Romanian Neurosurgery (2019) XXXIII, 1: 80-86  
DOI: 10.33962/roneuro-2019-017 
www.journals.lapub.co.uk/index.php/roneurosurgery 
 

 
 
 

Epidemiological study of intracranial 
meningiomas in a tertiary care hospital 
 

 
Avdhesh Shukla1, Asheesh Kumar Gupta1,  
Anand Sharma1, S. N. Iyengar1 
 
1 Department of Neurosurgery, G. R. Medical College Gwalior, INDIA 
 
 
 
  

ABSTRACT 
Meningiomas are tumours that arise from the meningothelial cells. Most of these 
tumours are intracranial; some are intraspinal and few extra cranial. There are many 
histological variants classified into three grades depending on clinical behaviour. 
Classification is important for determining the modality of treatment. Objectives: To 
study the incidence, location, sex and age predilection, histological variants and 
grading of meningiomas based on WHO 2007 classification and recurrence if present. 
Materials and methods: All 200 cases of meningiomas. Based on Histological features, 
typing and grading of meningiomas was done as per the WHO 2007 classification of 
Meningiomas. Age, Sex incidence, Location of meningiomas were studied. Results: 
Meningiomas comprised 26.17% of all CNS tumours during the study period. Of 764 
CNS tumours, 200 were meningiomas. Most of them were intracranial, 
predominantly involving the convexities of brain, females and the 41 – 50 age group. 
Of these, 180 were benign grade I tumours, 12 were grade II and 8 were grade III. The 
most common histological variant was fibroblastic and meningothelial. Grade II and 
Grade III tumours commonly recurred. Conclusion: Meningiomas are slow growing 
tumours arising from the meningothelial cells accounting for 26.17% of all CNS 
neoplasms showing a variety of histological patterns, more common in women, 
predominantly Grade I tumours. Recurrence of tumours depends on histological 
grade and extent of surgery. 
 

 
INTRODUCTION  
A meningioma is a tumour that develops from the specialized 
meningothelial cell called as arachnoidal cap cells, the membrane that 
surrounds the brain and spinal cord, and located along the parasagittal 
sinus, over the cerebral convexity, sphenoid wing, around the 
pontocerebellar angle and along region of the spinal cord (1). 
Meningiomas constitute approximately a quarter of central nervous 
system (CNS) neoplasms. Most meningiomas (90%) are categorized as 
benign tumours, with the remaining 10% being atypical or malignant. 

Harvey Cushing in 1922 coined the name “meningioma” for the 
most common dural based tumour, accounting for 15-30% of all 
primary intracranial tumours (2). These tumours can occur in any age, 
but commonly present in middle age and has a female preponderance, 

Keywords 
intracranial meningioma, 

epidemiological study, 
tertiary care hospital 

 

 
 

 
 

Corresponding author: 
Asheesh Kumar Gupta 

 
Department of Neurosurgery,  
G. R. Medical College Gwalior, 

India 
 

asheesh_gsvm@yahoo.com 
 
 

 
 

Copyright and usage. This is an Open Access 
article, distributed under the terms of the Creative 
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Derivatives License (https://creativecommons 
.org/licenses/by-nc-nd/4.0/) which permits non-
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The written permission of the Romanian Society of 
Neurosurgery must be obtained for commercial 
re-use or in order to create a derivative work. 
 

 
ISSN online 2344-4959 
© Romanian Society of 

Neurosurgery 
 

 
 

First published  
March 2019 by 

London Academic Publishing 
www.lapub.co.uk 

 



 81 Epidemiological study of intracranial meningiomas in a tertiary care hospital 

with a female/male ratio of approximately 2:1 
intracranial and 10:1 on the spine. Genetic factors 
also play a role in meningioma development and 
predisposition. Type 2 neurofibromatosis (NF2) is an 
autosomal dominant condition related to a mutation 
on chromosome 22q12 and is a common condition 
related to increased risk for developing 
meningiomas, among other neoplasms (3). Ninety 
percent of meningiomas are benign, 6% are atypical, 
and 2% are malignant tumours (4). 

Meningiomas vary in their symptoms, cranial 
meningiomas may cause seizures, headaches, and 
focal neurological deficits. Diagnosis is made by a 
contrast enhanced CT and/or contrast MRI (magnetic 
resonance imaging) scan. While MRIs are in some 
ways superior, the CT-scan can be helpful in 
determining if the tumour invades the bone, cause 
hyperostosis of bone. 

