The association between preoperative edema and postoperative cognitive functioning and health-related quality of life in WHO grade I meningioma patients

Abstract

Background Studies on the associations between preoperative cerebral edema, cognitive functioning, and health-related quality of life (HRQOL) in WHO grade I meningioma patients are virtually lacking. We studied the association between preoperative cerebral edema on postoperative cognitive functioning and HRQOL 6 months postoperatively in WHO grade I meningioma patients. Methods Twenty-one consecutive WHO grade I meningioma patients, who underwent surgery, were matched individually for age, gender, and educational level to healthy controls. Tumor and edema volume were assessed on preoperative T1- and T2-weighted MRI images, respectively. At least 5 months postoperatively, functional status, cognitive functioning, and HRQOL, using a cognitive test battery and the Short-Form Health Survey (SF-36), were determined. The correlation between preoperative tumor and cerebral edema volume with postoperative cognitive functioning and HRQOL was investigated using Kendall’s tau coefficients. Results Compared to healthy controls, patients had lower verbal memory capacity ( p = .012), whereas HRQOL was similar to matched healthy controls. In all cognitive domains, postoperative functioning was much lower in patients with preoperative cerebral edema than in those without. There were significant correlations between preoperative cerebral edema and tumor volume and postoperative cognitive functioning. Preoperative cerebral edema and/or tumor volume were not associated with HRQOL. Conclusions Our results suggest that WHO grade I meningioma patients with larger volumes of preoperative cerebral edema are more at risk of experiencing limitations in longer-term cognitive functioning than patients with no or less edema preoperatively. This is an important knowledge for neurologists and neurosurgeons treating patients with a meningioma. More studies regarding the effect of peritumoral edema on cognitive functioning in meningioma patients are necessary. Electronic supplementary material The online version of this article (10.1007/s00701-019-03819-2) contains supplementary material, which is available to authorized users.

Predictors of pre-operative cognitive impairment in meningioma patients over 60 years old

“…Cerebral blood flow and cerebral blood volume are also significantly low in the peritumoral edema [22]. Previous study has reported that the apathy is much severe in patients with brain edema of medial frontal meningioma [23], and preoperative cerebral edema in WHO grade I meningioma patients is correlated with post operative cognitive dysfunction [24]. In contrast, Tucha et al showed preoperative edema was not associated with cognitive function after surgery [25].…”

Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review

“…Table 1 summarizes the characteristics of all included studies and their corresponding patients that underwent neuropsychological cognitive evaluation prior to and after treatment. Overall, 9 retrospective [ 5 , 23 , 24 , 30 , 33 , 34 , 35 , 36 , 37 ] and 13 prospective [ 20 , 21 , 22 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 38 , 39 , 40 ] studies were reviewed, corresponding to a total of 1572 patients (range 9–261) with a mean age of 58.4 years (range 23–87). Most patients were female (n = 1084, 68.9%), with a female-to-male ratio of 2.3:1.…”

“…The identified literature consists of 18 cohorts treated with surgery [ 5 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 40 ], 3 cohorts that benefited from both surgery and adjuvant radiotherapy due to partial tumor removal [ 35 , 37 , 39 ], and 1 cohort that only received radiotherapy/radiosurgery [ 38 ] as a single treatment modality ( Table 2 and Supplementary Materials ). Table 2 provides a selected subset of the 5 biggest cohorts analyzed.…”

Microcystic Meningiomas: MRI‐Pathologic Correlation

“…Pathogenesis of PTBE in meningiomas is highly variable and multifactorial 20,21 . The mechanisms operating in edema genesis have not been completely elucidated 22‐25 . The expression of vascular permeability factor/vascular endothelial growth factor (VPF/VEGF) and its endothelial receptor “flt‐1” has been studied in MM by Christov et al, who reported that the density of vessels positive for VPF/VEGF/flt‐1 expression was much higher with MM than in other solid meningiomas, possibly ascribing it as a key role as a driver for microcyst formation.…”