Abstract
Objective: Meningiomas presented preferred intracranial distribution, which may reflect potential biological natures. This study aimed to analyze the preferred locations of meningioma according to different biological characteristics.Method: A total of 1,107 patients pathologically diagnosed with meningiomas between January 2012 and December 2016 were retrospectively analyzed. Preoperative MRI were normalized, and lesions were semiautomatically segmented. The stereospecific frequency and p value heatmaps were constructed to compare two biological phenotypes using two-tailed Fisher's exact test. Age, sex, WHO grades, extent of resection (EOR), recurrence, and immunohistochemical markers including p53, Ki67, epithelial membrane antigen (EMA), progesterone receptor (PR), and CD34 were statistically analyzed. Recurrence-free survival (RFS) were analyzed by Kaplan–Meier method.Result: Of 1,107 cases, convexity (20.8%), parasagittal (16.1%), and falx (11.4%) were the most predominant loci of meningiomas. The p-value heatmap suggested lesion predominance in the left frontal and occipital convexity among older patients while in the left sphenoid wing, and right falx, parasellar/cavernous sinus, and middle fossa among younger patients. Lesions located at anterior fossa and frontal structures were more frequently seen in the male while left parietal falx and tentorial regions, and right cerebellopontine angle in the female. Grades II and III lesions presented predominance in the frontal structures compared with grade I ones. Meningiomas at the left parasagittal sinus and falx, tentorium, intraventricular regions, and skull-base structures were significantly to receive subtotal resection. Lesions with p53 positivity were statistically located at the left frontal regions and parasellar/cavernous sinus, higher Ki67 index at the left frontal and bilateral parietal convexity and right parasellar/cavernous sinus, EMA negativity at the right olfactory groove and left middle fossa, and CD34 positivity at the sellar regions and right sphenoid wing. Tumor recurrence rates for grades I, II, and III were 2.8, 7.9, and 53.8%, respectively. Inferior RFS, higher Ki67 index, grades II and III, and a larger preoperative volume were observed in older patients. Recurrent meningiomas were more frequently found at the occipital convexity, tentorium, sellar regions, parasagittal sinus, and left sphenoid wing.Conclusion: The preferred locations of meningioma could be observed according to different biological characteristics, which might be helpful for clinical decisions.
Highlights
Meningiomas account for 37.6% of all primary central nervous system (CNS) tumors and 53.3% of non-malignant intracranial tumors, with an incidence rate of 8.6 per 100,000 [1]
Convexity (20.8%), parasagittal (16.1%), and falx (11.4%) were the three most common locations affected by meningiomas, followed by skull-base structures including sphenoid wing (9.8%), cerebellopontine angle (CPA, 7.7%), tuberculum sellae/planum sphenoidale/anterior clinoid process (7.6%), and olfactory groove (6.0%)
The present study visualized the preferred locations of meningioma in 1,107 patients according to different biological characteristics by voxel-wise constructing stereospecific frequency and p-value heatmaps, which could be a valuable reference for clinical decisions
Summary
Meningiomas account for 37.6% of all primary central nervous system (CNS) tumors and 53.3% of non-malignant intracranial tumors, with an incidence rate of 8.6 per 100,000 [1]. Meningiomas originate from the arachnoidal cap cell and are histologically divided into grades I, II (atypical), and III (anaplastic), according to the 2016 WHO classification [2, 3]. Surgery is recognized as the first option for treating patients with meningioma, pursuing the primary goal of complete resection (Simpson grade I) [5]. Patients with lesions in favorable locations (e.g., convexity meningiomas) presented improved recurrence-free survival (RFS) by extensive resection [6]. The meningioma locations are related to the symptoms, tumor histology, and the prognostic value of Simpson classification. Atypical meningiomas are associated with a location on the convexity, and Simpson grade is correlated to the high risk of recurrence for tumors in this location instead of falx and posterior fossa [8,9,10]. The location-specific difference in meningioma greatly influences clinical decisions and therapeutic strategies
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