Ayerbe et al identified risk factors for recurrence of an intracranial meningioma following surgical resection. These can help identify a patient who may benefit from closer monitoring and more aggressive management. The authors are from Hospital 12 de Octubre in Madrid, Spain.
Parameters from multivariate analysis:
(1) extent of resection based on the Simpson Grade
(2) histologic type
(3) CT scan appearance after enhancement
(4) number of mitoses in 10 high power microscopic fields (x400)
In Table 7 the relative risk for each factor was from 2.1 to 2.3. Table 6 and Figure 4 show the effect of Simpson grades on risk. This data can be used to construct a risk score (not included in the article).
Parameter |
Finding |
Points |
Simpson grade |
I |
0 |
|
II |
1 |
|
III to V |
2 |
histologic grade |
conventional |
0 |
|
unconventional (atypical or malignant) |
1 |
CT scan |
homogeneous |
0 |
|
heterogeneous |
1 |
mitoses per 10 hpf |
0 to 2 |
0 |
|
>= 3 |
1 |
where:
• Heterogeneous CT appearance may be due to necrosis in the tumor.
• CT signs of an unconventional meningioma include irregular margin and peritumoral edema (page 929).
• The number of mitoses would be affected by the area for the microscopic field.
total risk score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A meningioma that is low risk for recurrence has no risk factors (score = 0). These showed a recurrence rate of 4% at 5 years and 18% at 10 years).
• The authors describe intermediate and high risk groups on page 927. Based on the description a score of 1 would indicate intermediate risk while 2 or greater high risk.
Specialty: Hematology Oncology, Surgery, general, Neurology