Recurrent Meningiomas

ABSTRACT

With innovations in microneurosurgical techniques and equipment in the recent era, many difficult meningiomas can be removed completely in the hands of experienced neurosurgeons. Specific cranial base approaches provide a dissection technique focused on bone removal, rather than brain retraction, which is critical to the safe resection of deeply seated meningiomas. The surgical aim has focused not only on patients' survival but also on quality of life. Despite these advances, challenges remain in the treatment of meningiomas. Notable among these is the tendency of meningiomas to recur. Factors affecting the recurrence rate are age, sex, histology, location, and the modality of surgical treatment. Recurrence rates for benign meningiomas range from 4 to 52%. Volume of tumor removed and tumor attachment to neighboring tissues affect the recurrence rate. Magnetic resonance imaging is the most useful diagnostic tool in the detection of postoperative residual and recurrent tumor. Surgery remains the first option in the treatment of most recurrent meningiomas. Adjunctive treatments may be considered in selected cases.

KEYWORDS

Difficult meningiomas - recurrent meningiomas

REFERENCES

• 1 Bingham W F. W.W. Keen and the dawn of American neurosurgery.  J Neurosurg . 1986;  64 705-712
• 2 Cushing H W, Eisenhardt L. Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results.  Springfield, IL: Charles C Thomas 1938: 47-71
• 3 Simpson D. The recurrence of intracranial meningiomas after surgical treatment.  J Neurol Neurosurg Psychiatry . 1957;  20 22-39
• 4 Mathiesen T, Von Holst H, Askensten U, Collins P. DNA determination in the clinical management of patients with meningioma or hemangioblastoma.  Br J Neurosurg . 1989;  3 575-581
• 5 Mirimanoff R O, Dosoretz D E, Linggood R M, Ojemann R G, Martuza R L. Meningioma: analysis of recurrence and progression following neurosurgical resection.  J Neurosurg . 1985;  62 18-24
• 6 Jaaskelainen J. Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis.  Surg Neurol . 1986;  26 461-469
• 7 Adegbite A B, Khan M I, Paine K W, Tan L K. The recurrence of intracranial meningiomas after surgical treatment.  J Neurosurg . 1983;  58 51-56
• 8 Beks J W, de Windt L H. The recurrence of supratentorial meningiomas after surgery.  Acta Neurochir (Wien) . 1988;  95 3-5
• 9 Chan R C, Thompson G B. Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases.  J Neurosurg . 1984;  60 52-60
• 10 Giombini S, Solero C L, Morello G. Late outcome of operations for supratentorial convexity meningiomas. Report on 207 cases.  Surg Neurol . 1984;  22 588-594
• 11 Philippon J, Cornu P. The recurrence of meningiomas. In: Al-Mefty O, ed. Meningiomas New York: Raven Press 1991: 87-105
• 12 Skullerud K, Loken A C. The prognosis in meningiomas.  Acta Neuropathol (Berl) . 1974;  29 337-344
• 13 Yamasaki F, Yoshioka H, Hama S, Sugiyama K, Arita K, Kurisu K. Recurrence of meningiomas.  Cancer . 2000;  89 1102-1110
• 14 Alvarez F, Roda J M, Perez Romero M, Morales C, Sarmiento M A, Blazquez M G. Malignant and atypical meningiomas: a reappraisal of clinical, histological, and computed tomographic features.  Neurosurgery . 1987;  20 688-694
• 15 Jaaskelainen J, Haltia M, Servo A. Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome.  Surg Neurol . 1986;  25 233-242
• 16 Maier H, Ofner D, Hittmair A, Kitz K, Budka H. Classic, atypical, and anaplastic meningioma: three histopathological subtypes of clinical relevance.  J Neurosurg . 1992;  77 616-623
• 17 Palma L, Celli P, Franco C, Cervoni L, Cantore G. Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases.  J Neurosurg . 1997;  86 793-800
• 18 Mathiesen T, Lindquist C, Kihlstrom L, Karlsson B. Recurrence of cranial base meningiomas.  Neurosurgery . 1996;  39 2-7
