Long-Term Prognostic Impact of the Dural Tail in the Local Control of Intracranial Meningiomas

Abstract The role of dural tail resection in meningioma surgery remains controversial. While many surgeons consider completeness of resection dependent on the removal of involved dura, histological studies have provided inconsistent evidence of neoplastic infiltration. Furthermore, the prognostic benefit of including the dural tail in resection or radiation fields is unclear, and many prior studies lack long-term follow-up. This study evaluated the long-term impact of dural tail resection on local control of intracranial meningiomas. We retrospectively analyzed patients with surgically treated meningiomas from 2000 to 2015. Those receiving postoperative radiation were excluded. Radiological features of the dural tail were reviewed and correlated with tumor grade and extent of resection. A total of 101 patients were included; 78 (77.2%) had WHO grade I tumors. Complete resection, including the dural tail, was achieved in 63 patients (62.3%). Median follow-up was 127.1 months (IQR: 89.6–170.1). The overall recurrence rate was 9%, with a median time to recurrence of 52 months. Radiologic dural tail subtypes had no significant prognostic impact (p = 0.57) and showed no correlation with higher tumor grade. However, omission of dural tail resection negatively affected progression-free survival (PFS): 10-year PFS was 79% without dural tail removal versus 98% with dural tail resection (hazard ratio: 4.5; 95% CI, 1.13–18.2; p = 0.03). This association remained significant on multivariate Cox regression analysis (p = 0.04). In this large cohort with extended follow-up, dural tail resection significantly improved long-term PFS, supporting its inclusion in the surgical management of intracranial meningiomas.