Peritumoral brain edema in relation to tumor size is a variable that influences the risk of recurrence in intracranial meningiomas

Abstract Background Peritumoral brain edema (PBE) is common in intracranial meningiomas (IM) and can increase its morbidity. It is not uncommon for a neurosurgeon to face the diagnosis of a meningioma with a large proportion of PBE irrespective of the site and size of the contrast-enhancing lesion without any clinical and biological cause. Methods We performed a retrospective review of 216 surgically-treated patients with IM. We recorded clinical, biological, and radiological data. Based on the rate of tumor and edema volume, we divided the patients into a group with high-ratio Edema/Tumor and a group with a low ratio. We investigated how the ratio of edema/lesion may affect the outcome. Results Multivariate analysis was performed for the two groups. Smokers were more frequently associated with the high-rate group. The edema/tumor ratio does not influence surgical radicality, however, independently of the biological subtype, WHO grading, and EOR, a higher frequency of recurrence is shown in patients with a high edema/tumor ratio (70.5% versus 8.4%. p < 0.01). Conclusions The relationship between tumor and edema volume is respected in our series, but it does not explain why there are so many cases in which the ratio is so high. It seems that the blood-brain barrier (BBB) damage from smoke could have a role in an increased volume of PBE.