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The evolution of cranial meningioma surgery—a single-center 25-year experience.
- Source :
-
Acta Neurochirurgica . Sep2018, Vol. 160 Issue 9, p1801-1812. 12p. 1 Diagram, 4 Charts, 3 Graphs. - Publication Year :
- 2018
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Abstract
- Background: There have been major developments in diagnostic and surgical and non-surgical techniques used in the management of meningiomas over last three decades. We set out to describe these changes in a systematic manner.Method: Clinical and radiological data, surgical procedures, complications, and outcome of 817 patients who underwent surgery for primarily diagnosed meningioma between 1991 and 2015 were investigated.Results: Median age at diagnosis increased significantly from 56 to 59 years (p = .042), while tumor location and preoperative Karnofsky performance status did not change during the observation period. Availability of preoperative MRI increased, and rates of angiography and tumor embolization decreased (p < .001, each). Median duration of total, pre-, and postoperative stay was 13, 2, and 9 days, respectively, and decreased between 1991 and 2015 (p < .001, each). Median incision-suture time varied annually (p < .001) but without becoming clearly longer or shorter during the entire observation period. The use of intraoperative neuronavigation and neuromonitoring increased, while the rates of Simpson grade I and III surgeries decreased (p < .001). Rates of postoperative hemorrhage (p = .997), hydrocephalus (p = .632), and wound infection (p = .126) did not change, while the frequency of early postoperative neurological deficits decreased from 21% between 1991 and 1995 to 13% between 2011 and 2015 (p = .003). During the same time, the rate of surgeries for postoperative cerebrospinal fluid leakage slightly increased from 2 to 3% (p = .049). Within a median follow-up of 62 months, progression was observed in 114 individuals (14%). Progression-free interval did not significantly change during observation period (p > .05). Multivariate analyses confirmed the lack of correlation between year of surgery and tumor relapse (HR: 1.1, p > .05).Conclusions: Preoperative diagnosis and surgery of meningiomas have been substantially evolved. Although early neurological outcome has improved, long-term prognosis remains unchanged. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00016268
- Volume :
- 160
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- Acta Neurochirurgica
- Publication Type :
- Academic Journal
- Accession number :
- 131319775
- Full Text :
- https://doi.org/10.1007/s00701-018-3617-6