Retrospective study of peritumoral cerebral edema correlation with tumor size, its location and histological structure of sphenoid wing meningiomas

  • Received 17.06.2021

  • Revised 27.07.2021

  • Accepted 30.08.2021



  • 1,019 Views

  • Retrieved from Volume 3, No. 3, 2021

  • Pages 65-74

Summary. Meningiomas are one of the most common intracranial primary tumors. They are more common in women, their number increases with age. Sphenoid wing meningiomas make up 15–20 % of intracranial meningiomas. The aim of the study – to evaluate the relationship between preoperative peritumoral cerebral edema (PTCE) and tumor size, histological structure and location. Materials and Methods. Data from 67 patients with removed sphenoid wing meningioma in the period from January 2007 to January 2021 were retrospectively examined. One-factor and two-dimensional statistical analysis of factors that may affect PTCE was performed. Results. The average age of the patients examined was 47 years (ranging from 20 to 74), men – 16 (23.9 %), women – 51 (76.1 %). The mean tumor volume was 32.8 cm3, ranging from 4.2 cm3 to 143.7 cm3. The edema index (EI) is 1 in 27 (40.3 %) was absent, EI > 1 in 40 (59.7 %) was present. Small tumor volume was in 21 cases, PTCE – 57.2 %, medium – 32 cases, PTCE – 59.2 %, large tumor volume was in 9 cases, PTCE – 66.7 % and giant – in 5 cases, PTCE – 60.0 %. According to the WHO classification, there were 54 cases of central nervous system malignant tumors grade I (80.6 %), which were classified into endothelial type – 37 (68.5 %), fibrous – 7 (12.9 %), transient – 5 (9.2 %), angiomatous – 6 (11.1 %) ) and psammomatous type, which was found in one patient. Tumors grade II – atypical type, found in 11 cases (16.4 %), and III – anaplastic type, were in 2 cases (3.0 %). In a one-way analysis, we found a significant relationship between PTCE and the degree of malignancy (χ2 = 8.59, p = 0.0034), while no relationship was found between PTCE and tumor volume (W = 627, p = 0.27). PTCE was more pronounced in the lateral, middle and medial variants of location and less pronounced in the case of spheno-orbital location of the tumor (p = 0.10) and the overall edema index (χ2 = 4.48, p = 0.034). Conclusions. The relationship between PTCE and tumor volume is statistically insignificant. We found that high-grade (grade II and III) and low-grade subtypes (grade I, angiomatous type) are strongly associated with PTCE, although there is no relationship between the degree of malignancy and tumor location, χ2 = 0.37, p = 0.83. The results of a two-dimensional analysis of the simultaneous effect of tumor volume and PTCE on the pathological stage confirmed the higher risk of PTCE in tumors of grade II and III (p = 0.0027). There was also a small association between tumor volume and pathology (p = 0.74). A higher frequency of PTCE was found in the lateral variant in sphenoid wing meningioma, while a lower in spheno-orbital meningioma (p = 0.10), and a lower overall edema index (χ2 = 4.48,  p = 0.034)

peritumoral edema of the brain; sphenoid wing meningioma; tumor volume; grade of malignancy

https://doi.org/10.11603/bmbr.2706-6290.2021.3.12572

[1] Bondy M, Ligon BL. Epidemiology and etiology of intracranial  meningiomas:  a  review.  JNeurooncol.1996;29: 197-205.

[2] Franco De Monte,Michael W Mc Dermott,Ossama Al-Mefty. Al –Mefty Meningiomas; second edition. New York; Thieme. 2011.

[3] Al-Mefty O. Clinoidal  meningiomas.  J  Neuro-surg.1991;73: 840-9.

[4] Schmidek HH,ed,; Meningiomas and Their Surgical Management. Philadelphia: W B Saunders Company.1991

[5] Pierre-Olivier Champagne, Emile Lemoine, and Michel W. Bojanowski. Surgical management of giant sphe-noid wing meningiomas encasing major cerebral arteries. Neurosurg Focus.2018;44(4):E12.

[6] Raymond Y Huang, Wenya Linda Bi, Brent Griffith, Timothy  J  Kaufmann,  Christian  la  Fougère,  Nils  Ole Schmidt, Jöerg C Tonn, Michael A Vogelbaum, et al,.The International  Consortium  on  meningiomas.Imaging  and diagnostic  advances  for  intracranial  meningiomas.Neurooncology.2019;21(s1): 44-61.

[7] Sekhar LN, Babii RP and Wright DC: Surgical resec-tion of cranial base meningiomas. Neurosurgery Clinic of North America.1994;5(2): 258-313.

[8] Bernstein M, Mitchel S Berger. Neurooncology. The Essentials; 3 ed. Thieme.2015.

