DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20204882

The role of peritumoural brain edema in ascertaining the high risk meningiomas

Shristi Butta, Manoj Kumar Gupta, Sandeep B. V., Mallika Pal, Suniti Kumar Saha

Abstract


Background: Meningiomas are benign tumours which possess a potential to recur. Peritumoural brain edema (PTBE) has been associated with several complications and future recurrence. This study aims to establish the relation of PTBE in different histopathological grades and subtypes of meningiomas and in addition determines the significance of PTBE in ascertaining tumour recurrence.  

Methods: Complete surgical resection samples from 50 meningioma patients were obtained from the neurosurgical department and histopathologically processed. CT (computerised tomography) scans were used for ascertaining the tumour site and PTBE. Patients were followed up yearly for 4years. Recurrent cases were surgically resected and histologically typed.

Results: Meningiomas were more common in the females (70%) than males (30%). PTBE was found in 56% of the cases. 62% were <50 years of age. No significant association was found between gender or age and PTBE. Cerebral convexity was the most common site (56%). 48.8% of grade I meningiomas (p<0.05) and 100% of grade II and grade III meningiomas showed PTBE. Yearly follow up for 4 years showed 10 cases to recur. 90% of these had evidence of PTBE on their pre-operative CT scans. These results were statistically significant (Z=11.31, p<0.001).  

Conclusions: Meningiomas are mostly benign entities. However, some histological subtypes possess a potential to recur and invade. It has been found that cases showing radiological evidence of PTBE are at a high risk. Hence, follow up of such cases is essential to improve patient survival.


Keywords


Meningioma, Peritumoural edema, Recurrence

Full Text:

PDF

References


Adegbite AB, Khan MI, Paine KW, Tan LK. The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg. 1983;58(1):51‐6.

Bitzer M, Wöckel L, Morgalla M, Keller C, Friese S, Heiss E, et al. Peritumoural brain oedema in intracranial meningiomas: influence of tumour size, location and histology. Acta Neurochir (Wien). 1997;139(12):1136‐42.

Burger PC, Heinz ER, Shibata T, Kleihues P. Topographic anatomy and CT correlations in the untreated glioblastoma multiforme. J Neurosurg. 1988;68: 698–704.

Mahmood A, Caccamo DV, Tomecek FJ, Malik GM. Atypical and malignant meningiomas: a clinicopathological review. Neurosurg. 1993;33:955–63.

Mahmood A, Qureshi NH, Malik GM. Intracranial meningiomas: analysis of recurrence after surgical treatment. Acta Neurochir (Wien).1994;126:53–8.

Carvalho LH, Smirnov I, Baia GS, Modrusan Z, Smith JS, Jun P, et al. Molecular signatures define two main classes of meningiomas. Mol Cancer 2007;6:64.

Mirimanoff R O, Dosoretz D E, Linggood R M, Ojemann R G, Martuza R L. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg. 1985;62:18–24.

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.

Lee KJ, Joo WI, Rha HK, Park HK, Chough JK, Hong YK, et al. Peritumoral brain edema in meningiomas : correlations between magnetic resonance imaging, angiography, and pathology. Surg Neurol. 2008;69:350–5.

Tamiya T, Ono Y, Matsumoto K, Ohmoto T. Peritumoral brain edema in intracranial meningiomas: effects of radiological and histological factors. Neurosurg. 2001;49:1046–1051.

Markovic M, Antunovic V, Milenkovic S, and Zivkovic N. Prognostic value of peritumoral edema and angiogenesis in intracranial meningioma surgery. J Balk Unio Oncol. 2013;18(2):430–6.

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.

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.

Benzel EC, Gelder FB. Correlation between sex hormone binding and peritumoral edema in intracranial meningiomas. Neurosurgy. 1988; 23:169–74.

Schmid S, Aboul-Enein F, Pfisterer W, Birkner T, Stadek C, Knosp E. Vascular endothelial growth factor: the major factor for tumor neovascularization and edema formation in meningioma patients. Neurosurg. 2010;67:1703–8.

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

Goldman CK, Bharara S, Palmer CA, Vitek J, Tsai JC, Weiss HL: Brain edema in meningiomas is associated with increased vascular endothelial growth factor expression. Neurosurg. 1997; 40:1269–77.

Magill ST, Young JS, Chae R, Aghi MK, Theodosopoulos PV, McDermott MW. Relationship between tumour location, size and WHO grade in meningioma. Neurosurg Focus. 2018;44:E4.

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

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.

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.

