Article
Risk factors associated with postoperative outcome in intracranial meningiomas – a single center retrospective analysis of 331 patients
Risikofaktoren für das postoperative Outcome bei den Patienten mit intrakraniellen Meningeomen – eine unizentrische retrospective Analyse von 331 Patienten
Search Medline for
Authors
Published: | May 8, 2019 |
---|
Outline
Text
Objective: The majority of meningiomas are benign tumors and often incidental findings. At the same time, surgery may involve certain risks and complications. Therefore, patient-doctor consultation before surgery is essential.
The aim of this study was to investigate the scope and the factors associated with the worsening of patients’ performance after meningioma resection.
Methods: We searched our database retrospectively for patients with intracranial meningiomas (first diagnoses or recurrent tumors) within 7 years. Preoperative clinical patient data including gender, age, Karnofsky perfomance score (KPS), tumor localization and size were assessed. Postoperatively the WHO grade, special intraoperative aspects (e.g. vessel or cranial nerve manipulation) and the KPS at the first follow-up were collected. The primary endpoint was the postoperative worsening of KPS. Univariate and multivariate data analyses were performed. P<0.05 was considered significant).
Results: 331 patients fulfilled the inclusion criteria. Mean patient age was 58 years (range 24–85); there were 76.4% females. In 53 patients, (16.0%) a worsening of KPS was documented at FU, in n=22 (6.6%) KPS decreased ≤20 points at FU. n=8 (2.4%) died within 3–6 months after the operation. Sudden death due to pulmonary embolism was the most common cause of lethal outcome (n=5).
Patient age, gender, previous surgery, tumor diameter and WHO grade were not associated with KPS worsening. We found that intraoperative particularities e.g. manipulation on a) cranial nerves (OR 1.90 (1.05–3.44)) or b) brain vessels (OR 2.78 (1.51–5.11)) and tumor localization in the posterior fossa (OR 2.04 (1.04–4.02) were significantly associated with a poorer outcome. Eloquent localization was marginally insignificant (OR 1.79 (0.98–3.26)). After fitting into the multivariate model, only manipulation on brain vessels remained statistically significant factor.
The patients who died within 3-6 months were significantly older (mean age 57 vs. 71 years), harbored slightly larger tumors (2.9 vs. 4.0 cm) and were more often affected by intraoperative vessel and nerve manipulation.
Conclusion: Manipulation on cranial nerves, brain vessels and posterior fossa tumors were associated with a deterioration of postoperative clinical outcome. Our data may help for a more detailed consultation patients before surgery. However, it should be taken into account that KPS is clinician reported and not necessarily corresponding to the patients’ view.