Clinicopathological Correlations in Intracranial Meningiomas

Meningiomas are one of the most common primary intracranial neoplasms that may present with a wide variety of clinical symptoms, depending on multiple factors such as tumor size, location, and grade. Knowledge of the grade of meningioma correlated with their related symptoms is of great value in developing diagnostic and therapeutic approaches efficiently. Although various knowledge about meningiomas exists, there still seems to be a lacuna as far as explicit relations between tumoral characteristics and the severity or evolution of symptoms are concerned. The goal of this prospective study is to describe in detail such associations.  Objective: The goal of this paper is to try to explain the relationship between meningioma grades (I, II, and III) and the spectrum of their clinical manifestations, focusing on the symptom severity and progression dynamics, as well as the anatomical tumor distribution in a series of surgically treated cases.

In the present prospective study, 117 cases with established diagnoses of intracranial meningioma underwent surgical treatment from January 2021 to January 2024. Detailed analyses of presenting symptoms were done for headaches, seizures, visual disturbances, and motor deficits. Further details in tumor location, such as laterality and regional specificity, and the type of surgical approach adopted were considered in the clinical outcomes. Tumors were also categorized by size (small, large, and huge) to clarify the relationship between tumor size, histologic grade, and clinical symptoms. A correlation between histopathological features and clinical severity based on the grade of tumor was done using immunohistochemistry.

The symptoms presented were, among the three grades, headache in Grade I patients, 54.9%, followed by Grade II, 52.4%, and Grade III accounted for 80.0%. Seizures appeared among 23.8% of the patients in Grade II, whereas among Grade I patients, 15.4% had visual blurring. The size and location of the tumor also differed: the inverted U craniotomy was performed in 32.5% of cases with Grade I and III tumors, whereas the pterional approach was applied more in Grade II and III tumors at 35.9%. In addition, Grade II and III tumors tend to shift to the right side; no obvious asymmetry is seen in Grade I.

The presentation and clinical course of meningiomas seem to be greatly affected and formulated by variables other than meningioma grade, such as tumor location, tumor size, venous blockage (venous sinus/cortical vein), and concomitant perilesional edema. The research emphasizes the necessity for a thorough knowledge of meningioma features for appropriate diagnosis and therapy by highlighting the intricate interaction of various elements in determining symptomatology.