Preoperative Edema and Immediate Postoperative Tumor Bed Hemorrhage are Predictors of Intracranial Meningioma Recurrence following Surgical Resection

Objective: This study aims to identify perioperative radiological factors that would be predictive of meningioma recurrence following surgical resection.

Methods: A retrospective hospital-based study of all the patients assessed at our institution from January 1990 to June 2014 for surgical resection of meningiomas was conducted. The database constituted both, patients with a first time presentation of meningiomas (90%) and those with evidence of recurrence (10%). Information regarding background demographic data, perioperative imaging parameters such as peritumoral edema or postoperative hemorrhage or residual, and pathological characteristics of the resected lesions were collected. Linear and volumetric measurements (of both tumor volume and volume of edema) were collected as well. Univariate and multivariate cox regression analysis were conducted using STATA v11.0 software.

Results: Overall, 464 patients were reviewed; n = 154 (34%) patients were male. Overall, 44 cases (8.8%) represented prior recurrences whereas the remainder represented primary presentations. Among intracranial tumors, 296 (74.6%) were grade I, 78 (19.6%) grade II, and 23 (5.8%) grade III. Postoperative tumor bed hemorrhage, noted in 119 (29.9%) of cases, and peritumoral edema volume before resection were significant predictors of tumor recurrence following resection at our institution (p = 0.002 and 0.037, respectively). These parameters did not correlate with the MIB-1 index, tumor residual, the grade of the tumor, or primary versus recurrent presentation. Multivariate cox regression modelling of total recurrence was comprised of postoperative tumor bed hemorrhage (p = 0.045) and peritumoral edema volume (p = 0.029).

Conclusion: Preoperative peritumoral edema and postoperative tumor bed hemorrhage are radiological factors that are predictive of tumor recurrence, independently of other markers of tumor activity and proliferation. Identification of other molecular and genetic tumors markers associated with these findings can supplement known markers in the prediction of tumor behavior and recurrence patterns.