Hyperostosis in meningiomas - a retrospective exploration of histological correlates
EANS Academy. Khan D. Sep 27, 2019; 275972; EP04025
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Background: Cranial meningiomas are the most common type of primary brain tumour, with incidence estimated between 1.3-7.8/100,000. ~25% of meningiomas display hyperostosis, however its aetiology and implications remain controversial. This study aims to further illuminate the relationships between tumour variables and hyperostosis.
Methods: A mono-institutional retrospective analysis performed at Cambridge University Hospital. 275 histologically-confirmed meningioma cases, managed operatively between 2014-2017, were reviewed. Univariate analysis of relationships between variables and hyperostosis was performed.
Results: Summarised in Figure 1. The WHO 2016 Grading (G) distribution was; G1 =210 (76.36%), G2 =55 (20%), G3 =10 (3.64%). The most common subtypes were G1 Indeterminate =83 (30.18%), G2 Atypical =47 (17.09%) and G1 Meningothelial =45 (16.36%). 102 (37.09%) had evidence of radiological hyperostosis on CT/MRI. 23 (8.36%) had confirmed bony invasion, whilst 1 (0.36%) was an intraosseous tumour variant. No statistically significant relationship was found between WHO subtype and hyperostosis.
A statistically significant (p= 0.0003) association was found between tumour location and hyperostosis.
Hyperostosis was found at 55 (45.83%) of the 120 skull base tumours, versus 41 (28.67%) of the 143 convexity tumours.
Moreover, MIB-1 index (available in n=267) was lower in tumours with radiological hyperostosis (n=100, mean=4.45%) when compared to cases without hyperostosis (n=167, mean=6.06%; p=0.011).
Discussion: Many authors accept hyperostosis as a manifestation of bony infiltration by meningiomas, necessitating bony drilling or bone flap removal to achieve complete macroscopic resection. This is reflected in Simpson surgical resection grading. Higher MIB-1 scores have been associated with higher tumour grade and recurrence rates. However, our study describes a previously unknown negative association between MIB scores and hyperostosis. Further research is needed into the pathophysiology of the meningioma:bone interface, how it differs between subtypes and its implications for surgical management.

[Figure 1: Histological and Radiological Characteristics of Meningioma Cases]

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