Meningiomas (Grade II and III): Retrospective study in Basrah View PDF

Hassan Ali Abduljabbar Alawd
Department Of Neurosurgery, Al-Mauany Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq
^*Baqer Hadi Jasim Al-Mohammed
Department Of Neurosurgery, Al-Mauany Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq

^*Corresponding Author:

Baqer Hadi Jasim Al-Mohammed
Department Of Neurosurgery, Al-Mauany Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq

Published on: 2024-11-11

Abstract

Background: Non benign meningiomas include atypical type (WHO grade II tumor) and anaplastic type (WHO grade III tumor). Usually, gross total resection (GTR) at the time of diagnosis is considered as the line of management, but subsequent prognosis and optimal management remain unclear. The study aimed to determine the characterized meningiomas features in Department of Neurosurgery, Al-Mauany Teaching Hospital, and Al-Basrah Teaching Hospital.

Methods: A retrospective study of patients with malignant meningioma in Neurosurgery Department from May 2019 to June 2024. This study included 51 newly diagnosed patients with malignant meningioma (30 females and 21 males, with the median age 49 years). We reviewed all histopathological reports of the patients. Data was collected from our patient’s archiving system. We evaluate in this work the correlation between the above prognostic factors and recurrence rate. As regards the extent of tumor resection, we include in this study all patients with total tumor resection which are collected from operative data or postoperative Magnetic Reso nance Imaging (MRI). Postoperative follow up patient’s data was collected from computerized data system in outpatient clinics. The extent of surgical tumor resection was obtained by using the Simpson grading scale and depend on the operative note and post-operative radiology films.

Results: All patients data used in this study as age, gender, site of tumor, postoperative radiotherapy and extent of surgical tumor resection. This study included 51 newly diagnosed patients with meningioma (30 females and 21 males, the median age 49 years); 70% of them were in convexity, 100% of cases underwent total surgical resection and postoperative radiotherapy. Recurrence occurred in 22% of cases. Prognostic factors such as age, gender and tumor location and tumor types. As regard meningioma type, anaplastic type had significantly higher recurrence rate compared to patients with atypical meningioma. Yet, no other significant could be detected including demographic data such as age, gender, tumor location.

Conclusion: Patients with an anaplastic meningioma may develop a recurrent tumor than an atypical type. The anaplastic meningioma was a significant risk factor for shorter overall survival and for shorter disease-free survival. Radical surgical excision of the tumor or administration of adjuvant radiotherapy following initial incomplete surgical resection appears crucial for long-term treatment.

Keywords

Anaplastic, Atypical meningioma, Gross total resection, Neurosurgery operations, Adjuvant radiotherapy

Introduction

In 1922, Harvey Cushing described the term meningioma first as meningeal arising tumors in the spinal cord and brain, and he found these tumors arise from the arachnoid cap cells [1, 2]. Meningiomas considered as the most existing primary intracranial extra axial tumors with an incidence of 2.3-8.3/100,000 [3, 4]. Usually, meningiomas are benign in nature and slowly growing tumor, but there are malignant types as atypical (15%-20%) and anaplastic (1%-3%) varieties. The recurrence rate of meningiomas is low but it has bad clinical prognosis and higher mortality [4-6]. Sex, age, extent of tumor resection, location of tumor and prior radiation are risk factors for malignant meningioma. T he incident happened around the 6th and 7th decades of life, but the malignant types exist in younger patients. Benign meningioma’s are most common in women whereas the malignant meningioma occurs almost in men [7].

In relation to the site, non-benign meningioma’s usually occurs in cerebral convexities more than at the skull base. On the other hand, when these meningioma’s types exist at the skull base, they characterize with lower recurrence rates and good prognosis than similar tumors exist in cerebral convexities [5, 8].

Meningioma’s have a WHO grading system based on many items such as histopathology, tendency for recurrence and aggressiveness of the tumor and according to the above items meningioma’s classifies into grade I (benign), grade II (atypical) and grade III (anaplastic) [5]. Surgical tumor excision is the primary treatment for high grade meningioma. Small sized, asymptomatic meningioma’s with benign features may be monitored or treated with stereotactic radiotherapy. Generally, GTR considered Simpson grades I-III, while subtotal tumor resection considered as Simpson grades IV-V [6, 9]. Recently, a sixth grade category (Grade 0) was added when complete tumor resection with 2-3 cm more from the site of tumor insertion, with good outcome [10].

Radiotherapy is considered as an effective line of management for meningioma’s. Literature based evidence concise that, adjuvant radiotherapy is usually an important and recommended line of management of incomplete resected grade II meningioma’s and for grade III meningioma’s regardless of the extent of tumor resection [11-13].