Table 1.
Summary of Results of Italian survey about surgical management of MEP, stratified according the investigated domains
| Demographics and other respondent characteristics | ||
| Query | Response | N (%) |
| Indicate the type of hospital that you work for | Academic Hospital | 17 (33.3) |
| Public Hospital | 35 (66,7) | |
| Indicate your current working position | Chief | 21 (41.2) |
| Full-time Professor | 8 (15.6) | |
| Senior Researcher | 3 (5.8) | |
| Hospital Clinician | 19 (37.5) | |
| What is your level of experience in the surgical management of cranial meningiomas? | < 10 years | 10 (19.6) |
| 10–15 years | 7 (13.7) | |
| > 15 years | 34 (66.7) | |
| What is your age group? | 35–45 | 19 (37.3) |
| 46–55 | 13 (25.4) | |
| > 55 | 19 (37.3) | |
| Gender | Male | 45 (88.2) |
| Female | 6 (11.8) | |
| In which region do you work? | North | 29 (56.9) |
| Center | 14 (27.5) | |
| South | 8 (15.6) | |
| How many patients diagnosed with meningioma are treated on average each year at your center? | < 50 cases/year | 14 (27.5) |
| 50–99 cases/year | 25 (49) | |
| > = 100 cases/year | 12 (23.5) | |
| What treatments are currently available in your Center? (multiple choice available) | Endoscopic surgery | 36 (70.6) |
| Stereotactic radiosurgery | 28 (55.9) | |
| Fractionated stereotactic radiotherapy | 38 (74.5) | |
| Which preoperative MRI protocol do you use? | Standard MRI | 6 (11.8) |
| Advanced imaging protocol | 45 (88.2) | |
| Select the intraoperative tools available in your Department (multiple choice available) | Neuronavigation | 51 (100) |
| Electrophysiological monitoring/stimulation | 46 (90.2) | |
| Intraoperative ultrasound | 31 (60.8) | |
| 5ALA (to evaluate the bone infiltration) | 14 (27.5) | |
| Intraoperative CT | 10 (19.6) | |
| Intraoperative laser | 6 (11.8) | |
| Elderly definition and risk scales | ||
| Query | Response | N (%) |
| What is the percentage of elderly patients do you operate in a year? | 10–20 % | 8 (15.7) |
| 20–50% | 39 (76.5) | |
| > 50% | 4 (7.8) | |
| How do you define a patient as being elderly? | > 70 years | 34 (66.7) |
| > 75 years | 15 (29.4) | |
| > 80 years | 2 (3.9) | |
| Which grading system do you use to assess the preoperative risk in elderly patients) (multiple choice available) | ASA | 51 (100) |
| CCI | 7 (13.7) | |
| ECOG | 10 (19.6) | |
| Other: CRGS and Clinical Frailty Scale | 2 (3.9) | |
| Do you discuss cases within a multidisciplinary group for the stratification of the surgical risk and definition of the best therapeutic option (Surgery versus SRS, or debulking and subsequent SRS)? | Always | 19 (37.3) |
| Never | 5 (9.8) | |
| In selected cases | 27 (52.9) | |
| - midline lesions < 3 cm maximum diameter | - 14 (51.8) | |
| - high comorbidity risk | - 5 (18.6) | |
| - both | - 8 (29.6) | |
| Does the factor of age have an influence on the surgical indication? | Only for those cases with high comorbidity preoperative risk | 39 (76.4) |
| Always | 11 (21.5) | |
| Never | 1 (1.9) | |
| Questions on treatment options | ||
| Query | Response | N (%) |
| Does the factor of age play a role when deciding between an endoscopic approach compared to the classic microsurgical one? | Always | 3 (5.9) |
| Never | 38 (74.5) | |
| In selected cases | 10 (19.6) | |
| For which meningiomas do you select the endoscopic approach as the first option? (open question) | Midline lesions with a maximum diameter < 3 cm | 39 (76.4) |
