Exploring the role of volumetric and radiological features in meningioma behaviour and follow-up strategies.

Introduction: Meningiomas are typically slow-growing tumors, but their long-term behavior remains variable. Understanding growth dynamics and identifying predictive radiological markers are essential for optimizing follow-up strategies. Research question: Does long-term volume growth of meningiomas correlate with specific radiological markers, and can early growth predict future progression? Materials and methods: This retrospective study included 100 randomly selected patients with meningiomas treated between 2000 and 2018 at a single neurosurgical center. The patients had at least five MRI studies during the follow-up period. All images were assessed for radiological variables including growth rate. The tumors volume was evaluated on each MRI scan by three independent researchers. The interrater reliability of manual tumor volume segmentation was excellent (ICC = 1). The tumor growth was defined as volume increase over 0.2 cm3 and progression as ≥ 40 % volume growth. Results: The median age at diagnosis was 59 years (range 51-68). Tumor locations were mainly convexity (37.3 %) and anterior skull base (32.7 %), with a dural tail observed in 67.2 %. While 45 % of tumors showed some growth (the median volume increase was 0.27 cm3/year), only 22 % met the criteria for progression. Early volume increase within one and five years after the diagnosis and the presence of a dural tail were the strongest predictors of progression. The growth pattern of meningeomas is also presented. Conclusion: Only a minority (22 %) of meningiomas progressed significantly during extended follow-up. Early growth and certain radiological features may help predict future behavior, supporting the potential for more personalized surveillance protocols.