An anatomical investigation of intracranial meningiomas.
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Date
2021
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Abstract
Meningiomas are generally benign, highly vascularised, slow-growing tumours arising from the
arachnoid cap cells of the arachnoid villi. The clinical presentation of these tumours is usually
location dependant due to the vast expanse covered by the meninges. Resection of a meningioma
is generally performed after preoperative embolisation. A feeder vessel is selected and embolised
in an attempt to reduce excessive blood loss and postoperative complications. However,
embolisation requires a sound knowledge of the vasculature of the meninges since these vessels
supply portions of the cranial nerves. Literature consulted have investigated anatomical features
of meningioma’s; however, there is a scarcity of studies investigating patients specifically referred
for preoperative embolisation. Therefore, this study aimed to investigate the anatomical features,
namely the location, histology, volume and vascularity of intracranial meningiomas referred for
preoperative embolisation.
This entailed using Magnetic resonance imaging (MRI), Digital subtraction angiography (DSA),
and the histological reports obtained from the data bank at the central regional hospital in Durban,
South Africa. A retrospective chart review yielded 103 patients that met the inclusion criteria, of
which 98 patients (subset 1) presented with a single meningioma and 5 patients (subset 2)
presented with multiple meningiomas. The average age of patients (at the time of diagnosis) was
reported within the 40–49-year group and primarily within the female population (subset 1:
67.3%; subset 2: 80%). The benign grade of meningiomas was reported as the most common
(70.4%), of which the meningothelial subtype (48%) was predominant. Meningiomas were
mostly observed within the supratentorial region (subset 1: 57.2%; subset 2: 91.7%) with almost
equal incidences in subset 1 and a majority on the right side in subset 2. Regarding tumour
volume, subset 1 revealed the largest meningiomas within the supratentorial region (90.9 cm3),
and subset 2 revealed an average tumour volume of 43.9 cm3. In terms of meningioma vascularity,
within the supratentorial region, the external carotid arteries were noted to be a common primary
feeder vessel, for the skull base region the primary arterial supply is the internal carotid artery.
This study provides insight into the anatomical basis of intracranial meningiomas within a select
South African population as it has introduced a novel methodology of meningioma vascularity.
This may assist endovascular surgeons in assessing the feeder vessel contributions of
meningiomas and understand the prevalence of these anatomical parameters in this population.
Description
Masters Degree. University of KwaZulu-Natal, Durban.