J Korean Neurosurg Soc.  2014 Sep;56(3):194-199. 10.3340/jkns.2014.56.3.194.

Clinical Features and Treatment Outcome of Chordoid Meningiomas in a Single Institute

• Jee TK
• Jo KI
• Seol HJ
• Kong DS
• Lee JI
• Shin HJ

• KMID: 2339956
• DOI: http://doi.org/10.3340/jkns.2014.56.3.194

Abstract

OBJECTIVE
Meningioma is the second most common primary central nervous system neoplasm. In contrast, chordoid meningioma is rare; due to the paucity of cases, little is known about its clinical features or treatment outcomes. The objectives of this study were to describe the clinical characteristics and outcomes for patients with chordoid meningioma.
METHODS
In total, 16 patients, with newly diagnosed chordoid meningioma who underwent surgical excision between 1999 and 2012 were included. We retrospectively evaluated the medical records, radiological findings, and pathological findings. The median follow-up period was 56.5 (range, 3-170) months. The MIB-1 labeling index ranged from 1 to 26.60% (median, 5.04).
RESULTS
Simpson grade I, II, and III resections were performed in four, nine, and three patients, respectively. The overall recurrence rate was 37.5%. Overall progression-free survival (PFS) after resection was 94.7 months (95% CI=62.9-126.6). Of the 4 patients with Simpson grade I resection, recurrence occurred in one patient. Among the Simpson grade II and III resection groups, eight patients underwent adjuvant radiation therapy and they showed significantly longer PFS (121 months, 95% CI=82.1-159.9) than the patients who underwent surgery alone (40.5 months, 95% CI=9.6-71.3) by the log-rank test (p<0.05).
CONCLUSION
Chordoid meningiomas are difficult to manage and have a high rate of recurrence. Complete resection of the tumor is a key determinant of better outcomes. Adjuvant radiation therapy is recommended, eparticulary when Simpson grade I resection was not achieved.

Keyword

Chordoid meningioma; MIB-1 labeling index; Adjuvant radiation therapy

MeSH Terms

Central Nervous System
Disease-Free Survival
Follow-Up Studies
Humans
Medical Records
Meningioma*
Recurrence
Retrospective Studies
Treatment Outcome*

Figure

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  Fig. 1 Cumulative progression-free survival rate. Median PFS was 40.5 months (95% CI=9.6-71.3) for surgery alone and 121 months (95% CI=82.1-159.9) for surgery with adjuvant radiation therapy (log-rank test, p<0.027).

• 

  Fig. 2 Estimated growth rate based on MRIs, obtained before and after the diagnosis of meningioma. A and B : MRIs of patient no. 10. A was obtained 28 months before the initial diagnosis of meningioma (B). Estimated minimum growth rate was 1256 mm3/month. C and B : MRIs of patient no. 11. C was 20 months before the initial diagnosis of meningioma (D). Estimated minimum growth rate was 221 mm3/month.

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  Fig. 3 Brain MRI of the patient with CM at pineal area. (A) is axial T1-weighted contrast-enhanced MRI at initial diagnosis of patient no. 2. it showed small enhancing mass at pineal area with mild ventriculomegaly. After endoscopic biopsy and third ventriculostomy, MRI shows slightly decreased ventricular size. After Simpson grade 1 resection with occipitotranstentorial approach, postoperative MRI (C) shows no definite residual mass. Three months after second surgery, enhanced CT (C) was obtained for follow up study and it revealed recurred enhancing masses at pineal area and the right-side foramen of Monro. CM : chordoid meningioma.

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  Fig. 4 Spine MRI of the patient with CM at pineal area. Spine MRI was obtained 6 months after resection surgery due to intractable back pain. Sagittal T1-weighted contrast-enhanced MRI (A) showed multiple dural masses at the level of L3-4 (B) and L5-S1 (C). CM : chordoid meningioma.

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