Presenting Author:

Daniel Oyon, B.S.

Principal Investigator:

Orin Bloch, M.D.

Department:

Neurological Surgery

Keywords:

Meningioma, skull base, surgery, microsurgery, stereotactic radiosurgery, gamma knife, LINAC, cyberknife, adjuvant

Location:

Ryan Family Atrium, Robert H. Lurie Medical Research Center

C51 - Clinical

Surgical vs. combined approach for skull base meningioma: a meta-analysis

Background: Management of benign skull base meningiomas is challenging due to their location and proximity to critical neurologic structures. One goal in the management of such tumors is surgical decompression. However, while extent of resection is an important prognostic factor, gross total resection (GTR) is often not possible without causing significant morbidity. Objective: This study aims to determine whether a combined treatment approach for benign skull base meningiomas consisting of planned subtotal resection (STR) followed by stereotactic radiosurgery (SRS) yields comparable tumor control, while decreasing neurological morbidity, when compared to treatment with GTR alone. Methods: A systematic literature search was conducted regarding treatment of benign skull base meningiomas across three databases (PubMed, EMBASE, Cochrane). Studies from 1999-2015 with a minimum of 20 patients treated for benign skull base meningiomas with microsurgery, SRS, or both were included, for a total of 167 studies. Separate meta-analyses were conducted to calculate the pooled rates of tumor recurrence and cranial neuropathy after 1) GTR alone, 2) STR plus adjuvant postoperative SRS, 3) STR alone, and 4) SRS alone. Results are expressed as pooled proportions, and a random-effects model meta-analysis was used to control for study heterogeneity. Results: A total of 13,183 patients were included in the analysis, with a nearly 3:1 female predominance and a mean age of 53.3 years. Mean follow-up was 57.1 months. Pooled rates of tumor recurrence were 10% (CI 8–12) for GTR alone and 9% (CI 7–11) for STR+SRS, while pooled rates of neurological complications were 19% (CI 16–23) for GTR alone and 8% (CI 6–10) for STR+SRS. For the STR only and SRS only groups, the pooled tumor recurrence rates were 44% (95%CI: 36% – 54%) and 5% (95%CI: 4% – 6%), and the pooled rates of neurological complications were 37% (95%CI: 28% – 48%) and 6% (95%CI: 4% – 9%), respectively. Conclusion: Treatment of benign skull base meningiomas with planned STR followed by adjuvant postoperative SRS yields similar tumor control rates, but with significantly fewer neurological complications, as treatment with GTR alone. These results provide evidence for using a combined approach as a primary treatment for such tumors.