1. Neurology Case Conference 4 PROGNOSIS

2. Mortality and Morbidity Some patients die with meningioma and not from it Meningiomas usually grow slowly, and they may produce severe morbidity before causing death 5-year Survival Rate: 73-94%. Predictive factors of high postoperative morbidity rate: – Patient: advanced age, comorbid states such as diabetes or coronary artery disease, preoperative neurological status – Tumor: location, size, consistency, vascularity, vascular or neural involvement, histopathology – Previous surgery or radiation therapy.

3. Prognosis Patients whose meningiomas are completely resected usually have an excellent prognosis. Total removal of the meningioma is possible in about 80% of patients with benign tumors; about three-quarters of these patients survive at least 10 years without a recurrence.

4. Recurrence Increase Recurrace Rate: – Incomplete Removal of Meningiomas – Malignant Meningiomas – Atypical Meningiomas Addition of post-operative radiation to incomplete resections improves both progression free survival and improves overall

5. Simpson GradeCompleteness of Resection 10-year Recurrence Grade I complete removal including resection of underlying bone and associated dura 9% Grade II complete removal + coagulation of dural attachment 19% Grade III complete removal w/o resection of dura or coagulation 29% Grade IVsubtotal resection40%

6. Performance Status Scale – Attempt to quantify patients’ general well-being – If can receive chemotherapy – Need for dose adjustment – Required intensity of palliative care – Quality of life Karnofsky Performance Status Scoring ECOG Performance Status

7. ECOG PERFORMANCE STATUS* GradeECOG 0 Fully active, able to carry on all pre-disease performance without restriction 1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work 2 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours 3 Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours 4 Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair 5 Dead

8. Able to carry on normal activity and to work; no special care needed. 100 Normal no complaints; no evidence of disease. 90 Able to carry on normal activity; minor signs or symptoms of disease. 80 Normal activity with effort; some signs or symptoms of disease. Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed. 70 Cares for self; unable to carry on normal activity or to do active work. 60 Requires occasional assistance, but is able to care for most of his personal needs. 50 Requires considerable assistance and frequent medical care. Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly. 40Disabled; requires special care and assistance. 30 Severely disabled; hospital admission is indicated although death not imminent. 20 Very sick; hospital admission necessary; active supportive treatment necessary. 10Moribund; fatal processes progressing rapidly. 0Dead KARNOFSKY PERFORMANCE STATUS SCALE DEFINITIONS RATING (%) CRITERIA

9. Radhakrishnan and colleagues 3 followed 57 asymptomatic meningiomas for 32 months. None of the patients became symptomatic. A subset of 10 patients showed growth rates of 0.24 cm per year; however, 35 patients showed no growth during an average 29-month follow-up. In a single series of 1799 meningiomas from 1582 patients followed for an average of 13 years postresection, the nonrecurrence rate was 93% of WHO I tumors, 65% of WHO II, and 27.3% of WHO III. 16 Other studies have shown higher recurrence rates after surgery alone. 17 For patients undergoing subtotal resection and radiation therapy, the 5-year progression-free survival for WHO grades I and II was 98% and, for WHO III, slightly less than 50%. 183161718