Most patients with meningioma undergo 
resection to relieve neurological symptoms. 
Complete resection is often curative. For 
incompletely resected or recurrent tumors not 
previously irradiated, radiotherapy is administered. 
Two of the most important factors that determine 
the prognosis in patients with meningiomas are the 
extent of the resection and the tumor’s histological 
grade (5). Although as a group they are considered to 
be benign, symptoms, variability in recurrence 
frequency, life expectancy, histological appearance 
and prognosis exist. 
 

MATERIAL AND METHODS 
This study is a retrospective study conducted in the 
Department of Neurosurgery, G. R. Medical College 
and Jay Arogya Hospital, Gwalior, M.P. India, over a 
period of 5 years. Of all CNS tumours, only cases of 
meningiomas during the study period were included. 
Meningiomas in all age groups and both sexes were 
included in the study. Other CNS tumours were 
excluded. These cases were analysed for age, sex 
incidence, location and histopathological diagnosis. 
Statistical analysis was done by calculating the 
numbers and percentage for computing the 
incidence in various age groups, in sexes, location 
and HPE diagnosis. 
 

Study design: A meta-analysis 
Ethical approval: The study was undertaken after 
consent and clearance by the ethical committee of 
G.R. Medical College Gwalior 
Inclusion criteria: Of all CNS tumours, only cases of 

meningiomas during the period 2012 – 2017 were 
included. Meningiomas in all age groups and both 
the sexes were included in the study. 
Exclusion criteria: Other CNS tumours were 
excluded. 
Sample size: Two hundred cases of meningiomas 
Methodology: Based on Histological features, typing 
and grading of meningiomas was done as per the 
WHO 2007 classification of Meningiomas. Age, Sex 
incidence, Location of meningiomas were studied. 
Statistical analysis: It was done by calculating 
number and percentage for computing the incidence 
in various age groups, in sexes, location and also 
comparison with other studies. 

 
OBSERVATION AND RESULTS 

 
TABLE 1: Age wise distribution of patients 
 

S.No. Age (yrs) No. of patients Perce ntage  

1. < 20 9 4.5% 

2. 20-40 75 37.5% 

3. 41-60 96 48% 

4. > 60 20 10% 

 
TABLE 3: Presenting complaints 
 

S.No. 
Clinical 
presentation 

No. of 
patients Percentage 

1. Headache 178 89% 

2. Seizure 96 48% 

3. Raised ICP 80 40% 

4. Ptosis 20 10% 

5. Hemiparesis 69 34.5% 

6. 
Behaviour 
problem 15 7.5% 

7. 
Memory 
difficulties 40 20% 

8. 
Visual 
problem 27 13.5% 



 82 Avdhesh Shukla, Asheesh Kumar Gupta, Anand Sharma, S.N. Iyengar 

TABLE 2. Gender wise distribution of patients 
 

S.No. Gender No. of patients Perce ntage  

1. Male 92 46% 

2. Female 108 54% 

 
 
TABLE 4: Distribution of patients according to location of tumour 
 

S.No. Location of tumour No. of patients Perce ntage  

1. Falx or parasagital 40 20% 

2. Convexity 80 40% 

3. Sphenoid wing 20 10% 

4. Olfactory groove 13 6.5% 

5. Petroclival 3 1.5% 

6. Posterior fossa & CP angle 22 11% 

7. Tentorial 9 4.5% 

8. Pterional 2 1% 

9.. Tuberulam sellae 2 1% 

10 Intraventricular 5 2.5% 

11 Diploic 2 1% 

12 Foramen magnum 2 1% 

 

 
TABLE 5. Type of Craniotomy 
 

Location of tumour No. of patients Perce ntage  

Fronto-Temporo-Parietal craniotomy 20 10% 

Fronto- Parietal craniotomy 62 31% 

Frontal 33 16.5% 

Temporo-parietal 19 9.5% 

Tempro-parieto-occipital 9 4.5% 

Bifrontal 15 7.5% 

Parietal 5 2.5% 

Sub-occipital 24 12% 

Parieto-occipital 13 6.5% 



 83 Epidemiological study of intracranial meningiomas in a tertiary care hospital 

TABLE 6. Distribution of patients according to according to surgical excision 

S.No. Simpson grade No. of patients Percentage 

1. I 30 15% 

2. II 135 67.5% 

3. III 17 8.5% 

4. IV 16 8% 

5. V 2 1% 

 
 
