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



Islim, Abdurrahman I ORCID: 0000-0001-9621-043X, Mohan, Midhun, Moon, Richard DC, Srikandarajah, Nisaharan, Mills, Samantha J, Brodbelt, Andrew R and Jenkinson, Michael D ORCID: 0000-0003-4587-2139
(2019) Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes. JOURNAL OF NEURO-ONCOLOGY, 142 (2). pp. 211-221.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.

Item Type: Article
Uncontrolled Keywords: Asymptomatic, Incidental, Meningioma, Meta-analysis, Systematic review
Depositing User: Symplectic Admin
Date Deposited: 21 Jan 2019 09:21
Last Modified: 19 Jan 2023 01:06
DOI: 10.1007/s11060-019-03104-3
Open Access URL: https://link.springer.com/article/10.1007/s11060-0...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3031548