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Background: Studies on intraosseous meningiomas requiring cranioplasty have been scarce, and surgical outcomes thus remain poorly characterized. Using a population-based, multicentre cohort of patients who had undergone resection of intraosseous meningioma with concurrent cranioplasty, we aimed to establish long-term outcomes, as well as rates and predictors of complications and tumour recurrence.

Method: All patients who had undergone primary resection of an intraosseous meningioma with concurrent cranioplasty at four neurosurgical departments in Sweden between 2008 and 2022 were included. Data on patient demographics as well as tumour- and surgery-related data were collected retrospectively by scrutiny of medical records. Rates and predictors of surgical complications, and the composite outcome of tumour recurrence (including growth of residual tumour), were analysed using Cox regression.

Results: Of the 119 patients included, 16% experienced surgical complications requiring reoperation, 10% underwent implant explantation, and 31% developed tumour recurrence. Choice of implant material differed significantly across the participating centres but did not influence complication rates. Markers of biological aggressiveness were associated with an increased risk of surgical complications and tumour recurrence.

Conclusions: Surgical complications and tumour recurrence are common following resection of intraosseous meningiomas with concurrent cranioplasty. Rather than the material used for cranial reconstruction, biological and anatomical tumour-related factors were the strongest predictors of adverse outcomes.