Cranial meningioma with bone involvement: surgical strategies and clinical considerations

Abigail L Clynch; Max Norrington; Mohammad A Mustafa; George E Richardson; John A. Doherty; Thomas J Humphries; Conor S Gillespie; Sumirat M Keshwara; Catherine Mcmahon; Abdurrahman Islim; Michael D. Jenkinson; Christopher P Millward; Andrew R Brodbelt

doi:10.1007/s00701-023-05535-4

Cranial meningioma with bone involvement: surgical strategies and clinical considerations

Abigail L Clynch, Max Norrington, Mohammad A Mustafa, George E Richardson, John A. Doherty, Thomas J Humphries, Conor S Gillespie, Sumirat M Keshwara, Catherine Mcmahon, Abdurrahman Islim, Michael D. Jenkinson, Christopher P Millward, Andrew R Brodbelt

Division of Neuroscience

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients.

METHODS: A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0.

RESULTS: Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%).

CONCLUSION: Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.

Original language	English
Pages (from-to)	1355-1363
Number of pages	9
Journal	Acta Neurochirurgica
Volume	165
Issue number	5
Early online date	6 Mar 2023
DOIs	https://doi.org/10.1007/s00701-023-05535-4
Publication status	Published - 1 May 2023

Keywords

Adult
Female
Humans
Middle Aged
Meningioma/diagnostic imaging
Polymethyl Methacrylate/therapeutic use
Retrospective Studies
Titanium
Skull/diagnostic imaging
Postoperative Complications/epidemiology
Decompressive Craniectomy/adverse effects
Meningeal Neoplasms/diagnostic imaging
Bone involvement
Cranioplasty
Surgical technique
Meningioma

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Clynch, A. L., Norrington, M., Mustafa, M. A., Richardson, G. E., Doherty, J. A., Humphries, T. J., Gillespie, C. S., Keshwara, S. M., Mcmahon, C., Islim, A., Jenkinson, M. D., P Millward, C., & Brodbelt, A. R. (2023). Cranial meningioma with bone involvement: surgical strategies and clinical considerations. Acta Neurochirurgica, 165(5), 1355-1363. https://doi.org/10.1007/s00701-023-05535-4

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title = "Cranial meningioma with bone involvement: surgical strategies and clinical considerations",

abstract = "BACKGROUND: Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients.METHODS: A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0.RESULTS: Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%).CONCLUSION: Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.",

keywords = "Adult, Female, Humans, Middle Aged, Meningioma/diagnostic imaging, Polymethyl Methacrylate/therapeutic use, Retrospective Studies, Titanium, Skull/diagnostic imaging, Postoperative Complications/epidemiology, Decompressive Craniectomy/adverse effects, Meningeal Neoplasms/diagnostic imaging, Bone involvement, Cranioplasty, Surgical technique, Meningioma",

author = "Clynch, {Abigail L} and Max Norrington and Mustafa, {Mohammad A} and Richardson, {George E} and Doherty, {John A.} and Humphries, {Thomas J} and Gillespie, {Conor S} and Keshwara, {Sumirat M} and Catherine Mcmahon and Abdurrahman Islim and Jenkinson, {Michael D.} and {P Millward}, Christopher and Brodbelt, {Andrew R}",

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day = "1",

doi = "10.1007/s00701-023-05535-4",

language = "English",

volume = "165",

pages = "1355--1363",

journal = "Acta Neurochirurgica",

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Clynch, AL, Norrington, M, Mustafa, MA, Richardson, GE, Doherty, JA, Humphries, TJ, Gillespie, CS, Keshwara, SM, Mcmahon, C, Islim, A, Jenkinson, MD, P Millward, C & Brodbelt, AR 2023, 'Cranial meningioma with bone involvement: surgical strategies and clinical considerations', Acta Neurochirurgica, vol. 165, no. 5, pp. 1355-1363. https://doi.org/10.1007/s00701-023-05535-4

TY - JOUR

T1 - Cranial meningioma with bone involvement

T2 - surgical strategies and clinical considerations

AU - Clynch, Abigail L

AU - Norrington, Max

AU - Mustafa, Mohammad A

AU - Richardson, George E

AU - Doherty, John A.

AU - Humphries, Thomas J

AU - Gillespie, Conor S

AU - Keshwara, Sumirat M

AU - Mcmahon, Catherine

AU - Islim, Abdurrahman

AU - Jenkinson, Michael D.

AU - P Millward, Christopher

AU - Brodbelt, Andrew R

PY - 2023/5/1

Y1 - 2023/5/1

N2 - BACKGROUND: Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients.METHODS: A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0.RESULTS: Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%).CONCLUSION: Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.

AB - BACKGROUND: Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients.METHODS: A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0.RESULTS: Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%).CONCLUSION: Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.

KW - Adult

KW - Female

KW - Humans

KW - Middle Aged

KW - Meningioma/diagnostic imaging

KW - Polymethyl Methacrylate/therapeutic use

KW - Retrospective Studies

KW - Titanium

KW - Skull/diagnostic imaging

KW - Postoperative Complications/epidemiology

KW - Decompressive Craniectomy/adverse effects

KW - Meningeal Neoplasms/diagnostic imaging

KW - Bone involvement

KW - Cranioplasty

KW - Surgical technique

KW - Meningioma

UR - http://www.scopus.com/inward/record.url?scp=85149396173&partnerID=8YFLogxK

U2 - 10.1007/s00701-023-05535-4

DO - 10.1007/s00701-023-05535-4

M3 - Article

C2 - 36877330

SN - 0001-6268

VL - 165

SP - 1355

EP - 1363

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

IS - 5

ER -

Cranial meningioma with bone involvement: surgical strategies and clinical considerations

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