• Yuki Shinya, Hirotaka Hasegawa, Masahiro Shin, Mariko Kawashima, Motoyuki Umekawa, Atsuto Katano, Masako Ikemura, Tetsuo Ushiku, Kenta Ohara, Atsushi Okano, Yu Teranishi, Satoru Miyawaki, and Nobuhito Saito.
• Department of Neurosurgery, The University of Tokyo Hospital, Tokyo , Japan.
• Neurosurgery. 2023 Nov 1; 93 (5): 114411531144-1153.

BackgroundGross total resection, without causing neurological deficits, is challenging in skull base meningioma (SBM). Therefore, stereotactic radiosurgery (SRS) is an important approach for SBMs; however, it is difficult to predict the long-term prognosis.ObjectiveTo identify the predictive factors for tumor progression after SRS for World Health Organization (WHO) grade I SBMs, focusing on the Ki-67 labeling index (LI).MethodsIn this single-center retrospective study, factors affecting progression-free survival rates (PFSs) and neurological outcomes in patients undergoing SRS for postoperative SBMs were evaluated. Based on the Ki-67 LI, patients were classified into 3 groups: low (<4%), intermediate (4%-6%), and high LI (>6%).ResultsIn the 112 patients enrolled, the cumulative 5- and 10-year PFSs were 93% and 83%, respectively. The PFSs were significantly higher in the low LI group (95% at 10 years) compared with the other groups (intermediate LI, 60% at 10 years, P = .007; high LI, 20% at 10 years, P = .001). Multivariable Cox proportional hazard analysis demonstrated that the Ki-67 LI was significantly associated with the PFSs (low vs intermediate LI; hazard ratio, 6.00; 95% CI, 1.41-25.54; P = .015; low vs high LI; hazard ratio, 31.90; 95% CI, 5.59-181.77; P = .001).ConclusionKi-67 LI may be a useful predictor of long-term prognosis in SRS for postoperative WHO grade I SBM. SRS provides excellent long- and mid-term PFSs in SBMs with Ki-67 LIs <4% or 4% to 6%, with a low risk of radiation-induced adverse events.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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