title: Secretory meningiomas: systematic analysis of epidemiological, clinical, and radiological features.
abstract: BACKGROUND
  Secretory meningiomas are known as a rare histological subtype within the meningioma family. In contrast to benign intracranial meningiomas, they are dreaded for causing an extensive perifocal cerebral tumor edema and life-threatening complications. The objective of the present study is a systematic, retrospective analysis of epidemiological, clinical, and radiological features of secretory meningiomas to predict potential patterns prior to surgery to reduce associated morbidity.
  
  
  METHODS
  A systematic database search of PubMed with review of the literature was performed to identify clinical studies analyzing epidemiological, clinical, and radiological features of secretory meningiomas. Additionally, we supplemented our series of 17 patients with secretory meningiomas. Studies with available information for each patient were statistically metaanalyzed.
  
  
  RESULTS
  In summary, seven large series with a total number of 120 patients were identified, containing detailed information about epidemiological, clinical, and radiological features of secretory meningiomas. Epidemiologically, female predominance was a characteristic. Peritumoral brain edema occurred in about 70% of patients and holohemispheric in more than 50% of patients. Life-threatening complications and severe neurological deficits frequently occur potentially due to extensive peritumoral brain edema. At last, frontal location and age older than 66 years significantly correlated with the development of peritumoral brain edema.
  
  
  CONCLUSIONS
  Secretory meningiomas are histologically benign tumors and are therefore associated with an excellent prognosis. Nevertheless, frequently life-threatening complications due to the development of an extensive peritumoral brain edema are documented. Predictive risk factors are frontal tumor location, increasing age, and visible pial tumor vessel supply. A careful preoperative evaluation, identification of risk factors, and a specific therapy might reduce perioperative morbidity.
authors.affiliation: Department of Neurosurgery, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. MarcelAlexander.Kamp@uni-duesseldorf.de
authors.forename: Marcel Alexander
authors.initials: MA
authors.lastname: Kamp
authors.forename: Kerim
authors.initials: K
authors.lastname: Beseoglu
authors.forename: Sven
authors.initials: S
authors.lastname: Eicker
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.forename: Daniel
authors.initials: D
authors.lastname: Hänggi
mesh_terms: D000367:Age Factors; D001929:Brain Edema / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D009389:Neovascularization, Pathologic / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors