title: Skull base atypical meningioma: long term surgical outcome and prognostic factors.
abstract: OBJECTIVE
  The aim of this study was to examine the clinical outcomes of treating atypical meningioma at the skull base region following surgical resection and adjuvant radiotherapy, and to analyze the association between clinical characteristics and progression free survival.
  
  
  METHODS
  Twenty-eight patients with skull base atypical meningiomas underwent microsurgical resection between June 2001 and November 2009. The clinical characteristics of the patients and meningiomas, the extent of surgical resection, and complications after treatment were retrospectively analyzed.
  
  
  RESULTS
  Thirteen patients (46.4%) had disease recurrence or progression during follow up time. The median time to disease progression was 64 months. The extent of the surgical resection significantly impacted prognosis. Gross total resection (GTR) of the tumor improved progression free survival (PFS) compared to subtotal resection (STR, p = 0.011). An older patient age at diagnosis also resulted in a worse outcome (p = 0.024). An MIB-1 index <8% also contributed to improved PFS (p = 0.031). None of the patients that underwent GTR and received adjuvant radiotherapy had tumors recur during follow up. STR with adjuvant radiotherapy tended to result in better local tumor control than STR alone (p = 0.074). Three of 28 patients (10.7%) developed complications after microsurgery. The GTR group had a higher rate of complications than those with STR. There were no late adverse effects after adjuvant radiotherapy during follow up.
  
  
  CONCLUSIONS
  For patients with skull base atypical meningiomas, GTR is desirable for longer PFS, unless radical excision is expected to lead to severe complications. Adjuvant radiation therapy is advisable to reduce tumor recurrence regardless of the extent of surgical resection. Age of disease onset and the MIB-1 index of the tumor were both independent prognostic factors of clinical outcome.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Yu-Chi
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Chuang
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Wei
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Yung-Hsin
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Peng-Wei
authors.initials: PW
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chieh-Tsai
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chen-Kan
authors.initials: CK
authors.lastname: Tseng
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Yao-Liang
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Shih-Min
authors.initials: SM
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC. Electronic address: pinyuanc@gmail.com.
authors.forename: Pin-Yuan
authors.initials: PY
authors.lastname: Chen
mesh_terms: D017668:Age of Onset; D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000517:prevention & control; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D019292:Skull Base Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D019394:Ki-67 Antigen
keywords: Atypical meningioma; MIB-1 index; Radiotherapy; Skull base; Surgery