TABLE 7. Distribution of patients according to size of the tumour 

S.N. Size of tumour No. of patients Percentage 

1 1-3 cm 0 0 

2 3-4 cm 138 69 

3 4-5 cm 42 21 

4 >5 cm 20 10 

 
TABLE 8. Distribution of patients according to grade 

S.No. Grade  No. of patients Perce ntage  

1. I 180 90% 

2. II 12 6% 

3. III 8 4% 

 
TABLE 9. Post op complications 

S.No. Post op complications No. of patients 

1. Infection 38 

2. Seizure 23 

3. Hemiparasis 86 

4. Visual loss 1 

5. Behavior change 28 

6. Memory deficit 43 

7. Raised (ICP) 13 



 84 Avdhesh Shukla, Asheesh Kumar Gupta, Anand Sharma, S.N. Iyengar 

TABLE 10. Patient follow up data given as frequency  
 

S.No. Follow up No.  of patie nts  
with re curre nce  

% 

1. < 2 year 5 2.5% 

2. 2-5 years 12 6% 

 

FIGURE 1. Pre op and post op CT of tuberculum sellae meningioma.         FIGURE 2. Pre op and post op CT of olfactory groove  

d

 
 
 
 
 
 
 
 
FIGURE 3. Pre op and post op CT of posterior fossa meningioma                FIGURE 4. Pre op and post op CT of sphenoid wing meningioma 
 
 
 
 
 
 
 
 
 
 

FIGURE 5. Pre op and post op CT of frontal convexity  
meningioma 
 
 
 
 
 
 
 
 
 

FIGURE 6. Pre op and post op CT of para saggital  
meningioma 
 
 
 
 
 
 
  



 85 Epidemiological study of intracranial meningiomas in a tertiary care hospital 

DISCUSSION 
Meningiomas constitute 25 - 30% of all CNS tumours 
and are the most common tumour arising from the 
meninges (6). In our centre out of 764 cases of CNS 
tumours, Meningiomas constituted 200 (26.17 %), 
similar to studies by AB, Shah et al (7), Ruberti R F (8), 
Intisar SH Patty et al (9), Shrilakshmi 25.25% and Ejaz 
Butt et al (10). Women are more likely to develop a 
meningioma, (5) as in our study, females were more 
commonly affected 108 cases (54%) compared to 
males 92 (46%). A female preponderance for 
meningioma correlates with an endogenous 
hormone level and exogenous hormone 
replacement in postmenopausal women (in whom 
an increased incidence of meningioma is seen) as 
compared with postmenopausal women who have 
not taken exogenous hormone replacement 
therapy. 

The present study revealed that the incidence of 
meningioma was common in the age group 41-60 
years 48% of patients. The mean age was 48.54 
years. In the studies done by A B Shah et al (7), 
Shrilakshmi (2), the most common age group 
involved were also 40-50 years. 

Meningiomas in children are less common (11), 
and in our study, there were only 9 cases of 
meningiomas in children of age group 11-20 years. 
The intracranial location of meningiomas were 
distributed as to be the convexities were commonly 
involved 40%, in which frontal was more common, 
45.45%, followed by the parasagittal and falcine 
meningioma were 20%, 10% were in sphenoid wing, 
11% in CP angle and posterior fossa. In a study by 
shrilakshmi et al, 61.11% of tumours were located in 
convexity. The clinical presentation of meningiomas, 
depends on tumour location (12). The symptoms at 
presentation are rarely precipitous, but often 
insidious. Onset of slowly evolving headache is 
common and usually not associated with other 
symptoms suggestive of raised intracranial pressure, 
reflecting the slow growth of these tumours. A 
history of partial seizures is common for convexity 
meningiomas and an insidious personality change 
that is confused with dementia or depression is 
common in patients with large inferior frontal 
meningiomas (4). In our study, the most common 
clinical symptoms were headache, seizures and 
vomiting. The common radiological findings were 
mass lesions with pressure effect on adjacent 
structures and peritumoral edema. 