[9] Riemenschneider  MJ,  Perry  A,  Reifenberger  G. Histological  classification  and  molecular  genetics  of meningiomas.  Lancet  Neurol.  2006;5:  1045-54. Available from: https://doi.org/10.1016/S1474-4422 (06)70625-1

[10] Claus  EB,  Bondy  ML,  Schildkraut  JM,  Wiemels JL,  Wrensch  M,  Black  PM.  Epidemiology  of  intracranial meningioma. Neurosurgery.2005;57: 1088-95.

[11] Bitzer M, Wöckel L, Morgalla M, Keller C, Friese S, Heiss E, Meyermann R, Grote E, Voigt K. Peritumoural brain oedema in intracranial meningiomas: influence of tumour size, location and histology. Acta Neurochir.1997;139: 1136-42.

[12] Probst-Cousin S, Villagran-Lillo R, Lahl R, Bergmann M, Schmid KW, Gullotta F. Secretory meningioma: clinical, histologic, and immunohistochemical findings in 31 cases. Cancer.1997;79: 2003-15.

[13] Gebel  JM,  Sila  CA,  Sloan  MA,  Granger  CB, Weisenberger JP, Green CL, et al. Comparison of the ABC/2 estimation technique to computer-assisted volumetric analysis of intraparenchymal and subdural hematomas complicating the GUSTO-1 trial. Stroke. 1998;29(9): 1799-801. Available from: https://doi.org/10.1161/01.STR.29.9.1799

[14] Zeidman  LA, Ankenbrandt  WJ,  Du  H,  Paleologos N,  Vick  NA.  Growth  rate  of  non-operated  meningiomas. J  Neurol.  2008;255(6):  891-95.  https://doi.org/10.1007/s00415-008-0801-2

[15] Huttner HB, Steiner T, Hartmann M, Köhrmann M, Juettler E, Mueller S, et al. Comparison of ABC/2 estimation technique  to  computer-assisted  planimetric  analysis  in warfarin-related  intracerebral  parenchymal  hemorrhage. Stroke.  2006;37(2):  404-8.  Available  from:  https://doi. org/10.1161/01.STR.0000198806. 67472.5c.

[16] Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of  tumours  of  the  central  nervous  system.  Acta Neuropathologica.  2007;114(2):  97-109.  Available  from: https://doi.org/10.1007/s00401-007-0243-4

[17] Perry  A,  Louis  DN,  Scheithauer  BW,  Budka  H, Deimling Av. WHO grading of tumours of the central nervous system.  In:  Louis  DN,  Ohgaki  H,  Wiestler  OD,  Cavenee WK,  editors.  WHO  classification  of  tumors  of  the  central nervous system. Lyon: International Agency for Research on Cancer; 2007.

[18] Violaris  K,  Katsarides  V,  Sakellariou  P.  The recurrence rate in meningiomas: analysis of tumor location, histological grading, and extent of resection. Open J Modern Neurosurg.  2012;2:  6-10.  Available  from:  https://dx.doi.org/10.4236/ojmn.2012.21002

[19] Stephen T. Magill, Jacob S. Young, Ricky Chae, Manish  K.  Aghi,  Philip  V.  Theodosopoulos,  and  Michael W.  McDermott. Relationship  between  tumour  location, size,  and  WHO  grade  in  meningioma.Neurosurg  Focus. 2018;44(4): E4.

[20] Bradac  GB,  Ferszt  R,  Bender  A,  Schorner  W. Peritumoral  edema  in  meningiomas:  A  radiological  and histological study. Neuroradiology.1986;28: 304-12.

[21] Kim IS, Kim HD, Kim KU, Shin HC, Choin HJ, Kim KH. Factors  influencing  the  development  of  peritumoral  brain edema in menigiomas. J Korean Neurosurg Soc.1997;26: 940-5.

[22] Bitzer  M,  Opitz  H,  Popp  J,  Morgalla  M,  Gruber A,  Heiss  E,  Voigt  K. Angiogenesis  and  brain  oedema  in intracranial meningiomas: influence of vascular endothelial growth factor. Acta Neurochir (Wien). 1998;140: 333-40.

[23] Park KJ, Kang SH, Chae YS, Yu MO, Cho TH, Suh JK, et al. Influence of interleukin-6 on the development of peritumoral  brain  edema  in  meningiomas.  J  Neurosurg. 2010;112: 73-80.

[24] Benzel EC, Gelder FB. Correlation between sex hormone binding and peritumoral edema in intracranial menin-giomas. Neurosurgy. 1988;23: 169-74.

[25] Inamura T, Nishio S, Takeshita I, Fujiwara S, Fukui M.  Peritumoral  brain  edema  in  meningiomas-influence  of vascular supply on its development. Neurosurgery. 1992;31: 179-85.

