Secretory meningiomas: a benign subgroup causing life-threatening complications

¹ Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
² Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
³ Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

^* To whom correspondence should be addressed. E-mail: j.regelsberger{at}uke.uni-hamburg.de.

	Abstract

While meningiomas are known as slow growing extracerebral neoplasm the subgroup of secretory meningioma with histological benign caracteristics tends to cause disproportional peritumoral edema frequently leading to severe medical and neurological complications in the postoperative management. Among 1484 meningiomas which were operated in our institution between 1990 and 2007, 44 (3%) patients were found to have the histological diagnosis of a secretory meningioma. The clinical course, radiological appearance and histopathological features were retrospectively analyzed to point out the specifics of these benign lesions. Meningiomas were located at the convexity (n = 14), the cranial base (18) and the sphenoid ridge (12). Disproportional to the tumor size a severe, nearly hemispheric perifocal edema was seen on preoperative MR-imaging in 18 (41%) patients. Following surgical resection the postoperative course was uneventful in 29 patients. In 15 patients severe peritumoral edema continued or even increased on postoperative CT-imaging. Six patients showed midline shift and clinical worsening necessitating respirator assisted ventilation and intracranial pressure monitoring. An association between the extent of brain edema and number of PAS positive pseudopasmmomas was found (p<0.02). Further, the size of the edema correlated with the number of immunohistochemically detected cells expressing carcinoembryonic antigen (CEA) and cytokeratin (CK) (p<0.01). Mean MIB-1 proliferation index was 3.0% (range 0–17%) and did not correlate with edema or tumor recurrence. Secretory meningiomas are frequently associated with a severe peritumoral edema. The extent of edema correlates with immunohistochemically detected expression of CEA and CK. Extended perifocal edema in meningiomas is an unusual finding and should alert the neurosurgeon that surgery may aggravate edema excessively leading to a life threatening postoperative situation.

Key Words: brain edema, immunohistochemistry, PAS stain, secretory meningioma

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