Preoperative identification of meningiomas that are highly likely to recur.

OBJECT: Although generally they are well-circumscribed benign tumors, meningiomas recur even after complete removal. The aims of this study are to identify preoperatively groups of patients who have a high risk of meningioma recurrence by reviewing their clinicoradiological features and to plan appropriate treatments.
METHODS: One hundred one patients who underwent macroscopically complete removal of meningiomas were observed postoperatively for at least 5 years or until tumor recurrence. Preoperative radiological findings and clinical characteristics were assessed. Fifteen meningiomas recurred during the follow-up period, which extended to a maximum duration of 18 years. On univariate analysis, tumor size and shape, relation to the major sinuses, calcification, bone changes, and characteristics of the tumor-brain interface were significant predictive factors for recurrence. Patient age and gender were not deemed significant. Multivariate analysis revealed that only the shape of the tumor was significant; both "mushrooming" and lobulated meningiomas were more likely to recur than round ones. Recurrences most frequently occurred at the edge of the dural resection after a Simpson Grade I removal, whereas local recurrences were predominant after a Simpson Grade II or III removal.
CONCLUSIONS: Meningiomas with mushrooming or lobulated shapes should be treated more aggressively with a wider dural excision. This is not usually necessary for round tumors, although it may be beneficial in younger patients.