Table 5.
Level of evidence informing each primary outcome assessed using the GRADE framework
| Management | Outcome | Pooled risk (95% CI)a | No. of studies (no. of patients) | Quality assessment | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Type of evidence | Risk of bias | Heterogeneity | Directness | Precision | Reporting bias | Overall | ||||
| Active monitoring | Symptom development | 8.1% (2.7–16.1) | 12 (608) | + 2 | − 1 | − 1 | 0 | 0 | 0 | ⨁◯◯◯ Very low |
| Intervention | 24.8% (7.5–48.0) | 13 (971) | + 2 | − 1 | − 1 | 0 | − 1 | 0 | ⨁◯◯◯ Very low | |
| Surgery | Morbidity | 11.8% (3.7 23.5) | 5 (533) | + 2 | − 1 | − 1 | 0 | 0 | 0 | ⨁◯◯◯ Very low |
| WHO grade I | 94.0% (88.2–97.9) | 9 (316) | + 2 | − 1 | 0 | − 1b | 0 | 0 | ⨁◯◯◯ Very low | |
| Recurrence | 0.3% (0.2–2.2) | 2 (105) | + 2 | − 1 | + 1 | 0 | 0 | 0 | ⨁⨁◯◯ Low | |
| SRS | Morbidity | 32.0% (10.6–70.5) | 2 (389) | + 2 | 0 | − 1 | 0 | − 1 | NAc | ⨁◯◯◯ Very low |
| Recurrence | 1.5% (0.1–4.3) | 2 (389) | + 2 | 0 | − 1 | 0 | 0 | NAc | ⨁◯◯◯ Very low | |
The overall quality score was determined based on the sum of the included domains. Type of evidence was based on design of the included studies (+ 2 or + 4); + 2 equates to observational cohort studies and + 4 to randomized controlled trials. Risk of bias score reflected the selection process, measures and outcomes definitions and general methodological and statistical concerns across studies informing each outcome (range − 2 to 0). Heterogeneity was scored using the corresponding I2 statistic; low (≤ 25%) = + 1, moderate (~ 50%) = 0 and high (≥ 75%) = − 1. Directness was graded using PICO taking into consideration year of publication and the use of surrogate outcomes (range − 2 to 0). Precision was based on width of the 95% CI. Reporting bias was categorised into detected (+ 1) and not detected (− 1) and performed for each treatment arm using the outcome with the greatest number of studies. The overall quality for each outcome was considered high (≥ 4 points), moderate (3 points), low (2 points) or very low (≤ 1 point)
NA non-assessable, SRS stereotactic radiosurgery, WHO World Health Organization
aObtained by random effects model
bRegrading of meningiomas according to the 2016 WHO classification system of brain tumours could not be performed
cCould not be assessed due to the low number of studies