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Aims: WHO Grade 3 (G3) meningiomas are rare tumours with limited data to guide management. This retrospective study documents UK management approaches across 14 centres over 11 years., Materials and Methods: Patients with WHO G3 meningioma between 01/01/2008 and 31/12/2018 were identified. Data were collected on demographics, management strategy, adjuvant radiotherapy, approach in recurrence setting and survival., Results: 84 patients were identified. 21.4% transformed from lower-grade disease. 96.4% underwent primary surgical resection, with 20.8% having evidence of residual disease on their post-op MRI. 59.3% of patients underwent adjuvant radiotherapy (RT) following surgical resection. Overall median PFS and OS were 12.6 months and 28.2 months, respectively. Median OS in the group who underwent complete surgical resection was 34.9 months, compared to 27.5 months for those who had incomplete resection (HR 0.58, 95% CI 0.27-1.23, p = 0.15). Median OS was 33.1 months for those who underwent adjuvant RT and 14.0 months for those who did not (HR 0.48, 95% CI 0.27-0.84, p = 0.004). Median adjuvant RT dose delivered was 60Gy (range 12Gy-60Gy), 45.8% of adjuvant RT was delivered using IMRT. At disease relapse, 31% underwent salvage surgery and 29.3% underwent salvage RT. Of those treated with salvage RT, 64.7% were re-treats and all were treated with hypofractionated RT., Conclusion: Surgery continues to be the preferred primary management strategy. Post-operative MRI within 48 hours is indicated to assess presence of residual disease and guide further surgical options. Adjuvant radiotherapy plays an important part of the management paradigm in these patients with the data supporting an attached survival advantage. Further surgery and re-irradiation is an option in the disease recurrence setting with radiosurgery frequently utilised in this context., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Academic neurosurgery encompasses basic science and clinical research efforts to better understand and treat diseases of relevance to neurosurgical practice, with the overall aim of improving treatment and outcome for patients. In this article, we provide an overview of the current and future directions of British academic neurosurgery. Training pathways are considered together with personal accounts of experiences of structured integrated clinical academic training and unstructured academic training. Life as an academic consultant is also described. Funding is explored, for the specialty as a whole and at the individual level. UK academic neurosurgical organisations are highlighted. Finally, the UK's international standing is considered., Competing Interests: Competing interests: MW and BMD are supported by National Institute for Health Research (NIHR) Academic Clinical Fellowships. KKY is supported by an NIHR Academic Clinical Lectureship. DGB is supported by a Wellcome Trust Fellowship. AGK is supported by a Clinical Lectureship, School of Clinical Medicine, University of Cambridge. MRNK is supported by a NIHR Clinician Scientist Award (CS-2015-15-023). WPG is supported by and directs the HCRW B.R.A.I.N. Biomedical Research Unit. PJH is supported by a NIHR Research Professorship, the NIHR Cambridge Biomedical Research Centre and the NIHR Research Group on Global Neurotrauma., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Incidental meningiomas are increasingly being diagnosed due to widespread use of brain imaging. Treatment options include surveillance, surgery and stereotactic radiosurgery, but the natural history of these tumours is not fully understood and there are no accepted management guidelines to aid clinical decision-making. The aim of this study was to assess current practice in the United Kingdom and identify areas of variation for further study., Methods: A questionnaire was distributed to all members of the Society of British Neurosurgeons (SBNS). The main components of the survey included the assessment of which factors and tumour characteristics are considered in the management and follow-up of incidental meningiomas. Two case scenarios were also presented., Results: The response rate was 12.5% (44 completed surveys) with 74% (25/34) of neurosurgical centres represented. Absence of calcification was only considered by 36% (16/44) of neurosurgeons. Most neurosurgeons opt for surveillance at initial presentation, and the length of follow-up was 5 years (14/33) and 10 years (11/33). The case scenarios highlighted that tumour growth at follow-up resulted in a preference to change from surveillance to treatment with surgery or SRS. SRS was preferred in skull-base (23/36) and medial sphenoid wing (16/39) tumours., Conclusions: This survey has demonstrated that certain aspects of incidental meningioma management show variation and remain controversial. Further research through prospective cohort studies is required to provide evidence to support guidelines for the management of incidental meningiomas.