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

    Final Number:
    1608

    Authors:
    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.

    References:

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