Surgical outcomes after reoperation for recurrent skull base meningiomas.
OBJECTIVE
Skull base meningiomas are surgically challenging tumors due to the intricate skull base anatomy and the proximity of cranial nerves and critical cerebral vasculature. Many studies have reported outcomes after primary resection of skull base meningiomas; however, little is known about outcomes after reoperation for recurrent skull base meningiomas. Since reoperation is one treatment option for patients with recurrent meningioma, the authors sought to define the risk profile for reoperation of skull base meningiomas.


METHODS
A retrospective review of 2120 patients who underwent resection of meningiomas between 1985 and 2016 was conducted. Clinical information was extracted from the medical records, radiology data, and pathology data. All records of patients with recurrent skull base meningiomas were reviewed. Demographic data, presenting symptoms, surgical management, outcomes, and complications data were collected. Kaplan-Meier analysis was used to evaluate survival after reoperation. Logistic regression was used to evaluate for risk factors associated with complications.


RESULTS
Seventy-eight patients underwent 100 reoperations for recurrent skull base meningiomas. Seventeen patients had 2 reoperations, 3 had 3 reoperations, and 2 had 4 or more reoperations. The median age at diagnosis was 52 years, and 64% of patients were female. The median follow-up was 8.5 years. Presenting symptoms included cranial neuropathy, headache, seizure, proptosis, and weakness. The median time from initial resection to first reoperation was 4.4 years and 4.1 years from first to second reoperation. Seventy-two percent of tumors were WHO grade I, 22% were WHO grade II, and 6% were WHO grade III. The sphenoid wing was the most common location (31%), followed by cerebellopontine angle (14%), cavernous sinus (13%), olfactory groove (12%), tuberculum sellae (12%), and middle fossa floor (5%). Forty-four (54%) tumors were ≥ 3 cm in maximum diameter at the time of the first reoperation. In 100 reoperations, 60 complications occurred in 30 cases. Twenty of the 60 complications required surgical intervention (33%). Complications included hydrocephalus (12), CSF leak/pseudomeningocele (11), wound infection (9), postoperative hematoma (4), venous infarction (1), and pneumocephalus (1). Postoperative neurological deficits included new or worsened cranial nerve deficits (10) and hemiparesis (3). There were no perioperative deaths in this series. On multivariate analysis, posterior fossa location was significantly associated with complications (OR 3.45, p = 0.0472). The 1-, 2-, 5-, and 10-year overall survival rates according to Kaplan-Meier analysis after the first reoperation were 94%, 92%, 88%, and 76%, respectively. The median survival after the first reoperation was 17 years.


CONCLUSIONS
Recurrent skull base meningiomas are surgically challenging tumors, and reoperation is associated with high morbidity and complication rates. Despite these cautionary data, repeat resection of recurrent skull base meningiomas in appropriately selected patients provides excellent long-term survival.
['Magill|Stephen T|ST|', 'Lee|David S|DS|', 'Yen|Adam J|AJ|', 'Lucas|Calixto-Hope G|CG|', 'Raleigh|David R|DR|', 'Aghi|Manish K|MK|', 'Theodosopoulos|Philip V|PV|', 'McDermott|Michael W|MW|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D008579:Meningioma D008875:Middle Aged D009364:Neoplasm Recurrence, Local D019635:Neurosurgical Procedures D011183:Postoperative Complications D012086:Reoperation D012189:Retrospective Studies D018570:Risk Assessment D019292:Skull Base Neoplasms D016019:Survival Analysis D016896:Treatment Outcome D055815:Young Adult
reoperation recurrence skull base meningioma complications risk factor EBRT = external-beam radiotherapy EMR = electronic medical record repeat operation surgery