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  • Risk of Developing Postoperative Deficits Based on Tumor Location After Surgical Resection of an Intracranial Meningioma

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    Jeff Ehresman BS; Kelly Gassie; Tomas Garzon-Muvdi MD MS; Davis Rogers BA; Michael Lim MD; Gary L. Gallia MD; Jon D. Weingart MD; Henry Brem MD; Chetan Bettegowda MD, PhD; Kaisorn L. Chaichana MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Meningiomas occur in various intracranial locations. Each location is associated with a unique set of surgical nuances and risk profiles. The incidence and risk factors that predispose patients to certain deficits based on tumor locations are not clear. This study aimed to determine which preoperative factors increase the risk of patients having new deficits after surgery based on tumor location for patients undergoing intracranial meningioma surgery.

    Methods: Adult patients who underwent primary, non-biopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate logistic regression analyses were used to identify associations with postoperative deficits based on tumor location.

    Results: Of the 659 included patients, the tumors were location along the convexity in 188 (28.5%), anterior skull base in 81 (12.3%), parasagittal/parafalcine in 169 (25.6%), tentorial in 34 (5.2%), sphenoid wing in 112 (17.0%), cerebello-pontine angle in 67 (10.2%), and foramen magnum in 9 (1.4%). The factors independently associated with any postoperative deficits were Simpson grade 4 resections (HR [95 % CI] 2.171 [1.301-3.598], p = 0.003), non-convexity tumors (HR [95 % CI], 2.201 [1.168-4.472], p = 0.01), coronary artery disease (HR [95 % CI] 4.657 [1.852-11.122], p = 0.002), and KPS < 70 (HR [95 % CI] 2.222 [1.262-3.819], p = 0.006).

    Conclusions: Consideration of the factors associated with postoperative deficits in this study may help guide treatment strategies for patients with meningiomas.

    Patient Care: While surgical resection remains the gold standard for the treatment of a significant number of meningiomas, the risk for postoperative deficits is unclear. Based on tumor locations, we found that meningiomas in the convexity are much safer to resect in terms of postoperative deficits. The factors that independently associated with different types of postoperative deficits were distinct. By accounting for these risk factors, surgery may be able to better inform patients about the risk of deficits, as well as attempting to adjust their strategies in order to minimize the risk of postoperative neurological deficits.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) explain how postoperative deficits vary with tumor location and 2) explain the factors independently associated with higher rates of different postoperative deficits


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