Assessment and Treatment of Peritumoral Cortical Veins in Parasagittal Meningiomas with Application of 3-Dimensional Imaging Fusion Model

Evaluation of Parenchymal Collaterals in Patients with Meningioma Using Contrast-enhanced T1 MPRAGE Sequence

BACKGROUND

Post-contrast T1-MPRAGE sequence has been used in routine tumor imaging at many centers for decades. Meningiomas may be accompanied by leptomeningeal as well as parenchymal collaterals. In this study, we aimed to demonstrate the collaterals that may accompany meningiomas on postcontrast T1-MPRAGE imaging and to investigate their relationship with location, size, histologic features, adjacent bone, and parenchymal changes.

METHODS

In this study, postcontrast T1-MPRAGE images of 326 meningiomas from 259 patients were independently analyzed by two observers. The presence of parenchymal collaterals and unilateral, contralateral or bilateral localization were determined. Meningiomas' diameters, locations, presence of dural sinus invasion, associated parenchymal changes and bony changes were determined. Histologic grades were determined if applicable. The data obtained were analyzed statistically.

RESULTS

Parenchymal collaterals were demonstrated in 25% of meningiomas (66/259). Of these, 65% were unilateral, 12% contralateral and 23% bilateral. There was a significant correlation between malignancy and the presence of collaterals in histologically diagnosed meningiomas (77%, p = 0.01). The presence of collaterals was also significantly higher in meningiomas with sinus invasion and bone destruction (p < 0.001). As tumor size increased, unilateral and bilateral collateral development increased (p < 0.001, p = 0.008, respectively), but it was not significant in contralateral cases. There was significant concordance between the observers in terms of the presence of collaterals (kappa: 0.773).

CONCLUSIONS

Meningiomas may be accompanied by parenchymal collaterals. WHO grade 3 histologic type, sinus invasion, bone destruction and size increase are predictors of collateral development.

Preoperative diagnosis of meningioma sinus invasion based on MRI radiomics and deep learning: a multicenter study

OBJECTIVE

Exploring the construction of a fusion model that combines radiomics and deep learning (DL) features is of great significance for the precise preoperative diagnosis of meningioma sinus invasion.

MATERIALS AND METHODS

This study retrospectively collected data from 601 patients with meningioma confirmed by surgical pathology. For each patient, 3948 radiomics features, 12,288 VGG features, 6144 ResNet features, and 3072 DenseNet features were extracted from MRI images. Thus, univariate logistic regression, correlation analysis, and the Boruta algorithm were applied for further feature dimension reduction, selecting radiomics and DL features highly associated with meningioma sinus invasion. Finally, diagnosis models were constructed using the random forest (RF) algorithm. Additionally, the diagnostic performance of different models was evaluated using receiver operating characteristic (ROC) curves, and AUC values of different models were compared using the DeLong test.

RESULTS

Ultimately, 21 features highly associated with meningioma sinus invasion were selected, including 6 radiomics features, 2 VGG features, 7 ResNet features, and 6 DenseNet features. Based on these features, five models were constructed: the radiomics model, VGG model, ResNet model, DenseNet model, and DL-radiomics (DLR) fusion model. This fusion model demonstrated superior diagnostic performance, with AUC values of 0.818, 0.814, and 0.769 in the training set, internal validation set, and independent external validation set, respectively. Furthermore, the results of the DeLong test indicated that there were significant differences between the fusion model and both the radiomics model and the VGG model (p < 0.05).

CONCLUSIONS

The fusion model combining radiomics and DL features exhibits superior diagnostic performance in preoperative diagnosis of meningioma sinus invasion. It is expected to become a powerful tool for clinical surgical plan selection and patient prognosis assessment.

