Introduction: Recurrent meningiomas are primarily managed with radiation therapy or repeat surgical resection. Surgical morbidity after reoperation for recurrent meningiomas is poorly understood. Thus, the objective of this study was to report surgical outcomes after reoperation for recurrent non-skull base meningiomas.
Methods: A retrospective review was performed. Inclusion criteria were patients with recurrent meningioma who had prior resection and non-skull base location. Univariate and multivariate logistic regression and recursive partitioning analysis were used to identify risk factors for surgical complications.
Results: We identified 67 patients who underwent 111 reoperations. Median age was 53 years, 49% were female, and median follow up was 9.8 years. Meningiomas were WHO grade I (33%), grade II (49%), and grade III (18%). Tumor grade increased at reoperation in 22% of cases. Tumors were found in convexity (52%), parasagittal (33%), falx (31%), and multifocal (19%) locations. When tumor location was categorized in the sagittal plane, 43% were anterior, 39% middle, and 25% were posterior third. There were 48 complications that occurred in 32 patients (47%), and 26 (39%) required surgical intervention. There was no perioperative mortality. Complications included neurological deficits (14% total, 8% permanent), wound dehiscence/infection (14%), and CSF leak/pseudomeningocele/hydrocephalus (9%). Tumor location in the middle third of the sagittal plane (OR 5.0, 95% CI 1.3-19.2, p=0.010) and presentation with cognitive changes (OR 18.6, 95% CI 2.40-139.9, p=0.019) were significantly associated with complication occurrence on multivariate analysis. Median survival after the first reoperation was 11.5 years, and 2-, 5-, and 10-year Kaplan-Meier survival rates were 91.0%, 68.8%, and 50.0%, respectively.
Conclusions: Reoperation for recurrent non-skull base meningioma is associated with a high rate of complications. Patients with cognitive changes and tumors in the middle third of the sagittal plane are at increased risk of complications. Nevertheless, excellent long-term survival can be achieved without perioperative mortality.
Patient Care: Our findings will inform patients about the risks associated with reoperation for recurrent meningiomas as well as the observed long-term survival with continued reoperation and radiation, which allows patients to make a more informed decision about their treatment and creates appropriate expectations for their post-operative course.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Describe the morbidity associated with reoperation for recurrent non-skull base meningiomas. 2) Discuss the survival observed with continued reoperation for recurrent meningiomas. 3) Be able to discuss the risks and benefits of reoperation for recurrent meningioma with patients.