acta Neurochir (Wien) 2021;163:2871–2879. doi: 10.1007/s00701-021-04897-x. PubMed DOI PMC

Lee JH. Meningiomas. London, London: Springer; 2009.

Lemée J-M, Corniola MV, Da Broi M, Schaller K, Meling TR. Early postoperative complications in meningioma: predictive factors and impact on outcome. World Neurosurg. 2019;128:e851–e858. doi: 10.1016/j.wneu.2019.05.010. PubMed DOI

Meling TR, Da Broi M, Scheie D, Helseth E. Meningiomas: skull base versus non-skull base. Neurosurg Rev. 2019;42:163–173. doi: 10.1007/s10143-018-0976-7. PubMed DOI

Chen C-M, Huang AP-H, Kuo L-T, Tu Y-K. Contemporary surgical outcome for skull base meningiomas. Neurosurg Rev. 2011;34:281–296. doi: 10.1007/s10143-011-0321-x. PubMed DOI

Meixensberger J, Meister T, Janka M, Haubitz B, Bushe KA, Roosen K. Factors influencing morbidity and mortality after cranial meningioma surgery — a multivariate analysis. In: Fahlbusch R, Bock WJ, Brock M, Buchfelder M, Klinger M, editors. Modern Neurosurgery of Meningiomas and Pituitary Adenomas. Vienna: Springer Vienna; 1996. pp. 99–101. PubMed

Miao Y, Lu X, Qiu Y, Jiang J, Lin Y. A multivariate analysis of prognostic factors for health-related quality of life in patients with surgically managed meningioma. J Clin Neurosci. 2010;17:446–449. doi: 10.1016/j.jocn.2009.07.111. PubMed DOI

Raman SG, Prakash P, Sumit J, Bikram SD, Prasanna K. Clinical outcome and recurrence after meningioma surgery: an experience from a developing country, Nepal. World Neurosurg. 2021;148:e138–e144. doi: 10.1016/j.wneu.2020.12.079. PubMed DOI

Scheitzach J, Schebesch K-M, Brawanski A, Proescholdt MA. Skull base meningiomas: neurological outcome after microsurgical resection. J Neurooncol. 2014;116:381–386. doi: 10.1007/s11060-013-1309-x. PubMed DOI

Splavski B, Hadzic E, Bagic I, Vrtaric V, Splavski B. Simple tumor localization scale for estimating management outcome of intracranial meningioma. World Neurosurg. 2017;104:876–882. doi: 10.1016/j.wneu.2017.05.039. PubMed DOI

Zeng L, Wang L, Ye F, Chen J, Lei T, Chen J. Clinical characteristics of patients with asymptomatic intracranial meningiomas and results of their surgical management. Neurosurg Rev. 2015;38:481–488. doi: 10.1007/s10143-015-0619-1. PubMed DOI

Adachi K, Kawase T, Yoshida K, Yazaki T, Onozuka S. ABC Surgical Risk Scale for skull base meningioma: a new scoring system for predicting the extent of tumor removal and neurological outcome: Clinical article. JNS. 2009;111:1053–1061. doi: 10.3171/2007.11.17446. PubMed DOI

Bartek J, Sjåvik K, Förander P, Solheim O, Gulati S, Weber C, Ingebrigtsen T, Jakola AS. Predictors of severe complications in intracranial meningioma surgery: a population-based multicenter study. World Neurosurg. 2015;83:673–678. doi: 10.1016/j.wneu.2015.01.022. PubMed DOI

Ferroli P, Broggi M, Schiavolin S, Acerbi F, Bettamio V, Caldiroli D, Cusin A, La Corte E, Leonardi M, Raggi A, Schiariti M, Visintini S, Franzini A, Broggi G. Predicting functional impairment in brain tumor surgery: the Big Five and the Milan Complexity Scale. FOC. 2015;39:E14. doi: 10.3171/2015.9.FOCUS15339. PubMed DOI

Levine ZT, Buchanan RI, Sekhar LN, Rosen CL, Wright DC. Proposed grading system to predict the extent of resection and outcomes for cranial base meningiomas. Neurosurgery. 1999;45:221–229. doi: 10.1097/00006123-199908000-00003. PubMed DOI

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet. 1974;304:81–84. doi: 10.1016/S0140-6736(74)91639-0. PubMed DOI

Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH (1948) The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1:634–656. 10.1002/1097-0142(194811)1:4<634::AID-CNCR2820010410>3.0.CO;2-L

Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol, Neurosurg Psychiatry. 1957;20:22–39. doi: 10.1136/jnnp.20.1.22. PubMed DOI PMC

Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P. The 2007 WHO Classification of Tumours of the Central Nervous System. Acta Neuropathol. 2007;114:97–109. doi: 10.1007/s00401-007-0243-4. PubMed DOI PMC

Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131:803–820. doi: 10.1007/s00401-016-1545-1. PubMed DOI

Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1:480–484. doi: 10.1016/s0140-6736(75)92830-5. PubMed DOI

Landriel Ibañez FA, Hem S, Ajler P, Vecchi E, Ciraolo C, Baccanelli M, Tramontano R, Knezevich F, Carrizo A. A new classification of complications in neurosurgery. World Neurosurg. 2011;75:709–715. doi: 10.1016/j.wneu.2010.11.010. PubMed DOI

Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28:14–20. doi: 10.3171/jns.1968.28.1.0014. PubMed DOI

Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65:476–483. doi: 10.3171/jns.1986.65.4.0476. PubMed DOI

Zamanipoor Najafabadi AH, Genders SW, van Furth WR. Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosis. Acta Neurochir. 2021;163:73–82. doi: 10.1007/s00701-020-04554-9. PubMed DOI PMC

Champeaux-Depond C, Weller J, Froelich S, Resche-Rigon M. A nationwide population-based study on overall survival after meningioma surgery. Cancer Epidemiol. 2021;70:101875. doi: 10.1016/j.canep.2020.101875. PubMed DOI

Magill ST, Dalle Ore CL, Diaz MA, Jalili DD, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW. Surgical outcomes after reoperation for recurrent non–skull base meningiomas. J Neurosurg. 2019;131:1179–1187. doi: 10.3171/2018.6.JNS18118. PubMed DOI

Magill ST, Lee DS, Yen AJ, Lucas C-HG, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW. Surgical outcomes after reoperation for recurrent skull base meningiomas. J Neurosurg. 2019;130:876–883. doi: 10.3171/2017.11.JNS172278. PubMed DOI

Risk factors associated with higher WHO grade in meningiomas: a multicentric study of 552 skull base meningiomas