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Open Access 01-04-2019 | Meningioma | Topic Review

Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes

Authors: Abdurrahman I. Islim, Midhun Mohan, Richard D. C. Moon, Nisaharan Srikandarajah, Samantha J. Mills, Andrew R. Brodbelt, Michael D. Jenkinson

Published in: Journal of Neuro-Oncology | Issue 2/2019

Abstract

Background

Incidental discovery accounts for 30% of newly-diagnosed intracranial meningiomas. There is no consensus on their optimal management. This review aimed to evaluate the outcomes of different management strategies for these tumors.

Methods

Using established systematic review methods, six databases were scanned up to September 2017. Pooled event proportions were estimated using a random effects model. Meta-regression of prognostic factors was performed using individual patient data.

Results

Twenty studies (2130 patients) were included. Initial management strategies at diagnosis were: surgery (27.3%), stereotactic radiosurgery (22.0%) and active monitoring (50.7%) with a weighted mean follow-up of 49.5 months (SD = 29.3). The definition of meningioma growth and monitoring regimens varied widely impeding relevant meta-analysis. The pooled risk of symptom development in patients actively monitored was 8.1% (95% CI 2.7–16.1). Associated factors were peritumoral edema (OR 8.72 [95% CI 0.35–14.90]) and meningioma diameter ≥ 3 cm (OR 34.90 [95% CI 5.17–160.40]). The pooled proportion of intervention after a duration of active monitoring was 24.8% (95% CI 7.5–48.0). Weighted mean time-to-intervention was 24.8 months (SD = 18.2). The pooled risks of morbidity following surgery and radiosurgery, accounting for cross-over, were 11.8% (95% CI 3.7–23.5) and 32.0% (95% CI 10.6–70.5) respectively. The pooled proportion of operated meningioma being WHO grade I was 94.0% (95% CI 88.2–97.9).

Conclusion

The management of incidental meningioma varies widely. Most patients who clinically or radiologically progressed did so within 5 years of diagnosis. Intervention at diagnosis may lead to unnecessary overtreatment. Prospective data is needed to develop a risk calculator to better inform management strategies.

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Title: Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes
Authors: Abdurrahman I. Islim
Midhun Mohan
Richard D. C. Moon
Nisaharan Srikandarajah
Samantha J. Mills
Andrew R. Brodbelt
Michael D. Jenkinson
Publication date: 01-04-2019
Publisher: Springer US
Keywords: Meningioma
Meningioma
Published in: Journal of Neuro-Oncology / Issue 2/2019
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-019-03104-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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