Recurrence of Intracranial Meningioma after Surgery:
Analysis of Influencing Factors and Outcome
Pakpume Bumrungrachpukdee MD*, Nannapat Pruphetkaew MSc**,
Manlika Phukaoloun MD***, Nakornchai Pheunpathom MD****
Affiliation :
* Department of Surgery, Faculty of Medicine, Burapa University, Chonburi, Thailand
** Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
*** Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
**** Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Objective : To analyze the recurrent rate, timing, and influential factors of recurrence, including clinical outcome in patients
with intracranial meningioma who underwent surgery.
Material and Method: The medical records of surgically treated intracranial meningioma patients with histological
confirmation were reviewed. The diagnosis of recurrence was based on clinical condition and imaging study during
follow-up. The recurrent rate, timing of recurrence, factors that influence the recurrence and clinical outcome were analyzed.
Clinical outcome was measured by the Glasgow outcome scale.
Results : One hundred eighty one patients were recruited. Mean tumor diameter was 4.9 cm (1.2-9 cm). Mean follow-up
was 32.3 months. Median recurrent time was 21.6 months and overall recurrent rate was 21.5% with 5-year recurrence-free
survival rate of 65%. Factors associated with tumor recurrence were headache at presentation (p = 0.002), Simpson
grade III (p = 0.012), Simpson grade IV (p<0.001), Simpson grade V (p = 0.004), WHO grade II (p = 0.004) and WHO
grade III (p<0.001). Mortality rate in recurrent group was 12.8% compared with 3.5% in non-recurrent group (p = 0.039).
The favorable outcome was higher in non-recurrent group 91.5% compared with 76.9% in recurrent group(p = 0.02483).
Conclusion : The risk factors of recurrence were headache at presentation, extent of resection, and histological grading.
The extent of resection identified by Simpson grading effect the recurrent rate as stated previously in the literature. The
higher histological grade was associated with higher recurrent rate. The wide range of timing of tumor recurrence needs
both clinical evaluation and imaging study in short- and long-term follow-up especially in high-risk group. Recurrent
meningioma increased rate of morbidity and mortality.
Keywords : Meningioma, Recurrence, Surgery
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