CNS Invasion in Meningioma—How the Intraoperative Assessment Can Improve the Prognostic Evaluation of Tumor Recurrence

Abstract

The detection of the infiltrative growth of meningiomas into CNS tissue has been integrated into the WHO classification as a stand-alone marker for atypical meningioma. However, its prognostic impact has been questioned. Infiltrative growth can also be detected intraoperatively. The prognostic impact of the intraoperative detection of the central nervous system tissue invasion of meningiomas was analyzed and compared to the histopathological assessment. The clinical data of 1517 cases with follow-up data regarding radiographic recurrence was collected. Histopathology and operative reports were reviewed and invasive growth was seen during resection in 23.7% (n = 345) while histopathology detected it in 4.8% (n = 73). The histopathological and intraoperative assessments were compatible in 63%. The prognostic impact of histopathological and intraoperative assessment was significant in the univariate but not in the multivariate analysis. Both methods of assessment combined reached statistical significance in the multivariate analysis (p = 0.0409). A score including all independent prognostic factors divided the cohort into three prognostic subgroups with a risk of recurrence of 33.8, 64.7 and 88.5%, respectively. The intraoperative detection of the infiltrative growth of primary meningiomas into the central nervous system tissue can complement the histopathological assessment of CNS invasion. The combined assessment is an independent prognostic factor regarding tumor recurrence and allows a risk-adapted tumor stratification.

Diagnosis of Invasive Meningioma Based on Brain-Tumor Interface Radiomics Features on Brain MR Images: A Multicenter Study

“…The fundamental cause for the absence of CNS tissue is that neurosurgeons tend to keep the arachnoid membrane intact wherever possible to prevent neurological injury. Another possible explanation is nonstandardized intraoperative tumor sampling ( 37 ). Several operation-related variables, including partial resection and the use of a cavitron ultrasonic surgical aspirator (CUSA), appear to be relevant to the reduced ease of access to CNS tissue.…”

“…To remedy this shortcoming, two recent studies ( 37 , 39 ) sought to ascertain the advantages of a hybrid strategy that contained knowledge from both operative and pathological observations. Their early findings showed that the combined method had the ability to transcend the shortcomings of sole neuropathological evaluation and may be of considerable therapeutic benefit.…”

“…For example, if it can be shown that patients with BI are genuinely at greater risk of perioperative seizures, antiepileptic treatment could be commenced in a timely fashion. Finally, it has been proposed that surgical procedures and the degree of histological sampling may affect the neuropathological diagnosis of BI (1,(36)(37)(38).…”

Mib1 Expression Is Increased in Meningiomas with Histopathological Evidence of Cns Invasion

“…Besides the long-established histopathological assessment according to the WHO classification of central nervous system tumors [4], the detection of infiltrative meningioma growth into brain parenchyma has been added as a stand-alone criterion for atypia [4]. However, its prognostic significance has since been questioned based on contradictory results of retrospective analyses [6][7][8][9] and its role for tumor grading in the WHO classification is frequently discussed [10,11].…”

Editorial comment on “A new method for quantification and 3D visualization of brain tumor adhesion using slip interface imaging in patients with meningiomas”

“…However, in the last 2016 WHO classification, histopathological evidence of brain infiltration has been integrated as a marker for atypical meningioma, with an impact on prognosis [3]. Even so, some authors remark that histopathological assessment could be biased, as invasive margins may not be surgically resected, therefore impeding histopathological detection [4]. It is also well known that brain invasion or adhesion complicates surgical dissection and increases the risk of stroke, haemorrhage, and other injuries [5].…”