Declining age-adjusted surgical incidence of intracranial meningiomas: a 19-year retrospective analysis from an academic hospital.

PURPOSE: Intracranial meningiomas are the most common primary intracranial tumors, with rising detection rates due to increased neuroimaging. We examined surgical management trends to determine whether surgical incidence is independent of detection rate and to characterize shifts in surgical indications and patient demographics.

METHODS

This retrospective cohort study included 2,278 consecutive adults undergoing primary surgical resection for meningiomas at Helsinki University Hospital (2005-2023). Trends in absolute surgical caseload and patient demographics were analyzed. Surgical incidences were standardized to the European Standard Population (ESP 2013), and age-specific Observed-to-Expected (O/E) ratios were calculated against baseline incidences (2005-2008).

RESULTS

Absolute annual surgical caseload remained stable (range: 83-160 cases; crude incidence 3.8-7.7 per 100,000 person-years; p = 0.868), while the median age of operated patients increased significantly by 2.9 months per year (p = 0.018). The most common presenting symptoms were seizures (19%) and visual symptoms (14%); symptom relief was the most common surgical indication (62%). Age-standardized (ESP) surgical incidences declined over time (3-year sliding average p < 0.006 for all age groups), and demographic-adjusted O/E ratio analysis supports this decline, particularly in the 30-69 years age range. Prophylactic surgeries declined significantly (p < 0.001), while surgeries prompted by tumor growth (p = 0.031) and large tumor size (p < 0.001) increased.

CONCLUSION

Despite increased detection and an aging population, age-adjusted surgical incidence for meningiomas declined over 19 years, supporting the interpretation of a shift toward a more selective, risk-stratified approach. Surgery is increasingly reserved for cases with documented growth, mass effect, or functional deficits.