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Meningiomas - are we making progress?
EANS Academy. Meling T. Oct 23, 2018; 233885
Prof. Dr. Torstein Meling
Prof. Dr. Torstein Meling

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Abstract
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Background
To study improvements in outcomes after surgery for intracranial meningiomas.

Methods
We performed a longitudinal observational study comparing 1469 patients operated for intracranial meningioma in four consecutive time frames (1990-1994, 1995-1999, 2000-2004, and 2005-2010).

Results
Median age at surgery was 58.3 years. Median follow-up was 7 years. Patients in later periods were older than in the earlier ones (OR=1.19 [1.09-1.32], p<0.0005) indicating a trend towards operating more elderly patients. Before 2000, 42%, 32%, 6%, 19%, and 0.3% achieved Simpson Grade (SG) I, II, III, IV, and V, respectively, whereas the SG rates were 35%, 37%, 4%, 23%, and 0.9% in after 2000 (OR=1.18 [1.06-1.30], p<0.005). The perioperative mortality (OR=0.65 [0.46-0.91], p<0.05) and worsened neurological outcome rate (OR=0.70 [0.60-0.83], p<0.0001) were significantly lower in later decade, but the four surgical periods were similar regarding postoperative infections and hematomas. Retreatment-Free Survival (RFS) and Overall Survival (OS) increased significantly over the four time-frames (p<0.05 and p<0.0001, respectively). Multivariate analysis confirmed the improvement of surgical radicality, neurological outcome, perioperative mortality, OS, and RFS.

Conclusion:
Meningioma surgery as well as patient population have changed over the two decades considered in this study. We observed higher GTR rates in the later period while improving or keeping unchanged the perioperative outcomes that translates into better long-term outcomes RFS and OS.
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