Variability in Vascular Supply of Intracranial Meningiomas: An Angiographic and Anatomic Study

Introduction: Intracranial meningiomas are a diverse group of tumors that vary by grade, driving mutations, location, and vascular supply. Location significantly influences the management of meningiomas. Expanding the understanding of the vascular supply of skull base (SBMs) and non-skull base meningiomas (NSBMs) will serve to inform surgical resection strategies.

Objective: This study sought to delineate the vascular supply of a surgical series of intracranial meningiomas.

Method: A radiographic database of surgically treated intracranial meningiomas at a single tertiary referral center was queried between 2005 and 2020. As a subset of all meningiomas, included cases were studied preoperatively with catheter-based cerebral angiograms with intent of embolization or determining vascular supply and dynamics. Patient, tumor, radiologic, and treatment data were collected. Correlations between tumor location, grade, vascular supply, initial tumor size, and degree of resection were analyzed using Pearson's χ2 test, linear regression, ANOVA.

Result: A total of 153 patients with intracranial meningiomas underwent cerebral angiograms from 2005 to 2020 by fellowship-trained neurointerventional radiologists, of which 150 had angiographic vascular supply (99F:51M). Mean age was 56.9 (SD: 12.8). Mean tumor size was 4.9 cm (SD: 1.5) with a mean of 3.1 feeders (SD: 1.7). A total of 104 were Grade I, 36 II, 2 III, and 8 unknown. Gross total resection (GTR) was achieved in 41.7%. Parent arterial feeders were tabulated by Al-Mefty's anatomic designations ([Fig. 1]). NSBMs were larger (p < 0.001), had more pial supply (p = 0.002), had contralateral feeders (p = 0.002), were more likely Grade II/III (p < 0.001), and more often achieved GTR (p = 0.026), than SBMs. Larger tumors had more feeders (R ² = 0.120; p < 0.001) and contralateral feeders (R ² = 0.070; p = 0.001). Pial supply did not correlate with grade. Tumor grade and size predicted number of feeders in a multiple regression (F(2), 136) = 13.743, p < 0.001; R ² = 0.168). Grade I and greater size predicted more feeders (p = 0.006; p < 0.001). There was no difference in circulation supply between SBMs/NSBMs. Anterior base tumors were more frequently supplied by anterior circulation (p < 0.001), and middle/posterior base tumors by external circulation (p < 0.001; p < 001).

Conclusion: Meningioma location is associated with specific vascular supply patterns, grade, and patient outcomes. Our study is limited by its retrospective nature and reliance on radiological interpretation. Paradoxically, higher grade tumors do not have more pial/internal carotid supply. This information suggests that grade I tumors though known to be intrinsically less vascular than higher grade tumors, are more likely to have varied and diverse vascular supply patterns, adding to the surgical risk of peritumoral vascular injury. Our findings might inform safe and methodical surgical resection of these tumors ([Fig. 1]).

Fig. 1

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022