MRI and CT have contributed much to brain tumor care over the years

The prognosis for patients with meningiomas, the most common tumors of the brain and spinal cord, has improved in the decades since advanced imaging began aiding detection.

The improvement may owe as much to modern histopathological, immunohistochemical and genetic techniques as to imaging. Either way, the upshot is demonstrably better progression-free survival, according to a review of a European hospital’s records running in the October edition of Clinical Neurology and Neurosurgery.

Stefan Linsler, MD, and colleagues at Saarland University Hospital in Germany compared data on two groups of surgery patients treated at their institution. Those in the first group were operated on prior to 1985, when neither CT nor MRI was available. Those in the second group were treated after that year.

In total, the researchers analyzed 1,549 meningioma patients whose surgeries spanned the years from 1968 to 2011.

Follow-up reached as far back as 38 years, with average follow-up times of 17.9 ± 9.3 years for group 1 and 9.2 ± 4.3 years for group 2.

The team found that the number of older patients who had surgical treatment (those in their 60s, 70s and 80s) was significantly increased in the second group, while the number of perioperative complications was about equal (17.8 percent vs. 18.8 percent).

In the post-1985 group, perioperative morbidity was cut almost in half, dropping from 2.2 percent to 1.2 percent.  

Interestingly, the study also showed a notable increase in the incidence of WHO grade II meningiomas in patients treated after 1985.

Commenting on this latter finding in their discussion, the authors point out that the diagnosis of a WHO grade II meningioma largely depends on the different experience levels of the consulted neuropathologist.

“This result is important since in the literature no clear correlation between the histological grading and the rate of recurrence in meningiomas has been reported so far,” they write.

As for the impact of advanced imaging, Linsler et al. point out that CT and MR help clinicians formulate a “better preoperative surgical strategy” that can result in “better surgical outcomes and an improved postoperative resection control, impacting the progression-free survival time, which in this study was proven to be improved after the year of 1985.”

The numbers of partial resections were increased in the post-1985 group, an effect the authors attribute to the availability of postoperative imaging, especially MRI.

Today’s advanced imaging “has a higher sensitivity to detect even small remnant tumors compared to the first group, where the extent of tumor resection was documented by the neurosurgeon,” they note.

“[O]ur study demonstrates that the prognosis of meningioma patients could be improved by the introduction of imaging diagnostic tools in the last decades,” Linsler et al. write. “In addition, genetic diagnostic methods should be more widely used in order to add to histopathological markers to finally improve the estimation of a patient’s prognosis.”