Optimization of surgical strategy in parasagittal meningiomas. A 1605-case study

Based on experience in 1605 major surgeries for parasagittal meningiomas performed from 1954 to 1995, a statistical study was performed with the aim to evaluate the influence of various surgical and other factors on immediate and long-term results in our patients. Having analyzed the material with Excel 5.0, we have found more than 70 factors, significantly (p < 0.05 in all the cases) influencing the immediate and long-term surgical outcomes. Here we present the analysis of influence of details of surgical strategy and technique on quality of life in our patients early and up to 15 years after surgery. We have observed a decrease of postoperative mortality from 24.3% in 1954-1964 to 3.1% in the last decade and an increase of mean Karnofsky rating in our patients to 82 points at discharge from the hospital and to 87 points 1 year after surgery; tumor regrowth was observed in 29.3% of the survivors in a 15-year follow-up period. We attempted to find optimum between surgical radicality (the main factor besides malignancy influencing tumor regrowth, p < 0.001) and presumably concerned invalidation, but found that more “aggressive” surgical manipulations, such as bilateral craniotomy even in unilateral tumors, wide resection of involved dura, marginal sinus resection and even reconstruction (performed in 27 cases, in one of them with a complete reconstruction a plastic superior sagittal sinus in the middle third) correlated (p < 0.01) with the increase of Karnofsky score in our patients after surgery. Correspondingly, the increase of radicality of surgery evaluated with the Simpson gradation correlated with the increase of quality of life in all the comparable groups of patients, not only on long term, but also at discharge from the clinic. The details will be discussed. We can conclude, that a reasonable increase of surgical radicality does never produce extra invalidation or mortality but provides better quality of life in patients with parasagittal meningiomas.