Introduction: Peri-tumoral brain oedema (PTBE) associated with intracranial meningioma occurs variably. The causal factors and whether the presence of oedema contributes to post-operative complications is not known. We sought to determine correlations between PTBE in patients undergoing craniotomy for meningioma and the impact on post-operative complications.
Methods: Clinical and histological factors were identified by retrospective clinical chart review of a consecutive cohort of adult patients who underwent craniotomy for meningioma in a single institution. Factors included presenting clinical and radiological features, mode of admission and the use of pre-operative corticosteroids, WHO grade and histological subtype. Post-operative complications, including the presence of neurological deficits, seizures and infection were also recorded. Tumour and oedema volume were evaluated using manual segmentation to allow calculation of an oedema index (OI, volume oedema/volume tumor).
Results: 44 patients underwent surgical resection for meningioma from 1st January 2011 to 31st December 2011, including 11 men and 33 women with mean age of 59.9. PTBE was present in 61.4% of patients with a mean OI of 2.29 (range 0-23.3) Age, gender and histological subtype were not correlated with OI or complications. Tumours resected in asymptomatic patients (incidental finding) were associated with fewer post-operative complications than patients with pre-operative deficits or seizures (P=0.036). Use of pre-operative corticosteroids led to significantly more post-operative complications (P=0.008), mostly new neurological deficit or CSF leak. Other than tumour size (p=0.02), no other factors such as location or association with venous sinuses correlated with the presence of oedema.
Conclusions: PTBE occurs in a large proportion of patients with meningioma and OI is correlated to tumour size, but no other radiological or histological factor. Although the presence of oedema is not correlated with complications, patients who presented with a neurological deficit or seizures or had corticosteroids prior to surgery were more likely to develop post-operative complications.
Patient Care: By identifying reversible factors associated with the development of post-operative complications.
Learning Objectives: By the conclusion of this session, participants should be able to discuss the causal factors of oedema associated with intracranial meningiomas and the factors associated with post-operative complications