Risk factors for postoperative motor complications in middle-third parasagittal meningioma surgery

Middle one-third parasagittal meningiomas are surgically demanding due to their proximity to the motor cortex and complex venous anatomy. Preservation of neurological function while achieving maximal safe resection remains a key challenge. This study aimed to identify clinical, radiological, and intraoperative predictors of postoperative motor weakness in patients with middle one-third parasagittal meningiomas.

A retrospective review was conducted on 103 consecutive patients who underwent microsurgical resection for middle one-third parasagittal meningiomas at a tertiary care centre. Demographic, clinical, radiological, and surgical parameters were analyzed. Postoperative motor outcomes were correlated with these variables using univariate and multivariate logistic regression analyses. Factors with p < 0.1 in univariate analysis were entered into the multivariate model.

Of the 103 patients, 67 (65 %) were female and 36 (35.0 %) were male. The median tumor volume was 32.6 cc (range, 7.3-188 cc). The most common presenting symptoms were headache (68.0 %), seizures (44.7 %), and motor weakness (36.9 %). Simpson grade II resection was achieved in 52.4 % of cases. Postoperative weakness occurred in 37 patients (37/103, 35.9 %), of whom 34 patients (34/103, 33.0 %) experienced transient symptoms that improved with physiotherapy. Three patients (2.9 %) developed permanent weakness. Univariate analysis revealed that headache (OR 2.79, 95 % CI 1.07-7.27, p = 0.04), midline shift > 5 mm (OR 2.53, 95 % CI 1.05-6.12, p = 0.04), loss of brain-tumor interface (OR 3.59, 95 % CI 1.51-8.52, p < 0.01) and post-operative CVT (OR = 12.58, 95 % CI: 1.45-109.01, p = 0.02) were significantly associated with postoperative weakness. On multivariate analysis, loss of the brain-tumor interface (OR 4.33, 95 % CI 1.28-14.63, p = 0.02) and post-operative CVT (OR 12.98, 95 % CI: 1.25-134.76, p = 0.03) were found to have significant association.

Loss of the brain-tumor interface was the only independent pre- or intra-operative predictor of postoperative motor weakness in patients undergoing resection of middle one-third parasagittal meningiomas. Most postoperative deficits are transient. Preservation of the arachnoid plane, careful dissection near eloquent cortex, and avoidance of venous injury are essential for optimizing functional outcomes.