Anatomical location and long-term tumor control in skull base meningiomas: a cohort study with spatial visualization

Abstract Purpose Skull base location has been associated with poorer progression-free survival (PFS), but whether specific anatomical locations within the skull base provide additional prognostic information beyond WHO grade and extent of resection (EOR) remains less well defined. Here, we evaluated the association between anatomical location and long-term tumor control in surgically treated skull base meningiomas (SBMs). Descriptive voxel-based heatmaps were generated to visualize the spatial distribution of tumors and recurrent/progressive cases. Methods We retrospectively screened patients with SBMs who underwent surgical resection with complete follow-up data. Anatomical subgroups were consolidated into four regions for survival analysis. Kaplan–Meier analysis and Firth-penalized Cox regression were used to evaluate factors associated with PFS. Preoperative tumors were manually segmented and registered to the MNI152 template to generate spatial heatmaps. Results A total of 135 patients were included. Median age was 58 years, 83% were female, and median follow-up was 68 months. The 3-, 5-, and 10-year PFS rates were 84.5%, 75.6%, and 65.3%, respectively. WHO grade II/III was the strongest prognostic factor for progression. Posterior fossa location was associated with shorter PFS in the exploratory multivariable analysis, but the overall effect of anatomical location did not reach statistical significance. Descriptive heatmaps showed clustering of recurrent/progressive cases in the spheno-orbital, parasellar, and cerebellopontine angle regions. Conclusion WHO grade was the dominant prognostic factor for long-term tumor control. Posterior fossa location was associated with shorter PFS in an exploratory adjusted analysis, although the overall effect of anatomical location did not reach conventional significance after adjustment.