• 19 Zulch K J. Histologic Typing of Tumors of the Central Nervous System.  Geneva: World Health Organization; 1979
• 20 Kepes J J. Review of the WHO's new proposed classification of brain tumors. Proceedings of the XIth International Congress of Neuropathology, Kyoto, Japan, 1990, pp 87-97
• 21 Kleihues P, Cavenee W K. Pathology and genetics of tumors of the nervous system (WHO). Lyon: International Agency for Research on Cancer (IARCH Press) 2000
• 22 Von Deimling A, Larson J, Wellenreuther R. et al . Clonal origin of recurrent meningiomas.  Brain Pathol . 1999;  9 645-650
• 23 Wilson C B. Meningiomas: genetics, malignancy, and the role of radiation in induction and treatment. The Richard C. Schneider Lecture.  J Neurosurg . 1994;  81 666-675
• 24 Kunishio K, Ohmoto T, Matsuhisa T, Maeshiro T, Furuta T, Matsumoto K. The significance of nuclear organizer region (AgNOR) score in predicting meningioma recurrence.  Cancer . 1994;  73 2200-2205
• 25 Moller M L, Braendstrup O. No prediction of recurrence of meningiomas by PCNA and Ki-67 immunohistochemistry.  J Neurooncol . 1997;  34 241-246
• 26 Takeuchi H, Kubota T, Kabuto M, Kitai R, Nozaki J, Yamashita J. Prediction of recurrence in histologically benign meningiomas: proliferating cell nuclear antigen and Ki-67 immunohistochemical study.  Surg Neurol . 1997;  48 501-506
• 27 Cobb M A, Husain M, Andersen B J, Al-Mefty O. Significance of proliferating cell nuclear antigen in predicting recurrence of intracranial meningioma.  J Neurosurg . 1996;  84 85-90
• 28 De Ridder L. Meningiomas: behavior in vivo and in vitro. In: Mikkelson T, Bjerkving R, Laerum OD, Rosenblum ML, eds. Brain Tumor Invasion: Biological, Clinical and Therapeutic Consideration New York: John Wiley & Sons; 1998
• 29 Kakinuma K, Tanaka R, Onda K, Takahashi H. Proliferative potential of recurrent intracranial meningiomas as evaluated by labeling indices of BUdR and Ki-67, and tumor doubling time.  Acta Neurochir (Wien) . 1998;  140 26-31
• 30 Matsuno A, Fujimaki T, Sasaki T. et al . Clinical and histopathological analysis of proliferative potentials of recurrent and non-recurrent meningiomas.  Acta Neuropathol (Berl) . 1996;  91 504-510
• 31 Shibuya M, Hoshino T, Ito S. et al . Meningiomas: clinical implications of a high proliferative potential determined by bromodeoxyuridine labeling.  Neurosurgery . 1992;  30 494-497
• 32 Zankl H, Zang K D. Cytological and cytogenetical studies on brain tumors. 4. Identification of the missing G chromosome in human meningiomas as no. 22 by fluorescence technique.  Humangenetik . 1972;  14 167-169
• 33 Weber R G, Bostrom J, Wolter M. et al . Analysis of genomic alterations in benign, atypical, and anaplastic meningiomas: toward a genetic model of meningioma progression.  Proc Natl Acad Sci U S A . 1997;  94 14719-14724
• 34 Prayson R A. Malignant meningioma: a clinicopathologic study of 23 patients including MIB1 and p53 immunohistochemistry.  Am J Clin Pathol . 1996;  105 719-726
• 35 Nakabayashi H, Shimizu K, Hara M. Prognostic significance of cyclin A expression in meningiomas.  Appl Immunohistochem Mol Morphol . 2003;  11 9-14
• 36 Konstantinidou A E, Korkolopoulou P, Kavantzas N. et al . Mitosin, a novel marker of cell proliferation and early recurrence in intracranial meningiomas.  Histol Histopathol . 2003;  18 67-74
• 37 Kilic T, Bayri Y, Ozduman K. et al . Tenascin in meningioma: expression is correlated with anaplasia, vascular endothelial growth factor expression, and peritumoral edema but not with tumor border shape.  Neurosurgery . 2002;  51 183-192
• 38 Levicar N, Strojnik T, Kos J, Dewey R A, Pilkington G J, Lah T T. Lysosomal enzymes. Cathepsins in brain tumor invasion.  J Neurooncol . 2002;  58 21-32
