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Peritumoral edema in meningiomas: microsurgical observations of different brain tumor interfaces related to computed
F M Salpietro1, C Alafaci, S Lucerna
1Department of Neurosurgery, University of Messina, Italy.
Abstract:
Although generally benign tumors, meningiomas may be associated with extensive peritumoral brain edema as seen on computed tomographic scans. Fifty-two patients with intracranial meningiomas were studied, and the hypodense areas on computed tomographic scans were related to the intraoperative microsurgical findings and to the sizes of the tumors. We have identified three kinds of tumor-brain interfaces characterized by different difficulties in microsurgical dissection: smooth type, transitional type, and invasive type. These different microsurgical interfaces seem to correlate very precisely with computed tomographic images of halo-like and finger-like hypodense areas, allowing prediction of the microsurgical effort to be made in the surgery of meningiomas. The size of the tumor seems to be important in our subjects in determining the amount of edema produced. Indeed, a positive correlation (P < 0.001) was found between the sizes of the tumors and the extent of peritumoral hypodensity. A positive correlation (P < 0.002) also has been found between grade of edema and cortical penetration. Cerebral cortex disruption was systematically observed by us in invasive-type meningiomas and in 3 of 21 cases (14.3%) in transitional-type meningiomas. No penetration was observed in smooth-type meningiomas.
Insights
Meningioma tumor size correlates with brain edema extent. CT scan findings can predict microsurgical dissection difficulty, guiding meningioma surgery.
Area of Science:
- Neurosurgery
- Neuroradiology
- Oncology
Background:
- Meningiomas, typically benign tumors, can cause significant peritumoral brain edema.
- Computed tomography (CT) scans are crucial for visualizing edema and tumor characteristics.
Purpose of the Study:
- To correlate CT findings with microsurgical dissection challenges in meningioma surgery.
- To investigate the relationship between tumor size, edema, and cortical involvement.
Main Methods:
- Retrospective analysis of 52 patients with intracranial meningiomas.
- Correlation of CT-identified hypodense areas with intraoperative microsurgical findings.
- Assessment of tumor-brain interface types (smooth, transitional, invasive).
Main Results:
- Three distinct microsurgical tumor-brain interfaces were identified: smooth, transitional, and invasive.
- CT-detected halo-like and finger-like hypodensities accurately predicted these interface types.
- Tumor size positively correlated with the extent of peritumoral hypodensity (edema).
- Edema grade correlated with cortical penetration, observed in invasive and transitional types.
Conclusions:
- CT imaging can predict microsurgical difficulty in meningioma resection.
- Tumor size is a significant factor in the development of peritumoral edema.
- Understanding the tumor-brain interface is critical for surgical planning and minimizing cortical disruption.