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Characteristic features and proposed classification in 69 cases of intracranial microcystic meningiomas
Zhiqin Lin1, Meng Zhao2, Xiangrong Li2
1Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China.
Abstract:
Microcystic meningioma (MM) is a rare subtype of intracranial meningiomas, with clinical and radiologic features not well characterized in the literature. Based on our experience, we propose a classification system of intracranial MMs. We reviewed the medical records, radiographic studies, and operative notes of a group of consecutive patients with intracranial MM. The mean age of the 69 patients was 46.8 ± 10.6 years (range, 21-75 years). Three types of intracranial MMs could be identified. Type 1 MMs presented as a solid lesion, hypointense or isointense on T1WI, hyperintense on T2WI, and homogeneous or heterogeneous enhancement, and were found in 43 patients (67.2%). Type 2 MMs represented signals similar to CSF both on T1WI and T2WI, and faint reticular enhancement with marginal enhancement, and these were found in 7 patients (10.9%). Type 3 MMs consisted of cystic-solid or cystic lesion and were found in 14 patients (21.9%). Significant differences were observed among the different types of MMs for the following variables: sex, presence of severe peritumoral brain edema (PTBE), and extent of tumor resection. Females were found in all of patients with type 2 MMs, but were only 35.7% of those with type 3 MMs (P = 0.018). Severe PTBEs were more common among patients with type 1 MMs (55.8%) than among those with type 2 (14.3%) and type 3 MMs (14.3%) (P = 0.007). Type 1 MMs (97.7%) were associated with a significantly higher rate of gross total resection compared with the other two types (71.4 and 78.6%) (P = 0.019). Total length of hospital stay after craniotomy ranged from 4 to 30 days (median, 8 days). There were no significant differences in progression-free survival among the three types of MMs (P = 0.788). The current classification identifies three distinct types of intracranial MM based on their radiological findings and growth patterns. The type 1 MMs are more commonly associated with severe PTBE. Type 2 and Type 3 MMs have a higher predilection towards parasaggital location with venous involvement and therefore have a lower rate of gross total resection.
Insights
This study classifies intracranial microcystic meningiomas (MMs) into three types based on imaging. Type 1 MMs show solid lesions, while Types 2 and 3 have distinct cystic or CSF-like signals, impacting treatment and outcomes.
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Background:
- Microcystic meningioma (MM) is a rare intracranial tumor subtype.
- Its clinical and radiologic features require further characterization.
Purpose of the Study:
- To propose and validate a classification system for intracranial microcystic meningiomas.
- To correlate radiologic findings with clinical characteristics and outcomes.
Main Methods:
- Retrospective review of medical records, radiographic studies, and operative notes from 69 patients with intracranial MM.
- Classification of MMs into three types based on MRI signal characteristics (T1WI, T2WI) and enhancement patterns.
- Analysis of differences in sex, peritumoral brain edema (PTBE), extent of resection, and progression-free survival among the types.
Main Results:
- Three types of intracranial MMs were identified: Type 1 (solid, 67.2%), Type 2 (CSF-like signal, 10.9%), and Type 3 (cystic-solid/cystic, 21.9%).
- Type 1 MMs were associated with higher rates of severe PTBE (55.8%) and gross total resection (97.7%).
- Type 2 MMs predominantly affected females and showed faint enhancement, while Type 3 MMs had lower resection rates (78.6%) and were associated with parasagittal locations and venous involvement.
Conclusions:
- A novel classification system for intracranial MMs based on radiologic findings and growth patterns is proposed.
- Type 1 MMs are linked to severe PTBE, whereas Types 2 and 3 are associated with parasagittal locations and reduced gross total resection rates.
- Despite distinct radiologic and clinical features, progression-free survival did not significantly differ among the three MM types.
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