Association Between Tumor Consistency and the Surgical Management and Outcomes of Patients with Meningiomas

Introduction: Tumor consistency plays a significant role in the surgeon’s ability to resect meningiomas, especially with recently trends evolving towards minimally invasive approaches. Our team previously validated a practical 5-point scale for intraoperative grading of meningioma consistency. However, the impact of meningioma consistency on surgical management and outcomes has yet to be explored using this scale. This study aimed to determine associations between meningioma consistency and presenting symptoms, tumor characteristics, and postoperative outcomes.

Methods: The authors used our previously validated 5-point scale for intraoperative grading of meningiomas, ranging from extremely soft, suckable tumors (Grade 1) to firm/calcified tumors (Grade 5). 211 meningiomas were intraoperatively assigned a consistency score and presenting symptoms, tumor characteristics, postoperative complications, and surgical outcomes for these patients were retrospectively collected. Tumor consistency was analyzed in tertiles (grades 1+2, 3, 4+5) to determine associations. ANOVA and Chi-square/Fisher’s Exact Tests were used in data analysis.

Results: The study cohort included 76% females (n=160) with an average age of 55 years. A majority of the meningiomas were skull base tumors (84.8%, n=179). The distribution of consistency was grade 1 or 2 (10.4%), grade 3 (43.6%), grade 4 or 5 (46.0%). Higher consistency tumors were associated with pre-operative weakness (p < 0.001). Additionally, higher consistency tumors were associated with subtotal resection (p < 0.05), tumor recurrence following initial attempt of resection (p < 0.05), and tumor invasion (p < 0.05). Notably, there were no significant associations observed with tumor size (p=0.502) and duration of surgery (p=0.798).

Conclusion : Tumor consistency scoring using a 5-point scale is associated with important meningioma characteristics and perioperative outcomes. Thus, meningioma consistency scoring may be applied as an adjunct to improve surgical planning, instruments, and anticipation of postoperative outcomes.