Peritumoural brain edema is associated with seizure-related presentation in intracranial meningiomas.

PURPOSE: Peritumoural brain edema (PTBE) is associated with preoperative seizures in meningioma, but its association with seizure-related rather than other symptomatic presentation is less clear. We examined this relationship and associations of PTBE with tumour volume and anatomical location. METHODS: We retrospectively analysed 213 patients with surgically treated intracranial meningiomas. PTBE was classified on preoperative T2-weighted MRI by two independent neurosurgical reviewers, with disagreements resolved by consensus. The primary analysis compared seizure-related with other symptomatic presentation using Firth penalized logistic regression adjusted for skull-base status. Models incorporating tumour volume were treated as sensitivity analyses. RESULTS: PTBE was present in 113 of 202 evaluable tumours (55.9%). Its frequency increased from 25.0% in tumours <10 cc to 82.9% in those >40 cc, and each doubling in tumour volume was associated with approximately twice the odds of PTBE (OR 2.00, 95% CI 1.51-2.65; p < 0.001). Among 153 symptomatic patients, seizure-related presentation occurred in 5 of 69 PTBE-negative (7.2%) and 22 of 84 PTBE-positive cases (26.2%). After adjustment for skull-base status, PTBE remained associated with seizure-related presentation (Firth OR 3.65, 95% profile-likelihood CI 1.39-11.13; p = 0.008). The association persisted when incidentally detected lesions were retained (OR 3.53, 95% CI 1.38-10.57; p = 0.007). CONCLUSION: PTBE was associated with seizure-related rather than other symptomatic presentation. The retrospective design, binary edema assessment, incomplete volumetric data, and limited number of seizure events preclude causal interpretation and precise estimation of effect magnitude.