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October 2019, Volume 69, Issue 10

Evidence Based Neuro-Oncology

Factors affecting post-operative recurrence or growth of meningiomas, other than histological grade and extent of resection

Ayesha Quddusi  ( Department of Surgery, Aga Khan University Hospital, Karachi )
Qurat-ul-Ain Virani  ( Department of Surgery, Aga Khan University Hospital, Karachi. )
Muhammad Shahzad Shamim  ( Department of Surgery, Aga Khan University Hospital, Karachi )


Meningiomas are one of the commonest primary brain tumours, treated primarily with surgery. These are extraaxial tumours and their post-operative recurrence rates have been extensively studied. The most established predictor of meningioma recurrence is the WHO grade (based on histological features) and the Simpson grade, based on the extent of resection. In this review article, we look into the risk factors other than histological grade and Simpson grade that have been associated with recurrence of meningioma after resection.

Keywords: Meningioma, recurrence, brain tumour, radiotherapy.


Meningiomas account for up to 20-30% of all primary brain tumours and are generally considered benign diseases with excellent prognosis if resected completely.1 Surgery remains the mainstay of treatment although despite complete resection, they still carry a risk of recurrence. 1 Thevarious risk factors influencing recurrence have been extensively studied. Donald Simpson in his landmark 1957 paper published a grading system that used extent of resection as a possible predictor of recurrence. His five grades have been validated through several papers and Simpson grading is now a standard operative observation for neurosurgical teams. 2,3 Herein, we review factors other than histological grade and extent of resection that may influence recurrence or growth of meningiomas after surgery.

Review of Evidence

Ros-Sanjuan et al., looked at atypical meningiomas and reported histological features such as necrosis or high Ki67 index as common features in patients with recurrence. 5 Sumkovski et al., supported this finding and showed that mitotic count is an independent predictor of meningioma recurrence, and tumours with malignant transformation have a worse prognosis compared to de novo highgrade tumours. 67891011


We conclude that in addition to extent of resection and tumour grading, histopathological characteristics particularly molecular and genetic markers are of relevance with association of meningioma recurrence post resection. We believe that these factors may be incorporated in algorithms based on machine learning models and may be used for prognostication, as well as for counseling patients..


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2. Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry.1957; 20:22.
3. Perry A, Stafford SL, Scheithauer BW, et al. Meningioma grading: an analysis of histological parameters. Am J Surgical Pathology. 1997; 21:1455-1466.

4. Jiang Y, Lv L, Li J, Ma W, Chen C, Zhou P, et al. Clinical features, radiological findings, and treatment outcomes of high-grade lateral ventricular meningiomas: a report of 26 cases. Neurosurg

Rev. 2019;

5. Ros-Sanjuan A, Iglesias-Morono S, Carrasco-Brenes A, Bautista-Ojeda D, Arraez-Sanchez MA. Atypical Meningiomas: Histologic and Clinical Factors Associated With Recurrence. World Neurosurg. 2019; 1: 56

6. Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I. Surgical treatment of meningiomas - outcome associated with type of resection, recurrence, Karnofskyperformance score, mitotic count. Open access Maced J Med Sci. 2019; 7:56-64.

7. Kamamoto D, Saga I, Ohara K, Yoshida K, Sasaki H. Association Between CD133, CD44, and Nestin Expression and Prognostic Factors in High-Grade Meningioma. World Neurosurg. 2018; doi: 10.1016/j.wneu.2018.12.067.

8. Nakada S, Sasagawa Y, Tachibana O, Iizuka H, Kurose N, Shioya A, et al. The clinicopathological analysis of receptor tyrosine kinases in meningiomas: the expression of VEGFR-2 in meningioma was associated with a higher WHO grade and shorter progression-free survival.Brain Pathol. 2019; 36:7-13.

9. Pessina F, Navarria P, Clerici E, Soffietti R, Nibali MC, Ruda R, et al. Intracranial meningiomas: a systematic analysis of prognostic factors for recurrence in a large single institution surgical series. World Neurosurg. 2019; 123:e273-e9.

10. Barresi V, Lionti S, La Rocca L, Caliri S, Caffo M. High p-mTOR expression is associated with recurrence and shorter disease-free survival in atypical meningiomas. Neuropathol. 2019; 39:22-9.

11. San-Miguel T, Navarro L, Megias J, Munoz-Hidalgo L, Gil-Benso R, Roldan P, et al. Epigenetic changes underlie the aggressiveness of histologically benign meningiomas that recur. Human Pathol. 2019; 84:105-14.

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