[26] Kalkanis SN, Carroll RS, Zhang J, Zamani AA, Black PM. Correlation of vascular endothelial growth factor mes-senger RNA expression with peritumoral vasogenic cerebral edema in meningiomas. J Neurosurg.1996;85: 1095-101.

[27] Osawa  T,  Tosaka  M,  Nagaishi  M,  Yoshimoto  Y. Factors affecting peritumoral brain edema in meningioma: special  histological  subtypes  with  prominently  extensive edema. J Neuro-oncol. 2013;111(1): 49-57.

[28] Lobato RD, Alday R, Gomez PA, Rivas JJ, Domin-guez J, Cabrera A, et al. Brain oedema in patients with intra-cranial meningioma. Correlation between clinical, radiological, and histological factors and the presence and intensity of oedema. Acta Neurochir (Wien).1996;138: 485-93.

[29] Ildan Faruk, Erman Tahsin, kender Goc ̧er A, Tuna Metin,Bagdatoglu  Huseyin,  Burgut  Refik.  Predicting  the Probability of meningioma recurrence in the preoperative and early postoperative period: a multivariate analysis in the midterm follow-up. Skull Base 2007;17(3): 157-71.

[30] Mantle RE, Lach B, Delgado MR, Baeesa S, Belanger G. Predicting the probability of meningioma recurrence based onthe quantity of peritumoral brain edema on computerized tomographyscanning. J Neurosurg.1999;91(3): 375-83.

[31] Gurkanlar D, Er U, Sanli M, Ozkan M, Sekerci Z. Peritumoral brain edema in intracranial meningiomas. J Clin Neurosci. 2005;12: 750-3.

[32] Lobato RD, Alday R, Gómez PA, Rivas JJ, Domínguez J, Cabrera A, et al. Brain oedema in patients with intracranial meningioma.  Correlation  between  clinical,  radiological, and  histological  factors  and  the  presence  and  intensity  of oedema. Acta Neurochir (Wien). 1996;138: 485-93.

[33] Vignes  JR,  Sesay  M,  Rezajooi  K,  Gimbert  E, Liguoro D. Peritumoral edema and prognosis in intracranial meningioma surgery. J Clin Neurosci. 2008;15: 764-8.

[34] Shristi Butta, Manoj Kumar Gupta, Sandeep B. V., Mallika  Pal,  Suniti  Kumar  Saha.The  role  of  peritumoural brain edema in ascertaining the high risk meningiomas. Int J Res Med Sci. 2020;8(11): 3938-43.

[35] Taohui Ouyang, Na Zhang, Long Wang, Zheng Li, Jian Chen, Sphenoid wing meningiomas: Surgical strategies and evaluation of prognostic factors influencing clinical outcomes Clinical Neurology and Neurosurgery.2015;134: 85-90.

[36] Liang RF, Xiu YJ, Wang X, Li M, Yang Y, Mao Q, et al: The potential risk factors for atypical and anaplastic meningiomas: clinical series of 1,239 cases. Int J Clin Exp Med.2014;7:5696-5700.

[37] Bečulić H, Skomorac R, Jusić A, Alić F, Mašović A, Burazerović E, et al. Correlation of peritumoral brain edema with morphological characteristics and Ki67 proliferative in-dex in resected intracranial meningiomas. Acta Clinica Cro-atica. 2019;58(1): 42.  

[38] Dolecek TA, Dressler EV, Thakkar JP, Liu M, Al-Qa-isi A,Villano JL. Epidemiology of meningiomas post-Public Law107-206: The Benign Brain Tumor. Cancer Registries Amendment Act Cancer. 2015; 121:2400-10. DOI: 10.1002/cncr.29379

[39] de Azambuja Pereira-Filho N, Pasqualotto Soares F,  de  Mello  Chemale  I,  Barbosa  Coutinho  LM.  Peritu-moral brain edema in intracranial meningiomas. Arq Neu-ropsiquiatr.  2010;68:  346-9.  Available  from:  http://dx.doi.org/10.1590/S0004-282X2010000300003

[40] Kasuya H, Kubo O, Tanaka M, Amano K, Kato K, Hori T. Clinical and radiological features related to growth potential  of  meningioma.  Neurosurg  Rev.2006;29:  293-7. DOI: 10.1007/s10143-006-0039-3

[41] Tamiya T, Ono Y, Matsumoto K, Ohmoto T. Peritu-moral brain edema in intracranial meningiomas: effects of radiological and histological factors. Neurosurgery. 2001;49: 1046-52.

[42] Shibuya  M.  Pathology  and  molecular  genetics  of meningioma:  recent  advances.  Neurol  Med  Chir  (Tokyo). 2015;55: 14. DOI: 10.2176/nmc.ra.2014-0233.