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Secretory meningiomas: systematic analysis of epidemiological, clinical, and radiological features

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Abstract

Background

Secretory meningiomas are known as a rare histological subtype within the meningioma family. In contrast to benign intracranial meningiomas, they are dreaded for causing an extensive perifocal cerebral tumor edema and life-threatening complications. The objective of the present study is a systematic, retrospective analysis of epidemiological, clinical, and radiological features of secretory meningiomas to predict potential patterns prior to surgery to reduce associated morbidity.

Material and methods

A systematic database search of PubMed with review of the literature was performed to identify clinical studies analyzing epidemiological, clinical, and radiological features of secretory meningiomas. Additionally, we supplemented our series of 17 patients with secretory meningiomas. Studies with available information for each patient were statistically metaanalyzed.

Results

In summary, seven large series with a total number of 120 patients were identified, containing detailed information about epidemiological, clinical, and radiological features of secretory meningiomas. Epidemiologically, female predominance was a characteristic. Peritumoral brain edema occurred in about 70% of patients and holohemispheric in more than 50% of patients. Life-threatening complications and severe neurological deficits frequently occur potentially due to extensive peritumoral brain edema. At last, frontal location and age older than 66 years significantly correlated with the development of peritumoral brain edema.

Conclusion

Secretory meningiomas are histologically benign tumors and are therefore associated with an excellent prognosis. Nevertheless, frequently life-threatening complications due to the development of an extensive peritumoral brain edema are documented. Predictive risk factors are frontal tumor location, increasing age, and visible pial tumor vessel supply. A careful preoperative evaluation, identification of risk factors, and a specific therapy might reduce perioperative morbidity.

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Authors and Affiliations

  1. Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany

    Marcel Alexander Kamp, Kerim Beseoglu, Sven Eicker, Hans-Jakob Steiger & Daniel Hänggi

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  1. Marcel Alexander Kamp
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  2. Kerim Beseoglu
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  3. Sven Eicker
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  4. Hans-Jakob Steiger
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  5. Daniel Hänggi
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Correspondence to Marcel Alexander Kamp.

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Comment

An essential part of neuro-oncology group practice is the recognition of unusual to very rare CNS tumors and the tailoring of optimal therapy for their carriers. With scarce published data around, neuro-oncosurgeons are grateful when distinguished colleagues present their series of rare tumors from the last 10 to 20 years together with a systemic analysis of the literature.

The German colleagues review 137 secretory meningiomas, including their own 17 cases (1.5%) from a total of 1,112 meningioma patients. Now, 1.5% places secretory meningiomas in the league of hemangiopericytoma and the evil-doer anaplastic meningioma (WHO grade III)—but secretory meningiomas are benign with excellent response to microsurgical removal. However, they should be noted and suspected for extensive peritumoral edema with potentially life-threatening complications in as many as one third of the cases.

Juha E Jääskeläinen

Kuopio, Finland

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Kamp, M.A., Beseoglu, K., Eicker, S. et al. Secretory meningiomas: systematic analysis of epidemiological, clinical, and radiological features. Acta Neurochir 153, 457–465 (2011). https://doi.org/10.1007/s00701-010-0914-0

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  • DOI: https://doi.org/10.1007/s00701-010-0914-0

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