gms | German Medical Science

Objective: Texture-related factors such as consistency, vascularity and adherence vary considerably in meningioma and are thought to be linked with surgical resectability and morbidity. However, data analyzing the true impact of meningioma texture on the surgical management is sparse and the value of preoperative MR-imaging for the prediction of tumor texture is highly controversial.

Methods: Patients with intracranial meningioma treated between 08/2014–04/2018 were prospectively collected for demographics, clinical presentation, histology and surgical treatment with related morbidity and extend of resection. Tumor characteristics were reported by the surgeon using a standardized questionnaire including items such as tumor rigidity, homogeneity, vascularization and adherence to surrounding neurovascular structure and analyzed for their impact on duration of surgery and surgical outcome using univariate and logistic regression analyses. Preoperative MRIs were analyzed by measurements and comparison of signal intensity of tumor to cortex in T1-, T2- and ADC-weighted images.

Results: 296 patients (214 female (72.3%)) with meningioma of different localizations were included with a mean age of 60.4 years. 23% of patients had a transient and 6.1% a permanent neurological deficits and three patients (1.1%) died. Mean duration of surgery was 231±101 min. The occurrence of a neurological deficit was associated with duration of surgery (p=0.001), size of tumor (p=0.046), tumor vascularization (p=0.015) and adherence to neurovascular structures (p=0.002). The duration of surgery was significantly associated with size of tumor (p<0.001), vascularization (p<0.001) and adherence (p<0.001). Similar associations were observed in subgroup analyses of different tumor localizations (e.g. convexity and skull base). Noteworthy, the tumor rigidity had no significant impact and no routine modality of preoperative MR imaging displayed a consistent predictive value for intraoperative tumor characteristics.

Conclusion: Our analysis supports the notion that tumor texture has an impact on the surgical management of meningioma and provides solid data that tumor vascularization and adherence are significant factors influencing surgical outcome, whereas the influence of tumor rigidity has less impact than previously thought. Preoperative prediction of tumor texture is therefore required for optimized risk assessment but as our data demonstrate routine MR imaging is not sufficient in this regard.