title: Secretory Meningiomas: Increased Prevalence of Seizures Secondary to Edema Formation in a Rare Histologic Subtype.
abstract: OBJECTIVE
  Secretory meningioma (SM) is a rare histologic subtype known to cause disproportional peritumoral brain edema. Although meningiomas are defined by slow growth and mostly manifest with benign clinical symptoms, SMs can cause life-threatening deterioration. The aim of this study was to characterize the potential pitfalls in treatment of SMs by illustrating their characteristic clinical features.
  
  
  METHODS
  We analyzed 69 patients with SM who underwent surgery at our institution and compared them with a matched nonsecretory meningioma cohort. Retrospective data were analyzed for frequency of seizures as the first presenting symptom, maximum corticosteroid use, intensive care unit stay, and hospital stay. In addition, histologic and radiographic data were evaluated for the extent of peritumoral brain edema formation, tumor location, and tumor size and correlated to clinical presentation.
  
  
  RESULTS
  Seizures were observed at a significantly higher rate as the first presenting symptom leading to clinical admission in patients with SM (33.3%) compared with the matched nonsecretory meningioma cohort (13%, P = 0.008). In patients with SM, seizures were associated with increased edema formation, whereas seizures in patients with nonsecretory meningioma correlated with tumor size (P = 0.007). The clinically more complicated course in patients with SM was reflected by increased demand for corticosteroids and a prolonged intensive care unit stay (P < 0.001). SM further showed a higher recurrence rate of 35.9% compared with a cohort of 320 World Health Organization grade I meningiomas resected at our institution (P < 0.001).
  
  
  CONCLUSIONS
  Our results illustrate the complicated clinical course of this rare histologic meningioma subtype. The increased frequency of seizures may enable raised awareness of clinicians for potential complications and treatment adjustments perioperatively early at clinical admission.
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany. Electronic address: m.mohme@uke.de.
authors.forename: Malte
authors.initials: M
authors.lastname: Mohme
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Pedram
authors.initials: P
authors.lastname: Emami
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Regelsberger
authors.affiliation: Department of Neuropathology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Matschke
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Lamszus
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Westphal
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Sven Oliver
authors.initials: SO
authors.lastname: Eicker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D001929:Brain Edema / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007633:Keratins / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D008875:Middle Aged; D018396:Mucin-1 / Q000378:metabolism; D012640:Seizures / Q000453:epidemiology*; D055746:Stage-Specific Embryonic Antigens / Q000378:metabolism
chemical_list: D018396:Mucin-1; D055746:Stage-Specific Embryonic Antigens; D007633:Keratins
keywords: Complications; Edema; Meningioma; Secretory; Seizure