Article Text

Download PDFPDF
TM1-5 Optimising observation strategies for incidentally discovered intracranial meningiomas
  1. AI Islim1,2,
  2. M Mohan1,
  3. RDC Moon1,
  4. SJ Mills1,
  5. AR Brodbelt1,
  6. BJ Haylock3,
  7. N Rathi1,
  8. R Kolamunnage-Dona2,
  9. MD Jenkinson1,2
  1. 1The Walton Centre NHS Foundation Trust, Liverpool, UK
  2. 2Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  3. 3The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK


Objectives Develop a model to identify incidental meningiomas at risk of observation failure.

Design Retrospective study (2007–2015).

Subjects 385 patients. Mean age 62.6 years.

Methods Observation failure was defined as: new symptoms, MRI progression (absolute growth rate 2 cm3/year or absolute growth rate 1 cm3/year +relative growth rate 30%/year) or loss of treatment options. A prognostic model was developed using MRI and patient comorbidity.

Results Over a median of 36 months, 44 (10.9%) meningiomas failed observation. Median time to failure was 33 months. Model parameters were based on statistical and clinical considerations and included: increasing tumour size (HR=2.17 [95% CI=1.53–3.09], p<0.001), peritumoural signal change (HR=1.58 [95% CI=0.65–3.85], p=0.313), FLAIR/T2 hyperintense meningiomas (HR=10.6 [95% CI=5. 39–21.0], p<0.001) and proximity to neurovascular structures (HR=1.38 [95% CI=0.74–2.56], p=0.314). Patients were stratified based on the model into low, medium and high-risk groups and rates of failed observation at 5 years were 3%, 28% and 75% respectively. Low-risk patients had small meningiomas, free of all risk factors. After 5 years of follow-up the probability of failure plateaued in all risk groups. Older patients with comorbidities were 15-times more likely to die than to receive intervention at 5 years following diagnosis, regardless of risk group.

Conclusions Most meningiomas remain clinically and radiologically stable. Stratifying follow-up according to risk-group has the potential to reduce the cost to healthcare.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.