WP1-14 A systematic review to evaluate different management strategies for incidental intracranial meningiomas. Issue 3 (14th February 2019)

• Record Type: Journal Article
• Authors: Mohan, M; Islim, A; Moon, RDC; Srikandarajah, N; Brodbelt, AR; Mills, SJ; Jenkinson, MD
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 90:Issue 3(2019)
• Page Start: e5
• Page End: e5
• Publication Date: 2019-02-14
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2019-ABN.15
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objectives: Evaluate the outcomes of differing management strategies for incidental intracranial meningiomas. Design: Systematic review. Subjects: Studies with ≥10 patients≥16 years of age diagnosed radiologically with an incidental intracranial meningioma. Methods: PRISMA compliant methods were used to scan 6 databases up to September 2017. PROSPERO ID: CRD42017077928. Results: Twenty retrospective studies (n=2130 patients) were included. Initial management strategies at diagnosis were: 27% (n=560) surgery, 22% (n=450) SRS and 51% (n=1040) active monitroing with a mean follow-up of 49.5 months (SD=29.3). 21% (n=220) of patients in the active monitoring cohort eventually had or were recommended an intervention due to: radiological progression (n=153), development of symptoms (n=66) and patient preference (n=1). Mean time-to-intervention was 24.8 months (SD=18.2). 94% (n=207) of interventions were within 5 years. The definition of 'growth' and the radiological surveillance regimens varied widely. Morbidity rates following surgery and SRS, accounting for cross over, were 15% and 22% respectively. Surgery revealed benign histology in 94% of the cases. Quality of life is improperly examined. Conclusions: The management of patients with incidental intracranial meningiomas varies widely. Most patients who develop clinical or radiological progression will do so within 5 years of diagnosis. Intervention at diagnosis may result in unnecessary overtreatment. Prospective data is needed to develop a risk calculator for managing incidental meningioma.