Introduction: Resection of supratentorial meningiomas is generally considered a low risk procedure but tumors involving the rolandic cortex present a unique challenge. We sought to report the rates and predictors associated with postoperative motor deficit to support patient counseling and surgical decision making.
Methods: We screened all patients in our institution’s pathological meningioma database from 2000 to 2017 and identified a total of 89 patients with neuroradiological evidence of RC involvement and available medical records. Parameters screened as potential predictors included patient age, gender, pre-op motor severity, tumor location, tumor origin (falx vs. convexity), histological grade, FLAIR signal (T2 MRI), venous involvement (T1 MRI with contrast), intratumor hemorrhage, embolization, and degree of resection (Simpson grade). Outcome variables included preoperative weakness and poor motor outcome (novel or worsened permanent deficit). We utilized SPSS univariate and bivariate analysis functions and determined statistical significance with alpha < 0.05.
Results: In 89 patients who underwent resection of convexity (80.9%) or parasagittal (19.1%) rolandic meningiomas, a poor motor outcome occurred in 24.7%. Out of 53 patients (59.6%) with pre-operative motor deficits, 60.3% improved, 13.2% were unchanged, and 26.4% worsened following surgery. Among 36 patients without pre-operative deficits, 22.2% developed new weakness. Preoperative motor deficit was a major predictor of poor motor outcome (47.2% vs. 22.2%, p=0.017). Predictors of pre-operative motor deficit included tumor size (41.6 vs. 33.2 cm3; p=0.040) and presence of FLAIR signal (69.8% vs. 50.0%; p=0.046). Factors descriptively associated with postoperative weakness and near significant trend included parafalcine origin (41.2% vs. 20.8%, p=0.08), significant venous involvement (44.4% vs. 23.5%, p=0.09), and Simpson grade 2+ (34.2% vs. 17.6%, p=0.07).
Conclusions: Resection of rolandic area meningiomas carries a high rate of postoperative morbidity and deserves special preoperative planning. Large tumor size, peritumoral edema, parafalcine origin and venous involvement may further increase the risk profile.
Patient Care: We found that resection of rolandic meningioma carries a high rate of permanent postoperative motor deficit. Thus, this should always be thoroughly discussed with patients before surgery. The cautious selection of the best candidates for surgery is paramount, which may be optimized using the predictors identified in our study. These findings also provide justification for the future design of a multi-institutional prospective study to confirm our results and determine if modification of patient selection based on these predictors leads to a reduced rate of postoperative morbidity.
Learning Objectives: 1 State the expected rates of postoperative novel or worsened weakness in patients undergoing rolandic meningioma resection
2) Identify predictors of preoperative motor deficit
3) Identify patients during the pre-operative phase who are at highest risk for permanent post-operative deficit