{"title":"Preoperative tumor and edema volumes as predictors of ischemia and morbidity after intracranial meningioma surgery.","authors":"Sahin Hanalioglu, Efecan Cekic, Emin Tabipoglu, Zeynep Arzum Uyaniker, Gokcen Coban, Baylar Baylarov, Hacer Serdar, Sacide Kalaycioglu Korkmaz, Ahmet Ilkay Isikay","doi":"10.1093/noajnl/vdag092","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Ischemic complications remain a significant risk indicator of morbidity after meningioma surgery. While tumor size and extent of resection (EOR) are recognized risk factors, the prognostic impact of peritumoral brain edema volume (PTBEV) is not fully established. This study investigated whether preoperative tumor volume (TV) and PTBEV independently predict postoperative ischemia and neurological morbidity.</p><p><strong>Methods: </strong>We retrospectively investigated 152 patients who underwent resection of intracranial meningiomas from 2008 to 2023. Preoperative post-contrast T1W and Fluid-Attenuated Inversion Recovery (FLAIR) MRI were used to quantify TV and PTBEV, and postoperative DWI within 72 hours post-surgery was used to identify ischemic lesions. Volumetric segmentation was performed in 3D Slicer™ and validated by five independent reviewers. Statistical analysis included Spearman's correlation, univariate and multivariate linear regression for predictors of postoperative ischemic volume (PIV), and binary logistic regression for new neurological deficits. The <i>P</i> value < .05 was considered significant.</p><p><strong>Results: </strong>Median preoperative TV was 23.1 cm³ (IQR 9.3-48.4 cm³), and PTBEV was 3.5 cm³ (IQR 0.0-28.4 cm³). Median PIV was 1.5 cm³ (IQR 0.0-5.3). PIV correlated with preoperative TV (<i>r</i> = 0.393, <i>P</i> < .001) and PTBEV (<i>r</i> = 0.446, <i>P</i> < .001). Multivariate regression identified preoperative PTBEV (<i>P</i> < .001), preoperative TV (<i>P</i> = .015), and subtotal resection (STR) vs. GTR (<i>P</i> = .033) as independent predictors of postoperative ischemia. Overall, 11.8% of the patients developed new neurological deficits (1.3% permanent). Ischemic volumes >2 cm³ significantly increased risk of new neurological non-cranial nerve deficits (OR = 6.667, 95% CI 1.408-31.556, <i>P</i> = .017).</p><p><strong>Conclusion: </strong>Preoperative tumor and edema volumes are independent predictors of postoperative ischemia. Even modest ischemic lesions (>2 cm³) can cause clinically relevant morbidity. Volumetric biomarkers should be integrated into surgical planning, with prospective multicenter validation warranted.</p>","PeriodicalId":94157,"journal":{"name":"Neuro-oncology advances","volume":"8 1","pages":"vdag092"},"PeriodicalIF":4.1000,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135371/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuro-oncology advances","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/noajnl/vdag092","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Ischemic complications remain a significant risk indicator of morbidity after meningioma surgery. While tumor size and extent of resection (EOR) are recognized risk factors, the prognostic impact of peritumoral brain edema volume (PTBEV) is not fully established. This study investigated whether preoperative tumor volume (TV) and PTBEV independently predict postoperative ischemia and neurological morbidity.
Methods: We retrospectively investigated 152 patients who underwent resection of intracranial meningiomas from 2008 to 2023. Preoperative post-contrast T1W and Fluid-Attenuated Inversion Recovery (FLAIR) MRI were used to quantify TV and PTBEV, and postoperative DWI within 72 hours post-surgery was used to identify ischemic lesions. Volumetric segmentation was performed in 3D Slicer™ and validated by five independent reviewers. Statistical analysis included Spearman's correlation, univariate and multivariate linear regression for predictors of postoperative ischemic volume (PIV), and binary logistic regression for new neurological deficits. The P value < .05 was considered significant.
Results: Median preoperative TV was 23.1 cm³ (IQR 9.3-48.4 cm³), and PTBEV was 3.5 cm³ (IQR 0.0-28.4 cm³). Median PIV was 1.5 cm³ (IQR 0.0-5.3). PIV correlated with preoperative TV (r = 0.393, P < .001) and PTBEV (r = 0.446, P < .001). Multivariate regression identified preoperative PTBEV (P < .001), preoperative TV (P = .015), and subtotal resection (STR) vs. GTR (P = .033) as independent predictors of postoperative ischemia. Overall, 11.8% of the patients developed new neurological deficits (1.3% permanent). Ischemic volumes >2 cm³ significantly increased risk of new neurological non-cranial nerve deficits (OR = 6.667, 95% CI 1.408-31.556, P = .017).
Conclusion: Preoperative tumor and edema volumes are independent predictors of postoperative ischemia. Even modest ischemic lesions (>2 cm³) can cause clinically relevant morbidity. Volumetric biomarkers should be integrated into surgical planning, with prospective multicenter validation warranted.
背景：缺血性并发症仍然是脑膜瘤手术后发病率的重要危险指标。虽然肿瘤大小和切除程度（EOR）是公认的危险因素，但肿瘤周围脑水肿体积（PTBEV）对预后的影响尚未完全确定。本研究探讨术前肿瘤体积（TV）和PTBEV是否能独立预测术后缺血和神经系统疾病。方法：回顾性分析2008年至2023年接受颅内脑膜瘤切除术的152例患者。术前造影后T1W和FLAIR MRI量化TV和PTBEV，术后72h内DWI识别缺血性病变。在3D Slicer™中进行体积分割，并由五位独立审稿人进行验证。统计分析采用Spearman相关，单因素和多因素线性回归预测术后缺血体积（PIV），二元逻辑回归预测新出现的神经功能缺损。P值< 0.05被认为是显著的。结果：术前中位TV为23.1 cm³（IQR 9.3 ~ 48.4 cm³），PTBEV为3.5 cm³（IQR 0.0 ~ 28.4 cm³）。中位PIV为1.5 cm³（IQR为0.0-5.3）。PIV与术前TV相关(r = 0.393, P r = 0.446, P P P =。015)和次全切除（STR） vs. GTR （P = 0.033）作为术后缺血的独立预测因子。总体而言，11.8%的患者出现了新的神经功能障碍（1.3%是永久性的）。缺血容量bbb20 cm³显著增加新发神经非颅神经缺损的风险（OR = 6.667, 95% CI 1.408-31.556, P = 0.017）。结论：术前肿瘤和水肿体积是术后缺血的独立预测因子。即使是轻微的缺血性病变（>2 cm³）也可引起临床相关的发病率。体积生物标志物应整合到手术计划中，并有必要进行前瞻性多中心验证。
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