Meningiomas are the most common primary tumor of the brain and may elicit hyperostosis
of the adjacent bone. Whether hyperostosis is related to reactive changes of the overlying
bone or by invasion of the tumor itself is unclear. Here, we characterize the clinical
differences of meningiomas with hyperostosis from those without hyperostosis. One
hundred and eighty-one primary, nonsyndromic, non-radiation-induced meningiomas were
included ([Fig. 1A]). Preoperative MRI and CT scans were reviewed by a fellowship-trained neuroradiologist
to identify the presence of hyperostosis ([Fig. 1B, C]) or bone invasion ([Fig. 1D, E]). Clinical, radiographic, and surgical data were gathered for each patient. Sixty-six
(36.5%) meningiomas had radiographic evidence of hyperostosis compared to 115 (63.5%)
without. Patients with hyperostosis had more severe presentation with increased rates
of emergency admissions (p = 0.0320) and seizure presentation (p = 0.0480; [Table 1]). Hyperostotic tumors preferentially manifested in the convexity, parasagittal,
olfactory groove, and sphenoid wing locations (p = 0.004; [Table 1]). Radiographically, tumors with hyperostosis had higher rates of edema (p = 0.0280), midline shift (p = 0.010), non-homogeneous enhancement (p = 0.001), T2 hyperechoic signal (p = 0.001), and bone invasion (p < 0.001; [Table 2]). Patients with hyperostosis had increased estimated blood loss intraoperatively
(p = 0.006), longer time in the operating room (p = 0.045), and higher rates of craniectomy and cranioplasty (p < 0.001, p = 0.001; [Table 3]). In conclusion, meningioma with hyperostosis is region-specific, related to higher
intraoperative complications, and presents with distinct radiographic features.
