Morbidity, mortality, and quality of life following surgery for intracranial meningiomas

TLDR

Survival and quality of life after intracranial meningioma resection depend on tumor size, location, extent of excision, histology, patient condition, and seizure risk, with early CT diagnosis and postoperative imaging essential for monitoring recurrence. The study analyzed 257 patients undergoing 338 craniotomies, employing osmotic diuretics, subarachnoid drains, meticulous dissection, and venous preservation to reduce intraoperative complications. Median overall survival was 9.0 years with 8.3 years of acceptable quality of life; early CT detection of small recurrences facilitates complete resection and prolongs survival, while radiation extends survival in malignant cases but does not prevent further recurrences.

Abstract

The authors report 257 patients who underwent 338 craniotomies for the removal of meningiomas. The average duration of observed survival was 9.0 years, while that with acceptable quality of life was 8.3 years. Multiple factors including the size and location of tumors, the degree of tumor excision, the histological features, and the preoperative condition of the patients are important in both duration of survival and quality of life following surgery for intracranial meningiomas. Computerized tomography permits early diagnosis and is invaluable in follow-up assessment. It allows for recognition of small recurrent tumors, and offers a better opportunity for complete removal and, subsequently, a longer duration of reasonable survival. Radiation therapy may prolong survival time in patients with malignant meningiomas, but it fails to delay further tumor recurrences following its delivery to patients with recurrent tumors. There are multiple predisposing factors responsible for the development of postoperative seizures. These include tumor recurrence involving highly functional anatomical areas of the brain, history of preoperative seizures, and intraoperative factors such as excessive brain retraction and the sacrifice of major draining or bridging veins. Intraoperative complications may be decreased by using osmotic diuretics and subarachnoid drains, meticulous dissection, and with the increased awareness and preservation of the important venous structures.