MRI- and DWI-Based Radiomics Features for Preoperatively Predicting Meningioma Sinus Invasion

The aim of this study was to use multimodal imaging (contrast-enhanced T1-weighted (T1C), T2-weighted (T2), and diffusion-weighted imaging (DWI)) to develop a radiomics model for preoperatively predicting venous sinus invasion in meningiomas. This prediction would assist in selecting the appropriate surgical approach and forecasting the prognosis of meningiomas. A retrospective analysis was conducted on 331 participants who had been pathologically diagnosed with meningiomas. For each participant, 3948 radiomics features were acquired from the T1C, T2, and DWI images. Minimum redundancy maximum correlation, rank sum test, and multi-factor recursive elimination were used to extract the most significant features of different models. Then, multivariate logistic regression was used to build classification models to predict meningioma venous sinus invasion. The diagnostic capabilities were assessed using receiver operating characteristic (ROC) analysis. In addition, a nomogram was constructed by incorporating clinical and radiological characteristics and a radiomics signature. To assess the clinical usefulness of the nomogram, a decision curve analysis (DCA) was performed. Tumor shape, boundary, and enhancement features were independent predictors of meningioma venous sinus invasion (p = 0.013, p = 0.013, p = 0.005, respectively). Eleven (T2:1, T1C:4, DWI:6) of the 3948 radiomics features were screened for strong association with meningioma sinus invasion. The areas under the ROC curves for the training and external test sets were 0.946 and 0.874, respectively. The clinicoradiomic model showed excellent predictive performance for invasive meningioma, which may help to guide surgical approaches and predict prognosis.

Risk factors influencing cerebral venous infarction after meningioma resection

BACKGROUND

Cerebral venous infarction (CVI) is a serious complication after meningioma resection. The risk factors of postoperative cerebral venous infarction after surgical resection of meningioma can be determined through large samples and this study can add evidence to the literature.

METHODS

The clinical and imaging data of 1127 patients with intracranial meningiomas who underwent resection in our hospital were retrospectively collected and analyzed. CVI was evaluated by postoperative imaging and clinical manifestations. Univariate and multivariate analyses were performed to identify risk factors associated with CVI.

RESULTS

Overall, 4.7% (53/1127) of patients experienced CVI after meningioma resection. Multivariate analysis revealed superficial meningioma, moderate to severe peritumoral edema, peritumoral critical vein and WHO grade II-III as independent predictors of a postoperative CVI. After timely intervention, the symptoms were clearly alleviated in one month, and the prognosis was good, but injury to key veins could cause irreversible neurological disorders.

CONCLUSIONS

Intraoperative protection of veins is the primary way to prevent CVI. The present study identified several significant and independent risk factors for postoperative venous infarction, thereby enabling the identification of high-risk patients who require special attention during clinical and surgical management.

Classification of Peritumoral Veins in Convexity and Parasagittal Meningiomas and Its Significance in Preventing Cerebral Venous Infarction

OBJECTIVE

The medium (2-4 cm) convexity located closer to the sinus and parasagittal meningiomas (Sindou type I-Ⅲ) without obvious invasion of the superior sagittal sinus are considered simple to operate on. However, the tumors are often accompanied by the cortical bridging vein. Because of lack of collateral vein circulation in cortical areas, the damage of peritumoral veins will subsequently lead to venous infarction. To avoid the serious complications caused by intraoperative injury of peritumoral veins, it is necessary to define the classification of the progression of peritumoral veins and tumors to guide surgical safety.

METHODS

The clinical information of 57 patients with convexity and parasagittal meningiomas was collected and retrospectively analyzed. All patients underwent preoperative magnetic resonance imaging and magnetic resonance venography scanning to observe the imaging characteristics of peritumoral veins and preoperative evaluation. The actual relationship between the tumor and peritumoral vein was observed intraoperatively. Postoperative computed tomography and magnetic resonance imaging were used to determine tumor resection and the presence of venous infarction.

RESULTS

According to preoperative magnetic resonance venography and intraoperative findings, we divided the peritumoral veins into 3 types: type A (n = 33, 57.9%), the vein surrounds the tumor; type B (n = 15, 26.3%), the vein is located on the ventral side of the tumor; and type C (n = 9, 15.8%), the vein is located on the dorsal side of the tumor. Peritumoral vein injury occurred in 6 cases followed by serious complications. Treatments were as follows: 4 cases underwent decompression and 2 cases were treated conservatively. The prognosis Glasgow Outcome Scale (GOS) scores were as follows: 3 cases were score 5 for injury of posterior frontal vein or middle frontal vein, 2 cases were score 3 for injury of the central vein, 1 case was score 1 for death due to injury of the central vein. All cases were followed up for 6 months.

