Risk-adapted Surveillance Strategies for Intracranial Meningiomas: A Retrospective Analysis of Post-operative Imaging

Abstract

Background: Epidemiological research shows that meningiomas occur at a rate of 6 cases per 100,000 people,
with women twice as likely as men to develop them. These tumors, which originate from arachnoid membrane
cells, represent 13–26% of all brain tumors. This retrospective single-center study evaluated the importance
of short-term post-operative imaging in patients with intracranial meningiomas, considering the extent of
surgical removal (Simpson grade) and histological classification (World Health Organization [WHO] grade).
Methods: The medical records of 283 patients who underwent surgical removal of intracranial meningiomas
between 2016 and 2024 were reviewed. Logistic regression analysis identified WHO grade and post-operative
radiation therapy as the most significant predictors of recurrence. Results: The risk of recurrence increased with
higher WHO grades, with odds ratios of 3.18 and 6.59 for Grade II and Grade III meningiomas, respectively,
compared with Grade I. The extent of resection within Simpson Grades I and II did not significantly affect early
recurrence rates. The WHO grade I meningiomas with complete or nearly complete resection have a very low
recurrence risk, suggesting that routine high-frequency post-operative imaging may have limited value in the
absence of new neurological symptoms. In contrast, WHO grade II and III meningiomas showed significantly
higher recurrence risks, warranting closer post-operative monitoring, especially in the early post-surgery period.
Conclusion: These findings support a risk-adapted surveillance strategy based on the WHO tumor grade and
clinical presentation, which could optimize resource utilization while maintaining oncological safety of the
patients. Further prospective multicenter studies are required to refine evidence-based follow-up protocols for
patients with intracranial meningiomas.