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Peritumoral Brain Edema and Surgical Outcome in Secretory Meningiomas: A Matched-Cohort Analysis
Megh M Trivedi1, Sarah Worley2, Alankrita Raghavan1
1Department of Neurosurgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
Objective:
Secretory meningioma (SM) is a rare subtype of benign meningioma reported to cause significant peritumoral brain edema (PTBE). Therefore, patients with SM may have more severe presenting symptoms and possibly increased postoperative complications. Our aim was to perform a statistically rigorous comparison of patients with SM with other nonsecretory World Health Organization grade I meningiomas and examine PTBE, postsurgical outcomes, and recurrence in a large series of cases.
Methods:
A retrospective review of all patients at our institution with pathologically confirmed SM between 2000 and 2017 was performed. A control group of nonsecretory grade I meningiomas was matched 1:1 according to tumor location and size. Study groups were compared on clinical characteristics and outcomes using logistic, cumulative logit, and normal linear generalized estimating equations regression models.
Results:
Fifty-five patients with SM met inclusion criteria and were matched with 55 control patients. After adjusting for size and location, the odds of a patient with SM having a more severe T2 edema grade were 8.9 (95% confidence interval, 3.8-21.1; P < 0.001) times higher, and the odds of any T2 edema were 6.2 (95% confidence interval, 2.2-17.6; P < 0.001) times higher. Significance remained even when adjusting for age. Postoperative complications, Simpson grade resection, neurologic outcome, and recurrence were not significantly different.
Conclusions:
Patients with SM have significantly greater odds of having PTBE compared with patients with nonsecretory World Health Organization grade I meningiomas of a similar size and location. Despite this situation, surgical outcome and recurrence rates are similar.
Insights
Secretory meningioma (SM) causes significantly more brain edema than other benign meningiomas. However, surgical outcomes and recurrence rates are similar for both types of tumors.
Area of Science:
- Neurosurgery
- Neuropathology
- Oncology
Background:
- Secretory meningioma (SM) is a rare benign tumor subtype.
- SM is associated with significant peritumoral brain edema (PTBE).
- PTBE may lead to severe symptoms and increased surgical risks.
Purpose of the Study:
- Compare SM with nonsecretory meningiomas.
- Examine PTBE, surgical outcomes, and recurrence.
- Perform a statistically rigorous analysis.
Main Methods:
- Retrospective review of 55 SM patients (2000-2017).
- Matched 1:1 with 55 nonsecretory grade I meningiomas.
- Used logistic, cumulative logit, and GEE regression models.
Main Results:
- SM patients had 8.9x higher odds of severe T2 edema (P < 0.001).
- SM patients had 6.2x higher odds of any T2 edema (P < 0.001).
- No significant differences in complications, resection, outcome, or recurrence.
Conclusions:
- SM significantly increases PTBE risk versus nonsecretory meningiomas.
- Despite increased edema, surgical outcomes are comparable.
- SM does not appear to negatively impact long-term prognosis.