Kim BW, Kim MS, Kim SW, Chang CH, Kim OL. Peritumoral brain edema in meningiomas : correlation of radiologic and pathologic features. J Korean Neurosurg Soc. 2011;49(1):26‐30.

Samadi N, Ahmadi SA. Meningioma: a clinicopathological evaluation. Malays J Med Sci. 2007;14(1):46‐52.

Alvarez F, Roda JM, Romero MP, Morales C, Sarmiento MA, Btfizquez MG. Malignant and atypical meningiomas: a reappraisal of clinical, histological, and computed tomographic features. Neurosurg.1987; 20:688-94.

Constantini S, Tamir J, Gomori MJ, Shohami E. Tumor prostaglandin levels correlate with edema around supratentorial meningiomas. Neurosurg. 1993;33(2):204‐11.

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 index in resected intracranial meningiomas. Acta Clinica Croatica. 2019;58(1):42.

Bradec GB, Ferszt R, Bender A, Schrner W. Peritumoural oedema in meningiomas. A radiological and histological study. Neuroradiol. 1986;28:304-12.

Maiuri F, Oangemi M, Cirillo S, Delehaye L, Gallicchio B, Carandente M, Giamundo A. Cerebral oedema associated with meningiomas. Surg Neurol. 1987;27:64-8.

Philippon J, Foncin JF, Grob R, Srour A, Poisson M, Pertuiset BF. Cerebral oedema associated with meningiomas: possible role of a secretory-excretory phenomenon. Neurosur Gory. 1984;14:295-301

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.

Jan Regelsberger, Christian Hagel, Pedram Emami, Thorsten RieOliver Heese, Manfred Westphal, Secretory meningiomas: A benign subgroup causing life-threatening complications. Neuro-Oncol. 2009;11(6):819–24.

Inamura T, Nishio S, Takeshita I, Fujiwara S, Fukui M. Peritumoural brain oedema in meningiomas: influence of vas- cular supply on its development. Neurosurg. 1992; 31:179-85.

Smith HP, Challa VR, Moody DM, Kelly DL Jr. Biological features of meningiomas that determine the production of cerebral oedema. Neurosurg. 1981;8:428-33.

Marciscano A.E., Stemmer-Rachamimov A.O., Niemierko A, Larvie M, Curry W.T., Barker F.G.. et al. Benign meningiomas (WHO Grade I) with atypical histological features: correlation of histopathological features with clinical outcomes. J Neurosurg. 2016;124:106–14.

Ildan F, Erman T, Göçer Aİ, Tuna M, Bağdatoğlu H, Çetinalp E, et al. Predicting the probability of meningioma recurrence in the preoperative and early postoperative period: a multivariate analysis in the midterm follow-up. Skul bas. 2007;17(3):157.

Böker DK, Meurer H, Gullotta F. Recurring intracranial meningiomas. Evaluation of some factors predisposing for tumor recurrence. J Neurosurg Scienc. 1985;29(1):11.

Simis A, Pires de Aguiar PH, Leite CC, Santana PA Jr, Rosemberg S, Teixeira MJ. Peritumoral brain edema in benign meningiomas: correlation with clinical, radiologic, and surgical factors and possible role on recurrence. Surg Neurol. 2008;70(5):471‐7.

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.

Alaywan M, & Sindou M. Prognostic factors in the surgery for intracranial meningioma. Role of the tumoral size and arterial vascularization originating from the pia mater. Study of 150 cases. Neurochirurgie. 1993; 39:337–47.

Sindou MP, & Alaywan M: Most intracranial meningiomas are not cleavable tumors: anatomic-surgical evidence and angiographic predictibility. Neurosurg. 1998;42:476–80.

Ryan R, , Booth S, Price S. Corticosteroid-use in primary and secondary brain tumour patients: a review. J Neurooncol. 2012;106:449–59.

Go KG, Wilmink JT, Molenaar WM (1988) Peritumoral brain edema associated with meningiomas. Neurosurg. 1988;23:175-9.

Hou J, Kshettry VR, Selman WR, Bambakidis NC.Peritumoral brain edema in intracranial meningiomas: the emergence of vascular endothelial growth factor–directed therapy. Neurosurg Focus. 2013;35:E2.

Moussa W M. Predictive value of brain edema in preoperative computerized tomography scanning on the recurrence of meningiomas.. Alexandr J Medic. 2012;48.373-9.

Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20:22-39.

Sekhar LN, Levine ZT, Sarma S. Grading of meningiomas. J Clin Neurosci. 2001;8(1):1-70.