Meningiomas divided in wide variety of histological 
patterns. Our present study revealed that the most 
common histologic type was meningothelial 
(38.89%), similar to studies by Nasrin Samadi et al 
(13) Sangamithra et al (14), Thomas Backer et al (15), 
followed by atypical meningiomas (16.67%). The 
other variants were fibroblastic (11.11%), transitional 
(11.11%), psammomatous variant, angiomatous, 
lympho-plasmacytic and fibrous (5.56%) each. 
According to WHO (5) atypical meningiomas have 
more than three of the following features – increased 
cellularity, smaller cells with high N/C ratio, greater 
than 4 mitotic figures/ 10HPF, prominent nucleoli 
and geographic necrosis. In our study (16.67%) of 
atypical meningiomas were reported. Singh 
Avninder et al (16) reported that papillary 
meningiomas and anaplastic meningiomas are rare 
and constitute 1 – 2.5% of all meningiomas. In the 
studies done by S Hoon et al (17) and Gottfried et al. 
(18) Histological analysis reveals that 80–90% of 
meningiomas are benign [World Health Organization 
(WHO) Grade I], 5–15% are atypical (WHO Grade II) 
and associated with a marked increase in 
recurrence. Only 1–3% of the cases become 
anaplasic or malignant (WHOGrade III), developing a 
high tendency to invade brain structures, 
metastasize, and recur. In our study, 16.67% of 
atypical meningioma was observed. Though 
meningiomas are considered to be benign tumours, 
recurrence is frequently observed (19). Benign 
meningiomas can recur following incomplete 
resection, if large and associated with monosomy14 
and del (1p36). The extent of surgical resection 
depends on the size of the tumour, site, and its 
relation to vital structures. The best accepted system 
for prediction of recurrence is the Simpson grading 
system for completeness of resection (20), which 
evaluates the invasion of the venous sinuses, tumour 
nodules in adjacent dura, and infiltration of 
unresected bone by meningothelial cells. The 
recurrence rates that Simpson refers to 9% for grade 
I, 16% for grade II, 29% for grade III, 39% for grade IV, 
and 100% for grade V, respectively. 

 

Simpson’s scale of grading divides the extent of 
resection into 5 grades: 

Grade I: Complete removal 

Grade II: Complete removal with coagulation of 
dural attachment 



 86 Avdhesh Shukla, Asheesh Kumar Gupta, Anand Sharma, S.N. Iyengar 

Grade III: Complete removal, without coagulation of 
dural attachment or resection of involved sinus or 
hyperostotic bone 
Grade IV: Subtotal resection 
Grade V: Decompression biopsy. 
 

For patients with resection grades IV and V, endpoint 
for recurrence was enlargement of the remaining 
tumour, shown on MRI or CT. In addition, histological 
characteristics of malignancy such as peritumoral 
brain edema, cellular pleomorphism, nuclear atypia, 
presence of macronuclei, atypical mitoses, increase 
of neovascularization, brain invasion and necrosis, 
favour recurrence rate of meningiomas (20). 

The treatment in grade I meningioma is total 
resection. In grade II and grade III meningiomas (2), 
surgery and adjuvant radiotherapy are the 
treatment of choice. Extent of surgical resection is 
one of the most important factors in predicting 
recurrence along with histological grading. 

Bone flap removal was done for 2 cases due to 
intraoperative brain swelling. Immediate compli-
cation was haematoma in 2 cases (3.84%), for which 
reexploration was done. Major post-operative 
complications in our study were convulsions 21.1%, 
wound infection 17.3%, CSF leak in 9.62%, meningitis 
in 11.53%, of cases. All the patients before surgery 
were adequately treated with anti-convulsive 
therapy. Postoperatively 15% of cases developed 
convulsions within 48 hrs after surgery. They were 
controlled with increase in the dose of anti-epileptics 
or addition of another antiepileptic drug. The major 
morbidity in our series was post-operative infection, 
in the form of wound infection, CSF leak, and 
meningitis. 

Follow-up period was 6 months to 5 years. Cases 
were followed up with CT brain in symptomatic 
patients. Twelve cases of recurrence are noted on 
follow-up for which incomplete resection was done. 
Anyhow follow-up period was not enough to assess 
the recurrence as meningiomas are slow growing 
tumours. 
 
 
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