McDonald Malcolm F, Khan A Basit, Chang Andrew, English Collin, Goethe Eric A, Patel Ishan A, Gopakumar Sricharan, Trudeau Trevor, Nitturi Vijay, Lau Sean, Ledbetter Elizabeth, Rojas Diego, Harmanci Arif, Harmanci Akdes S, Klisch Tiemo J, Patel Akash J
Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA.
Medical Scientist Training Program, Baylor College of Medicine, Houston , Texas , USA.
Neurosurgery. 2025 Apr 30;97(4):842-852. doi: 10.1227/neu.0000000000003465.
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. In this article, we characterize the clinical and molecular differences of meningiomas with hyperostosis from those without hyperostosis.
One hundred and eighty-one primary, nonsyndromic, nonradiation-induced meningiomas with DNA and RNA sequencing were included in a retrospective study. Preoperative MRI and computed tomography scans were reviewed by a fellowship-trained neuroradiologist to identify the presence of hyperostosis or bone invasion. Clinical, radiographic, and surgical data were gathered for each patient. Bulk RNA sequencing was performed, and data were analyzed for gene set enrichment analysis, gene ontologies, and differentially expressed genes along with chromosomal deletions and canonical mutations.
Sixty-six (36.5%) meningiomas had radiographic evidence of hyperostosis compared with 115 (63.5%) without hyperostosis. Patients with hyperostosis had more severe presentation with increased rates of emergency department admissions ( P = .0320) and seizure presentation ( P = .0480). Hyperostotic tumors preferentially manifested in the olfactory groove location ( P = .004). Radiographically, tumors with hyperostosis had higher rates of edema ( P = .0280), midline shift ( P = .010), nonhomogeneous enhancement ( P = .001), T2 hyperechoic signal ( P = .001), and bone invasion ( P < .001). Patients with hyperostosis had increased estimated blood loss intraoperatively ( P = .006), longer time in the operating room ( P = .045), and higher rates of craniectomy and cranioplasty ( P < .001 and P = .001). Fifty-five percent of all upregulated differentially expressed genes in hyperostotic tumors are secreted, and many are related to skeletal system development ( BMP3 , RBP4, MATN4 , CILP2, and FGF7 ).
In a retrospective study, meningiomas with hyperostosis are region-specific, are related to higher intraoperative complications, and present with distinct radiographic features. Transcriptional analysis revealed upregulation of secreted proteins that positively influence bone development and growth.
脑膜瘤是最常见的原发性脑肿瘤，可引起邻近骨质增生。骨质增生是与覆盖骨的反应性改变有关还是由肿瘤本身浸润引起尚不清楚。在本文中，我们描述了伴有骨质增生的脑膜瘤与不伴有骨质增生的脑膜瘤在临床和分子方面的差异。
一项回顾性研究纳入了181例经DNA和RNA测序的原发性、非综合征性、非辐射诱导的脑膜瘤。由经过专科培训的神经放射科医生复查术前MRI和计算机断层扫描，以确定是否存在骨质增生或骨浸润。收集每位患者的临床、影像学和手术数据。进行批量RNA测序，并对数据进行基因集富集分析、基因本体分析以及差异表达基因分析，同时分析染色体缺失和典型突变情况。
66例（36.5%）脑膜瘤有骨质增生的影像学证据，115例（63.5%）没有骨质增生。有骨质增生的患者表现更严重，急诊科就诊率（P = 0.0320）和癫痫发作率（P = 0.0480）更高。骨质增生性肿瘤更常见于嗅沟部位（P = 0.004）。影像学上，有骨质增生的肿瘤水肿发生率更高（P = 0.0280）、中线移位发生率更高（P = 0.010）、不均匀强化发生率更高（P = 0.001）、T2高回声信号发生率更高（P = 0.001）以及骨浸润发生率更高（P < 0.001）。有骨质增生的患者术中估计失血量增加（P = 0.006）、手术时间更长（P = 0.045）以及颅骨切除术和颅骨成形术的发生率更高（P < 0.001和P = 0.001）。骨质增生性肿瘤中所有上调的差异表达基因有55%是分泌型的，许多与骨骼系统发育相关（BMP3、RBP4、MATN4、CILP2和FGF7）。
在一项回顾性研究中，伴有骨质增生的脑膜瘤具有区域特异性，与更高的术中并发症相关，且具有独特的影像学特征。转录分析显示对骨骼发育和生长有正向影响的分泌蛋白上调。
