Prognostic value of peritumoral edema and angiogenesis in intracranial meningioma surgery

Introduction: Meningiomas represent about 15% of all intracranial neoplasms, and are generally extra-axial and benign, but in more than 50% are accompanied by PTE which can increase the difficulty of surgical resection and affect the prognosis after surgical treatment. Increased expression of vascular endothelial growth factor (VEGF) plays significant role in meningioma hypervascularity and PTE genesis that also influences the prognosis in surgically treated patients. Aim: The aim of our study was to investigate the influence of peritumoral edema and angiogenesis (VEGF expression), microvascular density, and proliferative cell potential on prognosis in aspect of morbidity and postoperative complications after intracranial meningioma surgery. Material and methods: The analysis of clinical, neuroradiological, and histological data, with follow-up period of at least one year, of 78 microsurgically treated patients with intracranial supratentorial meningioma was performed. Presence or absence of PTE was examined on preoperative CT scan or MRI, and width of PTE was measured in millimeters (in direction of maximal tumor diameter). Angiogenesis was evaluated by imunohistochemical analyses for detection of VEGF (level of imunoexpression), microvascular density (by marking blood vessels on CD34), and proliferative potential detection (with Ki-67 antigen in tumor tissue). Results: Severity of peritumoral edema (PTE) showed significant correlation with VEGF expression, and all patients with large PTE (> 40 mm) had high level of VEGF expression (> 50%). Treatment outcome was significantly better in patients with low VEGF expression (p