• 39 Strojnik T, Zidanik B, Kos J, Lah T T. Cathepsins B and L are markers for clinically invasive types of meningiomas.  Neurosurgery . 2001;  48 598-605
• 40 Simon M, Park T W, Leuenroth S, Hans V H, Loning T, Schramm J. Telomerase activity and expression of the telomerase catalytic subunit, hTERT, in meningioma progression.  J Neurosurg . 2000;  92 832-840
• 41 Hunt D P, Freeman A, Morris L S. et al . Early recurrence of benign meningioma correlates with expression of mini-chromosome maintenance-2 protein.  Br J Neurosurg . 2002;  16 10-15
• 42 Konstantinidou A E, Patsouris E, Korkolopoulou P, Kavantzas N, Mahera H, Davaris P. DNA topoisomerase IIalpha expression correlates with cell proliferation but not with recurrence in intracranial meningiomas.  Histopathology . 2001;  39 402-408
• 43 Bonnal J, Brotchi J. Surgery of the superior sagittal sinus in parasagittal meningiomas.  J Neurosurg . 1978;  48 935-945
• 44 Barbaro N M, Gutin P H, Wilson C B, Sheline G E, Boldrey E B, Wara W M. Radiation therapy in the treatment of partially resected meningiomas.  Neurosurgery . 1987;  20 525-528
• 45 Kokubo M, Shibamoto Y, Takahashi J A. et al . Efficacy of conventional radiotherapy for recurrent meningioma.  J Neurooncol . 2000;  48 51-55
• 46 Mesic J B, Hanks G E, Doggett R L. The value of radiation therapy as an adjuvant to surgery in intracranial meningiomas.  Am J Clin Oncol . 1986;  9 337-340
• 47 Solan M J, Kramer S. The role of radiation therapy in the management of intracranial meningiomas.  Int J Radiat Oncol Biol Phys . 1985;  11 675-677
• 48 Taylor Jr W B, Marcus Jr B R, Friedman W A, Ballinger Jr E W, Million R R. The meningioma controversy: postoperative radiation therapy.  Int J Radiat Oncol Biol Phys . 1988;  15 299-304
• 49 Wara W M, Sheline G E, Newman H, Townsend J J, Boldrey E B. Radiation therapy of meningiomas.  Am J Roentgenol Radium Ther Nucl Med . 1975;  123 453-458
• 50 Wenkel E, Thornton A F, Finkelstein D. et al . Benign meningioma: partially resected, biopsied, and recurrent intracranial tumors treated with combined proton and photon radiotherapy.  Int J Radiat Oncol Biol Phys . 2000;  l48 1363-1370
• 51 Debus J, Wuendrich M, Pirzkall A. et al . High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results.  J Clin Oncol . 2001;  19 3547-3553
• 52 Kondziolka D, Lunsford L D, Coffey R J, Flickinger J C. Stereotactic radiosurgery of meningiomas.  J Neurosurg . 1991;  74 552-559
• 53 Kobayashi T, Kida Y, Mori Y. Long-term results of stereotactic gamma radiosurgery of meningiomas.  Surg Neurol . 2001;  55 325-331
• 54 Gutin P H, Leibel S A, Hosobuchi Y. et al . Brachytherapy of recurrent tumors of the skull base and spine with iodine-125 sources.  Neurosurgery . 1987;  20 938-945
• 55 Kumar P P, Patil A A, Syh H W, Chu W K, Reeves M A. Role of brachytherapy in the management of the skull base meningioma. Treatment of skull base meningiomas.  Cancer . 1993;  71 3726-3731
• 56 Kyritsis A P. Chemotherapy for meningiomas.  J Neurooncol . 1996;  29 269-272
• 57 Kaba S E, DeMonte F, Bruner J M. et al . The treatment of recurrent unresectable and malignant meningiomas with interferon alpha-2B.  Neurosurgery . 1997;  40 271-275
• 58 Schrell U M, Rittig M G, Anders M. et al . Hydroxyurea for treatment of unresectable and recurrent meningiomas. II. Decrease in the size of meningiomas in patients treated with hydroxyurea.  J Neurosurg . 1997;  86 840-844
• 59 Schrell U M, Rittig M G, Anders M. et al . Hydroxyurea for treatment of unresectable and recurrent meningiomas. I. Inhibition of primary human meningioma cells in culture and in meningioma transplants by induction of the apoptotic pathway.  J Neurosurg . 1997;  86 845-852
• 60 Koper J W, Zwarthoff E C, Hagemeijer A. et al . Inhibition of the growth of cultured human meningioma cells by recombinant interferon-alpha.  Eur J Cancer . 1991;  27 416-419