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  • Intraoperative Consistency of Intracranial Meningiomas Influences the Extent of Surgical Resection

    Final Number:

    Joshua W. Lucas MD; Gabriel Zada MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Intracranial meningiomas represent a diverse group of lesions that can occur throughout the intracranial compartment. Previously, a consistency grading scale has been developed to allow for more-standardized reporting of tumor characteristics. This scale, ranging from 1 (extremely soft tumor which is debulked with suction alone) to 5 (extremely firm, calcified tumor in which the capsule does not fold), provides a means by which to compare these heterogeneous tumors. This study aimed to determine the influence of intraoperative meningioma consistency on extent of resection.

    Methods: Fifty-nine patients underwent resection of an intracranial meningioma at a single institution over the course of 4 years. Resections were performed via either a transcranial approach or an endoscopic transsphenoidal approach. Each tumor was given a consistency grade by the primary surgeon based upon the established consistency scoring scale. The extent of resection was classified as either a gross total resection or subtotal resection based upon postoperative magnetic resonance imaging.

    Results: Of 59 patients, 40 (67.8%) had gross total resection whereas 19 (32.2%) had subtotal resection. An independent-samples T-test was conducted to compare the consistency grading within these groups. There was a significant difference between the gross total resection group (mean consistency score 2.85, range 1-4, standard deviation 0.74) when compared to the subtotal resection group (mean consistency score 3.42, range 2-5, standard deviation 0.77) (p=0.008).

    Conclusions: There was a significant difference between the average tumor consistency score in gross total resections when compared to subtotal resections. The inherent consistency of a meningioma is therefore an important factor in determining the extent of resection achieved by surgery.

    Patient Care: These results illustrate that firm tumors are associated with a lower rate of gross total resection. This is important information to relay to patients preoperatively. Also, these results validate a previously-described consistency grading system, which can be used to standardize results from trials in the future.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe intracranial meningioma consistency using a validated, standardized scoring system, 2) Understand how meningioma consistency is related to extent of resection, 3) Describe the importance of communicating with patients regarding tumor consistency and expected extent of resection.


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