Analysis of Intracranial Meningioma Recurrence after Surgical Management

Background: Meningioma is one of the well-known common primary brain neoplasms that account for more than 20% of intracranial tumors. Intracranial meningioma recurrence after surgery has long been recognized, although the mechanism of recurrence remains unclear. 
Objective: To analyse impact of pre-operative and peri-operative measurements in relation to pathological outcome. 
Patients and Methods: Retrospectively analysed 72 patients with meningiomas (45) female and (27) male who were treated surgically and re-operated again at our Hawler Teaching Hospital and West Emergency Hospital from June 2017 until June 2021 in Erbil Governorate in Northern Iraq.  Clinical characteristics and demographics possibly associated with tumor recurrence were assessed, including gender, age, clinical symptoms, tumor location, pathology data, and radiotherapy and recurrence rate were closely studied. 
Results: A total of 72 cases with meningioma included in the research, in which 17 cases recurrent cases were observed, in total of 72 cases 58 were benign (Grade I), and 14 were atypical/ malignant (Grade II/III). The mean age of patients (SD) was ± 51.2 years and a follow-up duration of 4 years. Overall recurrence rates 23.6% with Male to Female ratio of 0.55:1. Age, and gender could not be demonstrated as significant association factor in tumor recurrence. Factors significantly associated with tumor relapse in the analysis were tumor location at the Foramen magnum and Optic Nerve, both being (50%). The rates of recurrence were significantly high when the degree of removal (by Simpsons Classification) was for grade three (50%) and for grade four and five (70%), compared with 6.3% and 8.8% for grade one or two, respectively. A high recurrence rate was detected when the adjuvant was not received compared with the patients who received radiotherapy. Majority of patients had better outcome. 
Conclusion: it was concluded from this study that Meningioma recurrence is well recognized and there are many factors including age, gender, extend of tumor resection, location, histological type of tumor and adjuvant therapy that would determine the pathological outcome and impact on patient’s life.