Prognosis of meningiomas in the early 1970s and today
We analysed more than 1500 meningioma patients with a follow up as far as 38 yrs.
Main result is the better progression free survival nowadays.
The prognosis of meningiomas could be improved by the introduction of imaging.
Perioperative mortality rate has been reduced since the 1970s.
Detection of meningioma WHO grade II has been increased significantly today.
The benefit of the current strategy of diagnosis and treatment of meningiomas in contrast to the standard treatment in use before computer tomographic and magnetic resonance imaging and before the microsurgical era has not yet been determined.
Two groups of patients were compared, those on which surgery was performed before the year of 1985, when computer tomographic (CT) imaging was not yet available in our clinic and those who were treated after at the Neurosurgical Department of Saarland University. Average follow-up time was 17.9 ± 9.3 years for group 1 and 9.2 ± 4.3 years for group 2.
The number of patients with advanced age who had surgical treatment was significantly increased in the second group, whereas the number of perioperative complications found was nearly equal in both groups (17.8% vs. 18.8%). Nevertheless, perioperative morbidity was reduced from 2.2% to 1.2%. The postoperative recurrence free time period could be revealed to be longer in the first collective (p < 0.0001). Furthermore, this study shows a notable increase of the incidence of WHO grade II meningiomas in patients treated after 1985.
Based on the presented results, the overall prognosis for patients with meningiomas has changed from the 1960s until today, since over the last two decades there has been a prolonged progression free survival time in addition to a reduced perioperative mortality rate.
In the postoperative management of these patients genetic aberrations and microbiological markers should be considered as prognostic factors for meningiomas in addition to histopathological grading.