Poor brain-tumor interface related edema generation and cerebral venous decompensation in parasagittal meningiomas.

World Neurosurg. 2018 Apr 21. pii: S1878-8750(18)30811-8. doi: 10.1016/j.wneu.2018.04.092. [Epub ahead of print]

Poor brain-tumor interface related edema generation and cerebral venous decompensation in parasagittal meningiomas.



Parasagittal meningiomas (PSM) have a high incidence of peritumoral edema and unclear pathogenesis. The venous compression theory has been prposed as a pathomechanism; however, this is controversial and the various edema patterns have not been recognized.


We sought to establish the relationship between venous circulation status with different edema patterns in PSM and the neurological outcome of these different patterns.


We performed a retrospective study of 60 consecutive surgically-treated patients with PSM. Patients were divided into three groups: no-edema, poor brain-tumor interface related edema (PIRE), and strong brain-tumor interface related edema (SIRE). Single-blind observers scored venous circulation for each patient based on the degree of superior sagittal sinus (SSS) occlusion, number of involved cortical veins, and venous collateral grade. PIRE and SIRE were analyzed by multivariate analysis. Finally, we evaluated the Functional Independence and Mobility Score for every patient.


The PIRE group showed the highest rate of cerebral venous decompensation at 75% (n=15) compared to 38.5% (n=5) in the SIRE group and 22.2% (n=6) in the no-edema group. We observed a significant correlation between venous decompensation with PIRE on multivariate analysis (P=0.029). The PIRE group showed the worst immediate functional status, while the SIRE group had the best improvement in complete dependence rate (23%) at late evaluation.


The generation of PIRE, but not SIRE, may depend on venous decompensation in PSM. PIRE generation predicts a worse neurological outcome. Future studies into the pathogenesis of peritumoral edema should distinguish the different edema patterns.


brain edema; collateral circulation; parasagittal meningioma; treatment outcome; venous compression









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