FUNCTIONAL RECOVERY AND REHABILITATION POTENTIAL AFTER REMOVAL OF INTRACRANIAL MENINGIOMAS

Abstract

Meningiomas account for 30-35% of primary intracranial tumors in adults and are 1.8-2 times more common in women. Most Grade I tumors grow slowly, but up to 25% of Grade II-III tumors show atypia, deep invasion, and a high risk of recurrence. The proliferative index of Ki-67 and the microvascular density of CD34 reliably reflect the aggressiveness of meningiomas, and the depth of invasion ≥ 3 mm and incomplete resection according to Simpson increase the risk of tumor return. However, the effect of these markers on functional recovery (ΔKPS, ΔFIM) after surgery has not been sufficiently studied, and there is no single prognostic model for rehabilitation potential yet. Materials and methods. The study included 124 patients (mean age 56 ± 12 years; 61% women) operated on intracranial meningiomas in the period 2019-2024. Functional status was assessed before surgery and after 3 months using the Karnofsky Performance Status (KPS) scale (Mor et al., 1984) [13] and the Functional Independence Measure (FIM) scale (Keith et al., 1987) [8]; in this case, the increments of ΔKPS and ΔFIM were calculated. The histological grade of the tumor was determined according to the 2021 WHO classification. Using immunohistochemistry according to the protocol of Baay et al. (2018) [1], the Ki-67 proliferation index was assessed, and according to the method of Zhou et al. (2018) [21] - microvascular density (CD34, vascular/HPF). The depth of invasion into the brain was measured microscopically: ≥ 3 mm was considered significant (Behling et al., 2021) [2]. The degree of radical removal was classified according to the Simpson I-V scale (EANO, Marosi et al., 2008) [12]. Multivariate logistic regression analysis was used to identify independent factors associated with high rehabilitation potential (ΔKPS ≥ 15 and ΔFIM ≥ 20).  <0,05. Outcomes. ΔKPS and ΔFIM were significantly dependent on tumor grade: the median increase in KPS was +18 at Grade I, +11 at Grade II, and +4 at Grade III (p < 0.001); ΔFIM - +25, +14 and +6, respectively (p < 0.001). High RP (ΔKPS ≥ 15 and ΔFIM ≥ 20) was achieved in 73% of patients Grade I, 34,5 % - Grade II и 10,1 % — Grade III (p < 0,001). Independent predictors of high RP were: Ki-67 < 4% (OR = 4.6; p = 0.001), CD34 < 12 vessels/HPF (OR = 2.9; p = 0.008), Simpson I-II resection (OR = 2,5; p = 0,027) and the absence of diffuse invasion(OR = 3,2; p = 0,005). Conclusion: Low Ki-67 and CD34 values, radical resection and the absence of deep invasion serve as reliable markers of high rehabilitation potential. Taking them into account will make it possible to personalize the postoperative rehabilitation plan and improve recovery indicators in patients with intracranial meningiomas.