Comparative analysis of intraoperative and postoperative outcomes in primary vs. revision meningioma surgery: A propensity score-matched study

PURPOSE: Surgical resection is a critical intervention for meningiomas, but revision surgeries are challenging due to scar tissue, altered anatomy, and increased physiological stress. Our study evaluates differences in intraoperative and short-term postoperative outcomes between patients undergoing primary and revision meningioma surgery. METHODS: A retrospective analysis (2011-2023) was conducted using 1:3 propensity score matching with a 0.2 caliper. Matching was based on age, sex, tumor diameter, number of comorbidities, ASA score, and WHO grade. Multivariable logistic regression, controlling for extent of resection, assessed whether revision surgery predicted key intra- and postoperative outcomes. RESULTS: Of 362 patients included in the final analysis, 263 (72.7%) underwent primary surgery and 99 (27.3%) underwent revision surgery. There were no differences in matched characteristics or tumor location among the groups. There were no significant differences in operative time, estimated blood loss (EBL), or change in modified Rankin Scale (mRS) or Karnofsky Performance Status (KPS) between pre- and postoperative measurements. Surgical complications were observed in 0% of revision cases and 0.7% of primary cases (p = 1.00). Neurological complications occurred in 25.3% of the revision cases and 29.2% in the primary cases (p = 0.45), while non-neurological complications occurred in 16.2% vs. 16.0% of patients, respectively (p = 0.97). Length of hospital stay (LOS) and readmission rates trended higher for revision surgeries (4.7 vs. 3.7 days, p = 0.15 and 10.1% vs. 6.2%, p = 0.19, respectively). Revision surgery was not a significant predictor of operative time, EBL, LOS, postoperative mRS, postoperative KPS, changes in mRS or KPS from baseline, neurological or non-neurological complications, or readmission. CONCLUSION: Our propensity score-matched analysis indicates that revision meningioma surgery achieves comparable intraoperative and short-term postoperative outcomes to primary resection. These findings reassure that revision surgery does not inherently increase operative risk when performed with appropriate patient selection.