Impact of pre-operative edema index on surgical outcomes in supratentorial meningiomas: A retrospective analysis.

Objective: To assess how pre-operative Edema Index (EI) affects surgical outcomes, complications, and hospital stay in patients with supratentorial meningiomas and its role as a predictor for surgical planning and prognosis. Methodology: A retrospective observational study was conducted at the Department of Neurosurgery Unit-II, Punjab Institute of Neurosciences, Lahore, over 14 months (January 2024-February 2025). 31 patients with supratentorial meningiomas were included through non-probability consecutive sampling. Results: Mean age was 41.39 years (range: 18-64 yrs), with male-to-female ratio of 1:1.82. 58.1% (18) were located in the convexity, followed by Parasagittal 12.9% (4), olfactory groove 6.5%(2) , parafalcine 6.5%(2), sphenoid wing 6.5%(2), tuberculum sellae 6.5%(2) and temporal 3.2%(1) regions. Based on size. 3.2% (1) of the tumors were small (<2cm), 35.5% (11) were medium (2-4cm), 38.7% (12) were large (4.1-6 cm) and 22.6% (7) were giant (>6cm). EI was <1 in 38.7% (12), 1-2 in 12.9% (4), and >2 in 32.3% (10); 16.1% (5) had no edema. Higher edema (EI >2) was more common in males (54.5%) than females (20%). Expansion duraplasty was required in 58.1% (18), bone removal in 9.7% (3) and bleeding occured in 6.5% (2). Grade I-II resections were achieved in 90% of patients with EI>2. Neurological deficits occurred in 6 (19.4%). 22.6%(7) had hospital stay exceeding 10 days. Conclusion: Pre-operative EI and tumor location significantly influences surgical complexity, extent of resection, complications, and hospital stay. Incorporating EI into preoperative evaluation can improve surgical planning and outcomes.