Morbidity in 201 patients with small sized meningioma treated by microsurgery.
BACKGROUND
The management of patients with small, often asymptomatic meningiomas is controversial and includes observation, microsurgery (MS) and stereotactic radiosurgery (SRS). The purpose of this retrospective study was to analyze the morbidity and the extent of removal after MS for small (< or =3 cm) intracranial meningiomas and compare these results to those of SRS reported in the literature.


METHODS
All patients with an intracranial meningioma with a maximum diameter up to 3 cm operated on in our institution over a 10 year period (1992-2002) were included in the study and retrospectively analyzed. Patients were grouped into asymptomatic and symptomatic and according to tumor location as: group I (cranial vault, parasagittal, lateral sphenoid), group II (falx, frontobasal, medial sphenoid, parasellar and tentorial), group III (cavernous sinus, petroclival, petrosal, CPA and foramen magnum).


RESULTS
There were a total of 201 patients, of whom 102 were asymptomatic and 99 were symptomatic. The overall risk of permanent neurological morbidity was 4.9% in asymptomatic and 23.2% in symptomatic patients. The combined risk in asymptomatic and symptomatic patients was 5.4% in group I, 11.5% in group II, and 39.9% in group III lesions. Radical removal was achieved in all patients in group I, in 93.7% of group II, and 80% of group III lesions. There was no disease related mortality.


CONCLUSIONS
MS provides excellent efficacy and morbidity results in groups I and II meningiomas, especially in asymptomatic patients and might therefore be considered the first choice of treatment for these patients. The results of MS in group III were worse than those of SRS reported in the literature.
Reinert
M
M
Department of Neurosurgery, Inselspital Bern, University of Bern, Bern, Switzerland. michael.reinert@neurochirugie-bern.ch
Babey
M
M
Curschmann
J
J
Vajtai
I
I
Seiler
R W
RW
Mariani
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004388:Dura Mater / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012886:Skull / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D019291:Skull Base / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D019292:Skull Base Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome