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VLSM analysis of 350 meningioma resections links tumor location to histology, symptoms, and surgical outcomesBrain tumor location patterns linked to symptoms and surgical outcomes in study

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Key Takeaway
Consider spatial patterns from VLSM as associative, not causal, in meningioma management.

A retrospective, single-center cohort study analyzed 350 patients who underwent surgical resection of intracranial meningiomas. The study applied voxel-based lesion symptom mapping (VLSM), a method adapted for meningiomas, to investigate spatial correlations with tumor histology, preoperative symptoms, and surgical outcomes. A comparator was not reported.

The main results, reported as associations without specific effect sizes or p-values, showed meningiomas clustered along the anterior and middle skull base, falcine region, and sphenoid wing. WHO grade 2 meningiomas showed significant spatial clustering at the cerebral convexity and frontal base. Tumors involving the perirolandic area were associated with higher rates of pre- and postoperative motor deficits. Incomplete resections were more frequent in meningiomas of the medial sphenoid wing. The VLSM analysis based on dural attachment zone (DAZ) improved anatomical specificity and reduced volume-related bias compared to analyses using total tumor volume.

Safety and tolerability data were not reported. Key limitations include the retrospective design and the single-center setting, which limit the generalizability of the findings. The practice relevance is that this methodological approach may enable refined risk stratification and support the development of spatially informed treatment strategies, but this is based on observational associations from a single cohort. Multicenter prospective studies are needed to validate these spatial patterns and their clinical utility.

Researchers looked back at medical records and brain scans from 350 patients who had surgery to remove a type of brain tumor called a meningioma. They used a special mapping technique to see if the tumor's location in the brain was connected to the patient's symptoms before surgery and their recovery afterward.

The study found that tumors tended to cluster in certain areas of the brain. Tumors in a specific area near the top of the head were linked to more movement problems before and after surgery. The study also found that a more aggressive type of tumor was more common in certain locations. The researchers noted that surgeries were less likely to fully remove tumors located in a deep area near the temple.

It's important to know this was a retrospective study, meaning it looked at past data from just one hospital. The findings show links or associations, not proof that location causes certain outcomes. The results need to be checked in future studies with more patients from different hospitals before they can be widely used to guide treatment decisions.

What this means for you:
A single study found links between brain tumor location and patient symptoms, but more research is needed to confirm these patterns.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedMar 2026
View Original Abstract ↓
BackgroundVoxel-based lesion symptom mapping (VLSM) is a powerful neuroimaging technique for linking lesion location to clinical variables, widely used in stroke research. However, its methodological application in neuro-oncology, particularly for extra-axial tumors such as meningiomas, remains underexplored. This study aims to establish a methodological framework for extending VLSM to neurosurgical oncology by adapting it to the specific anatomical and biological features of meningiomas.MethodsIn this retrospective single-center study, we analyzed preoperative MRI data from 350 patients who underwent surgical resection of intracranial meningiomas. Tumors were semi-automatically segmented, normalized to MNI space, and mapped to identify the dural attachment zone (DAZ). VLSM was performed using univariable linear regression and corrected for multiple comparisons to assess spatial correlations with tumor histology, preoperative symptoms, surgical outcomes, and postoperative deficits.ResultsMeningiomas clustered predominantly along the anterior and middle skull base, falcine region, and sphenoid wing. WHO grade 2 meningiomas showed significant spatial clustering at the cerebral convexity and frontal base. Tumors involving the perirolandic area were associated with higher rates of pre- and postoperative motor deficits. Incomplete resections were more frequent in meningiomas of the medial sphenoid wing. VLSM results based on DAZ improved anatomical specificity and reduced volume-related bias compared to analyses using total tumor volume.ConclusionVLSM offers a robust and anatomically precise framework for studying spatial patterns in meningioma biology and outcomes. Focusing on the DAZ enhances interpretability by reducing volume bias. This approach enables refined risk stratification and supports multicenter collaboration for developing spatially informed, individualized treatment strategies in neurosurgical oncology.
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