What question did this study set out to answer?

This research aims to identify predictors of meningioma tumor consistency and their impact on surgical outcomes and prognosis.

January 17, 2026Open Access

Novel Surrogate Indicators of Intracranial Meningioma Consistency and Outcomes After Resection

Key Points

This research aims to identify predictors of meningioma tumor consistency and their impact on surgical outcomes and prognosis.
Retrospective review of patients undergoing meningioma resection from 2014 to 2024
Graded tumor consistency per Zada's criteria into five types
Collected data on demographics, MRI imaging, histology, and surgical outcomes
Calculated signal intensity ratios between tumor and cortex
Employed various statistical analyses including Cox regression for progression-free survival
Firmer tumors correlated with longer operative times and higher subtotal resection rates
Softer tumors exhibited higher signal intensity ratios and predicted lower complication rates
Identified significant thresholds for predicting tumor firmness based on signal intensity values
Firmer tumors were associated with worse progression-free survival due to lower resection extent
Strong correlations identified between tumor consistency and the prevalence of psammoma bodies

Abstract

BACKGROUND AND OBJECTIVES: Tumor consistency affects resection and outcomes in meningioma surgery. This study aimed to identify predictors of tumor consistency using the Zada grading scale and assess their association with surgical outcomes and prognosis. METHODS: We retrospectively reviewed patients aged 18 years and older who underwent intracranial meningioma resection from 2014 to 2024, with ≥1 year of follow-up. Tumors were graded into 5 consistency types per Zada's criteria. Data on demographics, imaging (T2-weighted MRI), histology, and surgical outcomes were collected. Signal intensity ratios between tumor and cortex were calculated. Statistical analyses included analysis of variance, linear regression, receiver operating characteristic analysis, and Cox regression for progression-free survival (PFS). RESULTS: Five hundred and fifty-four patients (67.7% female; mean age 58.1) were included. Firmer tumors were associated with longer operative times (492 vs 382.3 minutes for type 4 vs type 2, P 1.547 predicted firm and soft tumors with 95% sensitivity respectively. Type 2 tumors had the lowest complication rates (1.56%), whereas type 5 had the highest reoperation rates (33.3%). Firmer tumors were linked to worse PFS ( P = .0247), primarily due to lower resection extent (β = −0.8752, P = .0007). CONCLUSION: Higher meningioma consistency is linked to surgical difficulty and poorer PFS. Psammoma bodies, tissue adherence, and SI ratios are promising surrogate markers to guide surgical planning.

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