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Characteristic features and proposed classification in 69 cases of intracranial microcystic meningiomas

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Abstract

Microcystic meningioma (MM) is a rare subtype of intracranial meningiomas, with clinical and radiologic features not well characterized in the literature. Based on our experience, we propose a classification system of intracranial MMs. We reviewed the medical records, radiographic studies, and operative notes of a group of consecutive patients with intracranial MM. The mean age of the 69 patients was 46.8 ± 10.6 years (range, 21–75 years). Three types of intracranial MMs could be identified. Type 1 MMs presented as a solid lesion, hypointense or isointense on T1WI, hyperintense on T2WI, and homogeneous or heterogeneous enhancement, and were found in 43 patients (67.2%). Type 2 MMs represented signals similar to CSF both on T1WI and T2WI, and faint reticular enhancement with marginal enhancement, and these were found in 7 patients (10.9%). Type 3 MMs consisted of cystic-solid or cystic lesion and were found in 14 patients (21.9%). Significant differences were observed among the different types of MMs for the following variables: sex, presence of severe peritumoral brain edema (PTBE), and extent of tumor resection. Females were found in all of patients with type 2 MMs, but were only 35.7% of those with type 3 MMs (P = 0.018). Severe PTBEs were more common among patients with type 1 MMs (55.8%) than among those with type 2 (14.3%) and type 3 MMs (14.3%) (P = 0.007). Type 1 MMs (97.7%) were associated with a significantly higher rate of gross total resection compared with the other two types (71.4 and 78.6%) (P = 0.019). Total length of hospital stay after craniotomy ranged from 4 to 30 days (median, 8 days). There were no significant differences in progression-free survival among the three types of MMs (P = 0.788). The current classification identifies three distinct types of intracranial MM based on their radiological findings and growth patterns. The type 1 MMs are more commonly associated with severe PTBE. Type 2 and Type 3 MMs have a higher predilection towards parasaggital location with venous involvement and therefore have a lower rate of gross total resection.

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Abbreviations

MM :

microcystic meningioma

T1WI :

T1-weighted images

T2WI :

T2-weighted images

WHO :

World Health Organization

MRI :

magnetic resonance image

PTBE :

peritumoral brain edema

EI :

edema index

KPS :

Karnofsky performance scale

GTR :

gross total resection

STR:

subtotal resection

VEGF :

vascular endothelial growth factor

PFS :

progression-free survival

OS :

overall survival

PM :

psammomatous meningioma

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Author information

Author notes

  1. Zhiqin Lin and Meng Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Longyan First Hospital, Fujian Medical University, Fujian, China

    Zhiqin Lin, Ping Qiu, Folin Lan, Celin Guan, Dongwei Shen, Jing Lu & Shuanglin Que

  2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 TiantanXili, Dongcheng District, Beijing, 100050, China

    Meng Zhao, Xiangrong Li & Zhongli Jiang

  3. Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China

    Junmei Wang

  4. Department of Radiotherapy, Longyan First Hospital, Fujian Medical University, Fujian, China

    Dongxia Liao

Authors
  1. Zhiqin Lin
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Correspondence to Zhongli Jiang.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this retrospective study formal consent was not required.

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Informed consent was obtained from all individual participants included in the study.

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Lin, Z., Zhao, M., Li, X. et al. Characteristic features and proposed classification in 69 cases of intracranial microcystic meningiomas. Neurosurg Rev 42, 443–453 (2019). https://doi.org/10.1007/s10143-018-0982-9

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  • DOI: https://doi.org/10.1007/s10143-018-0982-9

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