Abstract
The pathogenesis of peritumoral brain edema (PTBE) in meningiomas remains unclear. The glymphatic system is recently recognized as a pathway for waste clearance and maintaining fluid balance in the brain parenchymal interstitium. We aimed to investigate if the PTBE volume of meningiomas correlates with their glymphatic function. A total of 80 meningioma patients (mean age, 58.8 years; 37 men) and 44 normal subjects (mean age 53.3 years; 23 men) who had preoperative diffusion-tensor imaging for calculation of the analysis along the perivascular space (ALPS) index were retrospectively included. Information collected from each patient included sex, age, tumor grade, Ki-67 index, tumor location, tumor volume, PTBE volume and ALPS index. Comparisons of ALPS index among meningiomas without PTBE, meningiomas with PTBE, and normal subjects were performed using analysis of covariance with Bonferroni correction and adjustments for age and sex. Pearson correlation coefficient and multivariable linear regression analyses were performed to identify factors associated with PTBE volume. Group comparisons revealed that the ALPS index was significantly higher (P < 0.05) in meningiomas without PTBE vs. meningiomas with PTBE and normal subjects. On the other hand, ALPS index was not different between meningiomas with PTBE and normal subjects. On Pearson correlation and multivariable linear regression analyses, the ALPS index was the only factor significantly (P < 0.05) associated with PTBE volume. In conclusion, PTBE volume inversely correlated with ALPS index in meningiomas. PTBE formation in meningiomas may be related to glymphatic dysfunction.
Highlights
Meningiomas account for 37.6% of primary brain tumors in population-based studies (Ostrom et al, 2019)
Among meningiomas with peritumoral brain edema (PTBE), along the perivascular space (ALPS) index is inversely correlated with PTBE volume
The relationship between PTBE volume and ALPS index of meningiomas suggested that PTBE formation may be related to glymphatic dysfunction
Summary
Meningiomas account for 37.6% of primary brain tumors in population-based studies (Ostrom et al, 2019). Up to 67% of meningiomas have peritumoral brain edema (PTBE) (Hou et al, 2013). Pathogenesis of PTBE remains unclear and there are conflicting reports on correlations between PTBE extension and imaging features such as tumor size or volume CSF from the subarachnoid space flows into brain parenchyma through periarterial spaces of the penetrating arteries under the influence of Aquaporin-4 water channels and mixes with parenchymal interstitial fluid. In glioma-bearing mice, CSF flow to extracranial spaces is reduced (Ma et al, 2019b) but in extra-axial tumors such as meningiomas, alterations of glymphatic function related to PTBE remain unclear
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