Scalp invasion by atypical or anaplastic meningioma is a risk factor for development of systemic metastasis.

Abstract Introduction Atypical and anaplastic meningiomas (AAM) are rare and comprise approximately 5% of all meningiomas. Extracranial metastases in meningioma patients occur in 0.1% of all cases but these lesions are difficult to treat and may be a poor prognostic factor. Methods We conducted a retrospective chart review between 1990-2016 of patients who had surgical resection of AAM. In a cohort of 149 patients, 6 had metastatic lesions that were histologically confirmed to be meningioma. We compared baseline characteristics between patients with and without metastasis and performed a multivariate Cox regression analysis to assess risk factors for the development of systemic metastasis. Results Six patients had histologically confirmed meningioma metastasis. We hypothesized that the presence of scalp invasion in patients could be a potential risk factor for the development of systemic meningioma metastasis. Nine out of the 149 patients without metastasis had scalp invasion, whereas 4 out of the 6 patients with metastasis had scalp invasion. Patients with metastasis had a median age of 62±20, patients without metastasis had a median age of 59±15 years. Gender distribution was very similar, approximately 50% of patients in each group were female. Eighty-five percent of patients with metastatic disease were white and 65% of patients without metastatic disease were white. 77% of patients without metastatic disease had WHO-II tumors, whereas 50% of patients with metastatic disease had WHO-II tumors. In multivariate analysis including age, tumor grade, size, location, extent of resection, sex, and scalp invasion, the only significant predictor of systemic metastasis was scalp invasion (OR=39.67;95%CI=3.74-421.12;p=0.0023). Median overall survival (OS) with metastasis was 126 months, median OS without metastasis was 158 months. Having metastatic disease was not significantly associated with worse OS (p=0.33). Conclusion Metastasis development from AAM is a rare but serious event. Because scalp invasion is a strongly associated predictive factor for development of systemic metastasis in patients with AAM, it is necessary to consider strategies to prevent and to be vigilant of the development of scalp invasion.