Prediction of Histological Grade and Completeness of Resection of Intracranial Meningiomas: Role of Peritumoural Brain Edema.

Kamalanathan Palaniandy,Norzaini Rose Mohd Zain,Mohammad Saffari Mohammad Haspani

doi:10.21315/mjms2017.24.3.5

Kamalanathan Palaniandy, Norzaini Rose Mohd Zain + Show 1 more

Open Access

https://doi.org/10.21315/mjms2017.24.3.5

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Abstract

Meningioma is the commonest primary intracranial tumour in adults. Excision is curative for low grade meningioma, whereas high-grade meningioma requires adjuvant therapy following surgery. Several studies have examined the association between peritumoural brain Edema - a common feature in meningioma - and histological grading with mixed results. The present study attempted to elucidate this association and if peritumoural brain Edema affects the intra-operative judgement of surgeons on the completeness of resection. An observational study was conducted among those who underwent surgery for meningioma. Eighteen subjects were recruited each for low- and high-grades, respectively. Magnetic resonance imaging (MRI) prior to surgery was employed for interpreting the Edema index and MRI after surgery was used to determine residual tumour. Median age was 50 years, male to female ratio was 1:3.5, 69.4% had peritumoural brain Edema and 75% had reported gross resection. Among the reported gross total resection cases, 40.7% had residual tumour. Analysis showed statistically significant association between peritumoural brain Edema (P = 0.027) and tumour volume (P = 0.001) with high-grade meningioma, however multivariate analysis did not present any association. No association was noted between judgement of tumour resection by surgeons and peritumoural brain Edema. Odds ratio for peritumoural brain Edema remained high and the tumour volume exhibited marginal P-value marginal significance for prediction of high grade meningioma. These two factors may still contribute to the tumour grade and should be included in further studies on the prognosis of meningioma.

Highlights

Meningiomas make up 33.8%–34.4% of the primary intracranial tumours observed in adults and are even more common than glial tumours, which comprise 31.1% of all primary intracranial tumours [1,2]
Tumour volume and peritumoural brain Edema had a significant association with highgrade meningioma upon univariate statistical analysis
The percentage of low-grade meningioma patients with peritumoural brain Edema was 50.0%, while that of patients with high-grade meningioma and peritumoural brain Edema was 88.9%. This finding was statistically significant upon univariate analysis, had an odds ratio (OR) of 8 and concurs with the results reported in prior studies [12, 19, 36], which suggested a positive correlation between peritumoural brain Edema and high-grade meningioma

Summary

Introduction

Meningiomas make up 33.8%–34.4% of the primary intracranial tumours observed in adults and are even more common than glial tumours, which comprise 31.1% of all primary intracranial tumours [1,2]. Meningiomas are distinguishable into three histological grades. Grade 1 meningioma occurs in almost 80% of cases, has a low proliferative potential, and is often cured through surgical resection. Grade 2 meningioma may infiltrate locally despite its low proliferative potential and carries a probability of recurrence. Several studies have examined the association between peritumoural brain Edema — a common feature in meningioma — and histological grading with mixed results. The present study attempted to elucidate this association and if peritumoural brain Edema affects the intra-operative judgement of surgeons on the completeness of resection

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