Intracranial Atypical Meningiomas: A Case Series

Background: Atypical meningiomas fall into a category World Health Organization Grade II, which have higher local recurrence rates and lower survival rates than their benign counterparts. The aim of this study is to review the outcome of newly diagnosed patients with atypical meningioma after therapy. Methods: We conducted a retrospective review of the medical records of patients having atypical meningiomas who were treated in our hospital between January 2005 and December 2014. Their age, sex, initial presentation, tumor location, tumor size, extent of resection, tumor recurrence or tumor progression, duration of follow-up, adjuvant therapy, and outcome were reviewed. Results: There were 27 consecutive patients (15 male and 12 female) having fresh intracranial atypical meningiomas treated in our hospital between January 2005 and December 2014. Their mean age at diagnosis was 60.81 years. Twenty-three patients (85.19%) underwent total resection of the tumor, whereas 4 patients (14.81%) had partial resection of their tumors during their first time of surgery. Fifteen patients (55.56%) had finished adjuvant radiotherapy. Nine patients (33.33%) had tumor progression or recurrence during follow-up, and 4 of them were proved to have malignant transformation to anaplastic meningiomas in the following operations. The mean time to tumor progression or recurrence of these nine patients was 17.67 months. Nineteen patients (70.37%) had a favorable outcome, 7 patients (25.93%) had an unfavorable outcome, and we lost 1 patient (3.7%) due to disease progression. Conclusions: Surgery remains the standard treatment to atypical meningioma, and postoperative adjuvant radiotherapy is still controversial especially to those who undergo total surgical resection of the tumors. Our study reveals that early postoperative adjuvant radiotherapy seems to play a role in local control. Atypical meningioma can have malignant transformation to anaplastic meningioma, so aggressive treatment and follow-up are essential to manage this particular tumor.