Meningioma Surgery–Are We Making Progress?
| Autor: | Michele Da Broi, Torstein R. Meling, Eirik Helseth, Nicolas R. Smoll, David Scheie |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment Kaplan-Meier Estimate Skull Base Neoplasms Disease-Free Survival Meningioma Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Meningeal Neoplasms medicine Humans Longitudinal Studies Craniotomy Aged Quality of Health Care Aged 80 and over business.industry Age Factors Odds ratio Perioperative Middle Aged medicine.disease Gross Total Resection Surgery Patient population Treatment Outcome 030220 oncology & carcinogenesis Retreatment Female Observational study Neurology (clinical) Intracranial meningioma business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 125:e205-e213 |
| ISSN: | 1878-8750 |
| Popis: | To study improvements in outcomes after surgery for intracranial meningiomas.We performed a longitudinal observational study comparing 1469 patients operated on for intracranial meningioma in 4 consecutive time frames (1990-1994, 1995-1999, 2000-2004, and 2005-2010).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 (odds ratio [OR], 1.19 [1.09-1.32]; P0.0005), indicating a trend toward operating on 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% after 2000 (OR, 1.18 [1.06-1.30]; P0.005). The perioperative mortality (OR, 0.65 [0.46-0.91]; P0.05) and worsened neurologic outcome rate (OR, 0.70 [0.60-0.83]; P0.0001) were significantly lower in later decades, but the 4 surgical periods were similar regarding postoperative infections and hematomas. Retreatment-free survival (RFS) and overall survival (OS) increased significantly over the 4 time frames (P0.05 and P0.0001, respectively). Multivariate analysis confirmed the improvement of surgical radicality, neurologic outcome, perioperative mortality, OS, and RFS.Meningioma surgery as well as patient population changed over the 2 decades considered in this study. We observed higher rates of gross total resection in the later period and the perioperative outcomes improved or were unchanged, which signifies better long-term outcomes, RFS, and OS. |
| Databáze: | OpenAIRE |
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