Peritumoral T2/FLAIR hyperintense MRI findings of meningiomas are not necessarily edema and may persist permanently: a systematic review

Laajava, Joonas; Korja, Miikka

doi:10.1007/s10143-023-02094-1

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…Hence, persistent edema is suggested to represent a blend of vasogenic brain edema and cerebral gliosis ( 41 ). The persistence and prevalence of postoperative T2/FLAIR hyperintensity in those patients with baseline hyperintense findings varied between 39% and 83% at the last follow-up examinations according to a recent systematic review ( 42 ). In the present series we observed the presence and persistence of these areas in 50% of the cases with baseline edema and available follow-up images.…”

Section: Discussionmentioning

confidence: 99%

The safety and use of perioperative dexamethasone in the perioperative management of primary sporadic supratentorial meningiomas

Arlt,

Basaran,

Vogel

et al. 2024

Front. Oncol.

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ObjectiveDespite the lack of prospective evidence for the perioperative use of dexamethasone in meningioma surgery, its use is well established in the daily routine of several centers. The present study evaluates the effect of dexamethasone on postoperative complications, peritumoral T2/FLAIR hyperintensity, and progression-free survival in patients with supratentorial meningiomas undergoing resection.MethodsA total of 148 patients who underwent resection of a primary sporadic supratentorial meningioma at the authors’ institution between 2018 and 2020 were included in this retrospective cohort. Safety criteria were side effects of dexamethasone (e.g. hyperglycemia), surgical morbidities, length of stay, and mortality. The individual Karnofsky Performance Scales (KPS) were evaluated regarding the individual development and the delta of KPS at 3- and 12-months compared to baseline KPS was calculated. Longitudinal assessment of the peritumoral T2-/FLAIR hyperintensity changes was performed.ResultsThe use of both pre- and postoperative dexamethasone did not influence the incidence rates of wound infections, infarctions, postoperative seizures, pulmonary embolism, postoperative hemorrhage, mortality, length of stay, new-onset hyperglycemia and new neurological deficits. Perioperative Dexamethasone use was associated with an improved Karnofsky performance development at 3- (delta of KPS 3.3 vs. -1.9, p=0.001) and 12-months (delta of KPS 3.8 vs. -1.1, p=0.008) compared to the preoperative Karnofsky performance status. Multivariable analysis revealed that perioperative dexamethasone use enhances the KPS improvement (OR: 3.65, 95% CI: 1.01-13.18, p=0.048). Persistent peritumoral T2/FLAIR hyperintensity changes were observed in 35 cases of 70 patients with available follow-up images and a baseline edema (50.0%). Perioperative dexamethasone use enhanced the reduction of the preoperative peritumoral T2-/FLAIR hyperintensity changes (mean reduction of maximum diameter: 1.8 cm vs. 1.1 cm, p=0.023). Perioperative dexamethasone use was independently associated with a lower risk for persistent peritumoral T2-/FLAIR hyperintensity changes (OR: 3.77, 95% CI: 1.05-13.54, p=0.042) The perioperative use of dexamethasone did not influence the progression-free survival time in Simpson grade I or II resected WHO grade 1 meningiomas (log-rank test: p=0.27).ConclusionPerioperative dexamethasone use seems to be safe in surgery for primary supratentorial meningiomas. Dexamethasone use might enhance the functionality by reducing postoperative peritumoral T2-/FLAIR hyperintensities. These findings highlight the need for prospective data.

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Section: Discussionmentioning

confidence: 99%

The safety and use of perioperative dexamethasone in the perioperative management of primary sporadic supratentorial meningiomas

Arlt,

Basaran,

Vogel

et al. 2024

Front. Oncol.

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Automated segmentation of meningioma from contrast-enhanced T1-weighted MRI images in a case series using a marker-controlled watershed segmentation and fuzzy C-means clustering machine learning algorithm

Mohammadi,

Ghaderi,

Ghaderi

et al. 2023

International Journal of Surgery Case Reports

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Radiographic predictors of peritumoral brain edema in intracranial meningiomas: a review of current controversies and illustrative cases

Orešković,

Blažević,

Kaštelančić

et al. 2024

Chin Neurosurg Jl

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Meningiomas are among the most common primary tumors of the central nervous system. In the past several decades, many researchers have emphasized the importance of radiographic findings and their possible role in predicting the various aspects of the meningioma biology. One of the factors most commonly analyzed with respect to the lesions’ clinical behavior is peritumoral brain edema (PTBE), not only one of the most common signs associated with meningiomas, but also a significant clinical problem. Radiographic predictors of PTBE are usually noted as being the size of the tumor, its location, irregular margins, heterogeneity, and the peritumoral arachnoid plane with its pial vascular recruitment. Here, we review the available literature on the topic of these radiographic predictors of PTBE formation, we analyze the methodology of the research conducted, and we highlight the many controversies still present. Indeed, the evidence about PTBE pathogenesis, predictive factors, and clinical significance still seems to be mostly inconclusive, despite intense research in the area. We believe that by highlighting the many inconsistencies in the methodology used, we can showcase how little is actually known about the pathogenesis of PTBE, which in turn has important clinical implications. Additionally, we provide several MR images of intracranial meningiomas from our own practice which, we believe, showcase the unpredictable nature of PTBE, and demonstrate vividly the topics we discuss.

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Peritumoral T2/FLAIR hyperintense MRI findings of meningiomas are not necessarily edema and may persist permanently: a systematic review

Cited by 3 publications

References 31 publications

The safety and use of perioperative dexamethasone in the perioperative management of primary sporadic supratentorial meningiomas

The safety and use of perioperative dexamethasone in the perioperative management of primary sporadic supratentorial meningiomas

Automated segmentation of meningioma from contrast-enhanced T1-weighted MRI images in a case series using a marker-controlled watershed segmentation and fuzzy C-means clustering machine learning algorithm

Radiographic predictors of peritumoral brain edema in intracranial meningiomas: a review of current controversies and illustrative cases

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