Intracranial Meningiomas: Predictor Factors of Clinical Behavior and Patients Outcome

Introduction: Meningiomas are common intracranial neoplasms that have a great variability in their clinical presentation and biological behavior. Patient demographics and tumor characteristics are important factors that are long thought to contribute to outcomes of surgical resection.

Purpose: The aim of this study was to identify factors that predict the biological behavior of meningiomas and patient outcome after surgical resection.

Methodology: We retrospectively reviewed 133 cases of meningiomas who had undergone surgical resection in the Department of Neurosurgery at Toronto Western Hospital between January 2007 to June 2013. Our cohort consisted of 43 males and 90 females. We reviewed all clinical, radiological, and pathological reports, and collected the following factors for statistical analysis: patients' sex, age, tumor grade, tumor location, presence of peritumoral edema prior to surgical resection, and tumors' largest extrameatal diameter as a clinical measure of tumor size. All analyses were performed using IBM SPSS 20.0.

Results: The incidence of peritumoral edema was significantly greater in males (31/43, 72%) than in female patients (47/90, 52.22%) (p = 0.03). Meningioma location was significantly associated with presence of edema; olfactory meningiomas showed the greatest incidence of edema (81.8%) followed by convexity meningiomas (60.7%), sphenoid wing meningiomas (63%) and other skull base tumor (55%) (p = 0.013). Tumors with larger extrameatal diameters (4.3cm versus 3.7cm) were more likely to have peritumoral edema (p = 0.019). The presence of residual tumor after surgical resection was more likely in meningiomas with higher grades; residual tumor was most common in grade III meningiomas (75%), followed by grade II (50%), and grade I (20.6%) (p = 0.002). Also, as expected the grade of tumor was significantly correlated with the incidence of recurrence; grade III meningiomas showed the highest incidence of recurrence (50%), followed by grade II (31.8%), and grade I (5.6%) (p = 0.000087). Recurrence was also found to be more common in men (23.2%) than in women (5.55%) (p = 0.003).

Conclusion: The present study demonstrates that specific demographic, radiologic, and pathologic characteristics are significant predictors of tumor response to therapy, tumor recurrence and overall patient outcome.