Felix Behling, Michael Bruneau, Jürgen Honegger, Moncef Berhouma, Emmanuel Jouanneau, Luigi Cavallo, Jan Frederick Cornelius, Mahmoud Messerer, Roy Thomas Daniel, Sébastien Froelich, Diego Mazzatenta, Torstein Meling, Dimitrios Paraskevopoulos, Pierre-Hugues Roche, Henry W. S. Schroeder, Idoya Zazpe, Eduard Voormolen, Massimiliano Visocchi, Ekkehard Kasper, Jens Schittenhelm, Marcos Tatagiba
- Background: Invasive growth of meningiomas into CNS tissue is rare but of prognostic significance. While it has entered the WHO classification as a stand-alone criterion for atypia, its real prognostic impact is controversial. Retrospective analyses, on which the current evidence is based, show conflicting results. Discordant findings might be explained by different intraoperative sampling methodologies that lead to heterogenous histopathological diagnostic yield.
Methods: To assess the currently applied sampling methods in the light of the novel prognostic impact of CNS invasion, an anonymous survey was designed and distributed via the EANS website and E-Mail newsletter. The survey was open from June 5th 2022 until July 15th 2022.
Results: Overall, 155 responses were submitted, and after exclusion of 13 incomplete responses, 142 (91.6%) datasets were used for further statistical analysis. Only 47.2% of the participants’ institutions utilize a standardized sampling method duringBackground: Invasive growth of meningiomas into CNS tissue is rare but of prognostic significance. While it has entered the WHO classification as a stand-alone criterion for atypia, its real prognostic impact is controversial. Retrospective analyses, on which the current evidence is based, show conflicting results. Discordant findings might be explained by different intraoperative sampling methodologies that lead to heterogenous histopathological diagnostic yield.
Methods: To assess the currently applied sampling methods in the light of the novel prognostic impact of CNS invasion, an anonymous survey was designed and distributed via the EANS website and E-Mail newsletter. The survey was open from June 5th 2022 until July 15th 2022.
Results: Overall, 155 responses were submitted, and after exclusion of 13 incomplete responses, 142 (91.6%) datasets were used for further statistical analysis. Only 47.2% of the participants’ institutions utilize a standardized sampling method during meningioma surgery, and 54.9% regularly attempt a complete sampling of the area of contact between the meningioma surface and adjacent CNS tissue. The majority did not change their sampling practice since the WHO classification of 2016 (77.5%). More participants agreed with the statement that CNS invasion could be detected intraoperatively (82.4%) compared to detection by preoperative MR-imaging (58.5%). Intraoperative suspicion of CNS invasion changes the sampling for half of the participants (49.3%). An additional sampling of suspicious areas of interest is done in 53.5%. Dural attachment and adjacent bone are more readily sampled separately if tumor invasion is suspected (72.5% and 74.6%, respectively), compared to meningioma tissue with signs of CNS invasion (59.9%).
Conclusions: Current intraoperative sampling methods during meningioma resection vary among neurosurgical departments. In light of the integration of CNS invasion into the WHO classification, insufficient awareness of the need for a structured and complete sampling to optimize the diagnostic yield of CNS invasion exists. A standardized sampling recommendation is needed.…
