{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:38:01Z","timestamp":1792809481489,"version":"4.5.0"},"reference-count":53,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Sex is a recognized factor in meningioma development, but its effect on recurrence and survival remains insufficiently studied in large clinical cohorts. This study aimed to investigate sex-specific differences in recurrence and survival across WHO grade I\u2013III meningiomas, focusing primarily on outcomes after gross-total resection (GTR). Secondary analyses investigated outcomes after subtotal resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients with intracranial meningiomas (n = 5441) from the international Personalized Neurosurgery database were identified; all were diagnosed according to the 2007 or 2016 WHO classification criteria, surgically treated, and followed between 1989 and 2019. The primary cohort consisted of 4372 patients who underwent Simpson grade I\u2013III resections. Cumulative recurrence and survival risk were estimated. Multivariable logistic regression was used to obtain adjusted odds ratios comparing males to females. Counterfactual risk modeling and post hoc analyses were performed to assess age effects and center-level robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among patients with WHO grade II meningiomas, males had a significantly higher recurrence risk than females after GTR. At 5 years, males had more than two times the risk of recurrence (OR 2.21, 95% CI 1.42\u20133.42), declining toward no sex difference at 10 years. Counterfactual modeling showed an 83% higher 5-year recurrence risk in males with WHO grade II meningiomas (ratio of population-averaged risks 1.83, 95% CI 1.28\u20132.37), whereas no sex difference was observed if the same patients were instead classified as having WHO grade I meningioma. Post hoc analyses indicated that sex differences peaked in individuals of premenopausal age and diminished thereafter. The higher recurrence risk for males with WHO grade II meningiomas remained robust in sensitivity analyses. No consistent sex-related differences were detected in recurrence risk in WHO grade I meningioma or in the risk of death for WHO grade I or II meningioma. Among 1069 patients with Simpson grade IV resections, sex differences in recurrence and survival were not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In this observational cohort, males with WHO grade II meningiomas who received GTR had a higher risk of early recurrence than females, an effect that appeared to be age dependent. These results do not exclude the possibility of sex-related risk differences in more slowly growing WHO grade I meningiomas with follow-up beyond 10 years. The findings raise the possibility of biological contributions linked to sex hormones, and the impact of sex on these survival outcomes should be validated in molecularly annotated cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.3.jns252398","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T01:40:18Z","timestamp":1789177218000},"page":"1-14","source":"Crossref","is-referenced-by-count":0,"title":["Increased risk of early recurrence after gross-total resection in males with a WHO grade II meningioma: the impact of sex on recurrence and death in 5441 meningioma patients"],"prefix":"10.3171","author":[{"given":"Anders","family":"Broechner","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lasse","family":"Rehn\u00e9 Jensen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tareq A.","family":"Juratli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Neuro-Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany;"},{"name":"Department of Neurosurgery, Laboratory of Translational Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Daniela","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark;"},{"name":"Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sverre H.","family":"Torp","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Laboratory Centre, St. Olav\u2019s Hospital, Trondheim;"},{"name":"Department of Pathology, Laboratory Centre, St. Olav\u2019s Hospital, Trondheim, Norway;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen A.","family":"Shih","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin A.","family":"Morshed","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob S.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen T.","family":"Magill","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"},{"name":"Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Bertero","sequence":"additional","affiliation":[{"name":"Pathology Unit, Department of Medical Sciences, University and Citt\u00e0 della Salute e della Scienza University Hospital of Turin, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Stummer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of M\u00fcnster;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothee C\u00e4cilia","family":"Spille","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of M\u00fcnster;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Brokinkel","sequence":"additional","affiliation":[{"name":"Institute for Neuropathology, University of M\u00fcnster;"},{"name":"Department of Neurosurgery, Clemenshospital M\u00fcnster, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soichi","family":"Oya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saitama Medical Center\/University, Saitama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Miyawaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhito","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Proescholdt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Regensburg Medical Center, Regensburg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Kuroi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokyo Women\u2019s Medical University, Adachi Medical Center, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Gousias","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Athens Medical Center, Athens, Greece;"},{"name":"European University of Cyprus, Nicosia, Cyprus;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bethel Clinic 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