Predictors of Recurrence and Long-Term Outcomes of Intracranial Meningiomas: A Retrospective Multicenter Study from Saudi Arabia.

INTRODUCTION

Meningioma is the second most prevalent primary tumor of the central nervous system. The World Health Organization (WHO) categorizes meningiomas into three grades, with the less frequent higher grades (2 and 3) demonstrating a high local recurrence rate even after complete resection. This study aims to elucidate the tumor recurrence predictors and treatment outcomes associated with various histopathological types of intracranial meningiomas.

METHODS

A retrospective study was conducted to analyze the electronic medical records of histopathologically confirmed meningioma patients at two tertiary centers in Jeddah, Saudi Arabia, from 2005 to 2015. The primary objective was to delineate the clinical and radiological characteristics associated with various histopathological types of meningioma, as well as to ascertain the longterm outcomes and risk factors for tumor recurrence.

RESULTS

A comprehensive review of 255 patients demonstrated a predominance of females (72.9%) and a mean age at presentation of 51.8 years. The follow-up period had a minimum duration of five years. The most prevalent clinical manifestation was headache, occurring in 41.6% of cases. Notably, 90.6% of cases did not exhibit apparent preoperative sensory-motor neurological deficits, while 5.5% presented with marked hemiparesis. The histopathologic pattern predominantly consisted of meningothelial meningioma (47.1%). The overall tumor recurrence rate during follow-up was observed in 26 patients (10.2%). This rate varied depending on the WHO grade: 13 patients (5.1%) with grade 1, 9 patients (3.5%) with grade 2, and 5 patients (1.6%) with grade 3 meningiomas. The recurrence rate exhibited a statistically significant correlation with the extent of resection. Notably, there was a higher recurrence rate associated with Simpson's grade 3 and 4 resections (p<0.008 and <0.003, respectively). The radiological findings, including peritumoral edema (56.2%), midline shift (17.9%), calcification (14.3%), and central necrosis (6.3%), exhibited no significant correlation with recurrence. Notably, there was a substantial correlation between tumor size and the probability of recurrence, with a likelihood ratio of 1.75 (p<0.04).

CONCLUSION

Our study presents comparable findings to international data pertaining to clinical behaviors, radiological, and histopathological characteristics. Its significance lies in underscoring the statistically significant coefficients for recurrence, encompassing WHO grading, extent of resection, and tumor size.