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Objective  This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas. Study Design  This study is a retrospective volumetric analysis. Setting  This study was conducted at a single institution. Participants  Patients who underwent subtotal resection of a WHO grade I skull base meningioma and postsurgical observation (July 1, 2007–July 1, 2017). Main Outcome Measure  The main outcome was radiographic tumor progression. Results  Sixty patients with residual skull base meningiomas were analyzed. The median (interquartile range) RTV was 1.3 (5.3) cm 3. Tumor progression occurred in 23 patients (38.3%) at a mean duration of 28.6 months postsurgery. The 1-, 3-, and 5-year actuarial progression-free survival (PFS) rates were 98.3, 58.6, and 48.7%, respectively. The Cox multivariate analysis identified increasing RTV (p  = 0.01) and history of more than 1 previous surgery (p  = 0.03) as independent predictors of tumor progression. In a Kaplan–Meier analysis for PFS, the RTV threshold of 3 cm 3 maximized log-rank testing significance between groups of patients dichotomized at 0.5 cm 3 thresholds (p  < 0.01). The 3-year actuarial PFS rates for meningiomas with RTV ≤3 cm 3 and >3 cm 3 were 76.2 and 32.1%, respectively. When RTV >3 cm 3 was entered as a covariate in the Cox model, it was the only factor independently associated with tumor progression (p  < 0.01). Conclusion  RTV was associated with tumor progression after subtotal resection of WHO grade I skull base meningioma in this cohort. An RTV threshold of 3 cm 3 was identified that minimized progression of the residual tumor when gross total resection was not safe or feasible. [ABSTRACT FROM AUTHOR]

Objectives  To better understand the risk-benefit profile of skull base meningioma resection in older patients, we compared perioperative complications among older and younger patients. Design  Present study is based on retrospective outcomes comparison. Setting  The study was conducted at a single neurosurgery institute at a quaternary center. Participants  All older (age ≥ 65 years) and younger (<65 years) adult patients treated with World Health Organization grade 1 skull base meningiomas (2008–2017). Main Outcome Measures  Perioperative complications and patient functional status are the primary outcomes of this study. Results  The analysis included 287 patients, 102 older and 185 younger, with a mean (standard deviation [SD]) age of 72 (5) years and 51 (9) years (p  < 0.01). Older patients were more likely to have hypertension (p  < 0.01) and type 2 diabetes mellitus (p  = 0.01) but other patient and tumor factors did not differ (p ≥ 0.14). Postoperative medical complications were not significantly different in older versus younger patients (10.8 [11/102] vs. 4.3% [8/185]; p  = 0.06) nor were postoperative surgical complications (13.7 [14/102] vs. 10.8% [20/185]; p  = 0.46). Following anterior skull base meningioma resection, diabetes insipidus (DI) was more common in older versus younger patients (14 [5/37] vs. 2% [1/64]; p  = 0.01). Among older patients, a decreasing preoperative Karnofsky performance status score independently predicted perioperative complications by logistic regression analysis (p  = 0.02). Permanent neurologic deficits were not significantly different in older versus younger patients (12.7 [13/102] vs. 10.3% [19/185]; p  = 0.52). Conclusion  The overall perioperative complication profile of older and younger patients was similar after skull base meningioma resection. Older patients were more likely to experience DI after anterior skull base meningioma resection. Decreasing functional status in older patients predicted perioperative complications. [ABSTRACT FROM AUTHOR]

This article discusses the issue of unplanned hospital readmissions following trans-sphenoidal surgery for Cushing's disease. The study analyzed data from a multi-institutional database of patients who underwent this surgery between 2003 and 2023. The results showed that 10.3% of patients experienced unplanned readmissions, with the most common reasons being hyponatremia, CSF leak evaluation, headache/nausea, and epistaxis. The study also found that an increased number of chronic medical conditions and the need for a return to surgery were associated with a higher chance of unplanned readmission. The authors suggest strategies to mitigate these readmissions, such as fluid restriction and optimizing chronic medical conditions. [Extracted from the article]