| For those cases with high comorbidity preoperative risk | 20 (39.2) | |
| Residual management | 34 (66.7) | |
| In what percentage of median skull base meningiomas (tuberculum, planum, Clivus) is the endoscopic procedure the first choice? (open question) | < 10% | 28 (54.8) |
| 11–30% | 17 (33.3) | |
| > 31% | 6 (11.8) | |
| Does the factor of age influence the choice of a SRS approach compared to "open" surgery? | Always | 4 (7.8) |
| Never | 15 (29.4) | |
| In selected cases | 32 (62.8) | |
|
For which meningiomas do you select the neuroradiosurgical approach as the first option? (open question) |
Midline lesions with a maximum diameter < 3 cm | 39 (76.4) |
| For those cases with high comorbidity preoperative risk | 20 (39.2) | |
| Residual management | 34 (66.7) | |
| In cases of meningiomas of the convexity associated with significant hyperostosis, is the cranioplasty procedure performed during the same surgical procedure? | Always | 48 (94) |
| Never | 3 (6) | |
|
Which material do you use for cranioplasty procedure? Responders 44/48 |
Custom made | 13 (29.5) |
| Acrylic/Alumina Ceramics/Methyl- Methacrylate | 27 (61.4) | |
| Titanium | 4 (9.1) | |
| How do you manage elderly patients with asymptomatic incidental meningiomas without edema | Preventive SRs | 0 |
| Preventive surgery | 0 | |
| Wait and scan | 51 (100) | |
| How do you manage elderly patients with asymptomatic incidental meningiomas showing a volumetric MRI progression | Wait and see with regular MRI follow-up | 12 (23.6) |
| SRs | 6 (11.8) | |
| Surgery | 33 (64.6) | |
| Questions on perioperative and postoperative management | ||
| Query | Response | N (%) |
| For which cases is preoperative AGF and embolization used (open question) | Always | 1 (1.9) |
| Never | 8 (15.6) | |
| In selected cases: | 42 (84.5) | |
| - vascular encasement | - 15 (35.7) | |
| - skull base lesions | - 25 (59.5) | |
| - giant supratentorial lesions | - 7 (16.7) | |
| In cases of meningiomas with incomplete removal and WHO diagnosis I what is the postsurgical treatment of choice? | Wait and scat with regular MRI follow-up | 42 (82.4) |
| SRs | 9 (17.6) | |
| In cases of meningiomas with incomplete removal and WHO diagnosis II what is the postsurgical treatment of choice? | Wait and scan with regular MRI follow-up | 17 (33.3) |
| fRT/SRs | 33 (64.8) | |
| Adrotherapy / Proton Therapy | 1 (1.9) | |
| In cases of meningiomas with incomplete removal and WHO diagnosis III what is the postsurgical treatment of choice? : | fRT/SRs | 22 (43.1) |
| Adrotherapy /Proton Therapy | 29 (56.9) | |
|
Do you perform early (within 24 hours) DVT/TE prophylaxis in elderly patients operated for meningioma? Total responders 26/51 |
Yes | 24 (92.4) |
| No | 2 (7.6) | |
|
How do you make DVT/TE prophylaxis in elderly patients operated for meningioma? (multiple choice) Total responders 26/51 |
Identifying patients at high risk for the development of venous TE | 4 (15.4) |
| Preoperative compression stockings | 19 (73.1) | |
| Intraoperative intermittent pneumatic compression | 8 (30.8) | |
| Low molecular weight heparin (LMWH) (24 hours after surgery) | 24 (92.4) | |
| Early mobilization | 24 (92.4) | |
| Continuous postoperative saturation monitoring for 48 h after surgery | 2 (7.7) | |
|
Do you perform early brain CT scan before starting prophylaxis? Total responders 26/51 |
Yes | 19 (73.1) |
| No | 7 (26.9) | |