CONCLUSIONS

Attention should be paid to the peritumoral vein of special meningiomas. Injured vein in the medial third of superior sagittal sinus carries a high rate of postoperative morbidity. Understanding the type of peritumoral veins preoperatively can be used as a guide in determining the corresponding protective strategy during surgery, which can significantly decrease postoperative disability and improve quality of life.

Can safe and radical resection of all types of parasagittal meningiomas be achievable? -the introduction of a simplified surgical strategy

Background: Surgery of parasagittal meningiomas (PSMs) is still technically challenging, for the balance between radical resection and preservation of venous circulation. In this article, we'd systemically introduce the technical nuances of a simplified strategy for radical resection of all types of PSMs. All the cases were operated by one single neurosurgeon from a single institution.Methods: Clinical charts of patients with PSMs between 2014 and 2020were retrospectively reviewed. A simplified classification method was adopted, which was based on the relationship between the tumor and superior sagittal sinus (SSS). Surgery aiming at radical resection and venous flow preservation was performed. Only in case of total occlusion of SSS, we performed tumor resection without reconstruction of the venous sinus.Results: Clinical data obtained in 55 consecutive patients (47 primary and 8 recurrent cases) were analyzed, among which 20 were with patent sinus, 27 were with partially occluded sinus and 8 were with completely occluded sinus. Forty-two (76.4%) and 13 patients (23.6%) had the same and improved functional status as compared to that of pre-operation, respectively. Four patients (7.3%) experienced transient neurological deterioration but improved to the normal level in the long-term follow-up. All patients achieved Simpson I/II radical resection. No patients suffered from post-operative recurrence in the follow-up duration of 27.05 ± 19.55 (2-91) months.Conclusion: Radical and safe resection of all types of PSMs is achievable and not difficult if the simplified surgical strategy mentioned in the article is adopted, no matter to which extent the sinus is invaded.

Optimal surgical strategy for meningiomas involving the superior sagittal sinus: a systematic review

Involvement of the superior sagittal sinus (SSS) by meningiomas poses specific challenges, without an agreement about the degree of surgical aggressiveness when dealing with these lesions. In this systematic review and meta-analysis, we compare outcomes and complication rates, after different surgical strategies. Studies focused on meningiomas involving the SSS were collected from numerous online databases. Surgical outcome and complication data were abstracted. Comparisons were made considering complication and recurrence rates between an "aggressive" and a "non-aggressive" surgical attitude. A total of 26 studies, encompassing 1614 patients, were identified. Most of the tumors (53%) arose from the middle third of SSS and 75% of patients had a patent sinus at the time of surgery. A favorable outcome was achieved in 73% of patients treated with an "aggressive" surgical attitude compared to 78% of patients treated with a "non-aggressive" surgical attitude. Complication rates were similar between "aggressive" and "non-aggressive" attitudes, except for a higher rate of venous infarct (4% versus 2%, respectively) and worsening of preexisting motor deficits (34% versus 13%, respectively) in aggressively treated patients. Recurrence rates were not substantially different in the two groups after accounting for length of follow-up. Patients with incomplete resection (Simpson grades II-V) or with high histological grade (WHO grade III) had significantly higher recurrence rates. A complete resection achieves higher rates of tumor control, however, without nullifying the risk of recurrence. Moreover, "aggressive" tumor removal is associated with higher rates of venous complications and worsening of preexisting motor deficits.

Poor Brain-Tumor Interface-Related Edema Generation and Cerebral Venous Decompensation in Parasagittal Meningiomas

BACKGROUND

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

OBJECTIVE

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

METHODS

We performed a retrospective study of 60 consecutive patients who underwent surgical treatment for PSM. Patients were divided into 3 groups: no edema, poor brain-tumor interface-related edema (PIRE), and strong brain-tumor interface-related edema (SIRE). Single-blinded observers scored venous circulation for each patient based on the degree of superior sagittal sinus (SSS) occlusion, the number of involved cortical veins, and venous collateral grade. PIRE and SIRE were analyzed using multivariate analysis. Finally, we evaluated the functional independence and mobility score for every patient.

RESULTS

The PIRE group showed the highest rate of cerebral venous decompensation at 75% (n = 15) compared with 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 and PIRE generation on multivariate analysis (P = 0.029). The PIRE group showed the worst immediate functional status, and the SIRE group had the best improvement in complete dependence rate (23%) at late evaluation.

CONCLUSIONS

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