Recurrence in Intracranial Meningiomas: A Retrospective Analysis of Tumor Location Differences

Introduction: Meningiomas are the most common intracranial tumor, with surgical resection being the primary treatment. However, complete resection is challenging in certain regions such as the posterior fossa. We aimed to compare recurrence patterns and clinical outcomes among foramen magnum, cerebellopontine angle (CPA), and supratentorial meningiomas.

Methods: A retrospective review was conducted on adult patients who underwent meningioma resection between 2000 and 2023. Data were extracted from electronic medical records, including preoperative and postoperative tumor volumes, symptoms, neurological deficits, radiation therapy, and recurrence outcomes. Exclusion criteria included incomplete records, non-WHO grade I pathology, prophylactic radiation, neurofibromatosis type 2, or prior childhood leukemia/radiation. Statistical analysis was performed using R software, with chi-squared and Fisher’s exact tests comparing outcomes by tumor location, and multivariate logistic regression models evaluating recurrence risks.

Results: A total of 216 meningiomas from 215 patients were included, categorized by tumor location: foramen magnum (n=22), CPA (n=88), and supratentorial (n=106). The mean age at diagnosis was 56.0 years (SD=12.4), with no significant difference among locations (p=0.948). A higher proportion of females (76.9%) was observed (p=0.040), consistent with the known female predominance of meningiomas. Gross total resection was achieved in 73.1% of cases, with significant variation by location (p < 0.001). CPA tumors had the highest recurrence rate (25%) compared to supratentorial (9.4%) and foramen magnum (4.5%) tumors (p=0.004). CPA tumors had a higher recurrence risk than supratentorial tumors (OR: 0.34; 95% CI: 0.12–0.90; p=0.04) and foramen magnum tumors (OR: 7.45; 95% CI: 1.25–145.27; p=0.07). Lastly, subtotal resection significantly increased recurrence risk (OR: 5.81; 95% CI: 2.24–15.47; p< 0.001).

Conclusion : Our findings show that CPA meningiomas carry a significantly higher recurrence risk, even after accounting for extent of resection. Emerging molecular data support the theory that meningioma genetics differ depending on location, and that certain genetic drivers contribute to an increased likelihood of recurrence. Our findings may have significant implications for both prognosis and the development of targeted therapies for meningiomas, but additional studies including additional institutions and molecular profiling data are needed.