Article
Postoperative imaging after resection of meningioma in non-eloquent brain areas
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Published: | May 21, 2013 |
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Objective: Although postoperative imaging is conducted routinely after resection of meningioma, it remains unclear whether it should be performed in neurologically asymptomatic patients after resection of meningioma of the convexity, the cerebral falx, the cerebellar tentorium and the sphenoid wing.
Method: From January 2010 to January 2012 a total of 113 patients (f:m 1.9:1) with meningioma of the convexity (45 %), of the cerebral falx (26 %), of the cerebellar tentorium (9 %) and of the sphenoid wing (20 %) underwent surgery at our institution. Maximum tumor diameter was divided into groups of < 3 cm (22 %), 3 to 6 cm (62 %) and > 6 cm (16 %). Patient and tumor characteristics, date and modality of postoperative imaging, symptoms and changes in treatment were entered into a prospectively updated database.
Results: Overall resection of the meningioma was performed in 113 patients. When reviewing these patients it was seen that 83 (73 %) did not present any new neurological deficit, whereas 30 patients (27 %) developed clinical symptoms. Symptomatic patients received a change in treatment after imaging in 21 cases (70 %), while imaging did not result in a therapeutic consequence in 9 patients (30 %). In the symptomatic patients 18 received CT scans which led to a change in treatment regimen of 9 patients (50 %) and 12 patients received MRI which resulted in a change of treatment in 7 patients (68 %; p = 1). Postoperative imaging in asymptomatic patients did not result in a change of treatment in all 68 patients (p < 0,00001) independent of tumor size (p < 0,00001) and tumor localization (p < 0,00001).
Conclusions: These data supply detailed information about the necessity of postoperative imaging in patients with meningioma in non-eloquent areas. Apparently, MR imaging did not result in a higher rate of changed treatment regimen compared to postoperative CT imaging in symptomatic patients. We demonstrate that postoperative imaging is necessary for clinically symptomatic patients but it might be safe to waive postoperative imaging in clinically asymptomatic patients even in patients with large meningiomas in size.