Brain oedema in patients with intracranial meningioma

Abstract

The authors analysed the correlation between different clinical, radiological, and pathological variables and the presence and intensity of brain oedema associated to intracranial meningioma in 400 consecutive patients studied by computerized tomography (CT). The following factors did not show significant correlation with brain oedema development: the age and sex of the patient, the occurrence of focal deficits, the presence of skull changes (endostosis, exostosis, osteolysis), the occurrence of tumour calcification, the density of the tumour on plain CT scan, the presence of a cystic component, the pathological subtype of meningioma (both conventional and non-conventional), and the presence of histological features of tumour aggressiveness, such as an increased vascularization, high cellularity, high mitotic index, pleomorphism, necrosis, and brain infiltration. Factors showing a statistically significant correlation with the presence and intensity of brain oedema at the bivariate analysis were: the presence of symptoms (p < 0.001), the duration of the clinical history (p < 0.05), the location and size of the tumour (p < 0.001), the type (heterogeneous vs homogeneous), and intensity of tumour contrast enhancement (p < 0.001), the presence of irregular tumour margins (p < 0.001), and the existence of focal low density intratumoural areas (p < 0.001). The multivariate analysis using only clinical parameters showed that the group of variables with the highest power for predicting the presence of brain oedema (concordance level of 76.8%) included: the presence of symptoms, the occurrence of seizures (focal or generalized), the presence of an intracranial hypertension syndrome, and the age of the patient. The multivariate analysis using only anatomico-radiological parameters showed that the model which included the size of the tumour, the intensity of contrast enhancement, the tumour margins, and meningioma location, predicted the presence of brain oedema in 80.8% of the cases. Though the results of the present study do not definitively support any of the major physiopathological theories proposed to explain brain oedema formation in patients with intracranial meningioma, some findings could favour the so-called hydrodynamic theory.

Seizures in supratentorial meningioma: a systematic review and meta-analysis

“…1,3–6,8,9,11,12,18–22,25,26,28–30,35–38,40,41,43,48,51–53,55,59,60, 62–64,68–70 All investigations were retrospective observational case series, and no prospective controlled trials were identified.…”

“…Brain edema is found in between one-third to two-thirds of intracranial meningiomas, and several previous studies have observed a relationship between edema and epilepsy. 5,11,29,37,38 Vasogenic peritumoral edema in meningioma is believed to be related to angiogenesis and increased pial blood supply, and has been associated with increased expression of vascular endothelial growth factor, metallo-proteinases 2 and 9, and aquaporins 4 and 5. 27,34,45–47,50,65,67 Two studies found edema to be most common with convexity or parasagittal meningiomas, 11,38 but another did not observe a relationship to location, 29 and no consistent association between edema and tumor size or pathological subtype is present across studies.…”

“…5,11,29,37,38 Vasogenic peritumoral edema in meningioma is believed to be related to angiogenesis and increased pial blood supply, and has been associated with increased expression of vascular endothelial growth factor, metallo-proteinases 2 and 9, and aquaporins 4 and 5. 27,34,45–47,50,65,67 Two studies found edema to be most common with convexity or parasagittal meningiomas, 11,38 but another did not observe a relationship to location, 29 and no consistent association between edema and tumor size or pathological subtype is present across studies. 11,29,38,49 Some groups have also suggested a relationship between brain invasion and edema, 39,44 although it is unclear if edema resulting from tumor infiltration differs from vasogenic edema in meningiomas without invasion.…”

Do aggressive imaging features correlate with advanced histopathological grade in meningiomas?

“…Many factors have been proposed regarding the development and degree of meningioma-induced brain edema, including tumor size, histological subtypes, tumor vascularity, venous stasis, type of arterial supply (pial or dural predominance), sex hormone receptors, effect of vascular endothelium growth factor, secretory activity, ischemia and true brain invasion. [20][21][22][23][24][25][26][27][28][29] Some investigators have found no significant correlation between histological subtypes of meningiomas and peritumoral brain edema. 19 that the degree of peritumoral brain edema is more significant in atypical and malignant meningiomas than in typical meningiomas.…”

Predictors of Morbidity and Cleavage Plane in Surgical Resection of Pure Convexity Meningiomas Using Cerebrospinal Fluid Sensitive Image Subtraction Magnetic Resonance Imaging

“…It has been described in classical literature the cleft sign on T 2 and the absence of PTE as favorable factors for the resection of meningiomas. 9–12) …”