Association of tumor locations, clinical manifestations, and histopathological grade in meningioma: a 10-year single-center study.

Background: Meningiomas are the most common primary intracranial tumors, with clinical manifestations that vary depending on tumor location and biological behavior. Understanding the relationship between tumor location, presenting symptoms, and histopathological grade is essential for improving diagnostic accuracy and clinical management. This study aimed to evaluate the association between tumor location, clinical manifestations, and World Health Organization (WHO) grade in patients with intracranial meningioma. Methods: This retrospective observational study included consecutive patients aged ≥18 years who underwent first-time intracranial meningioma resection over a 10-year period (2013-2023) at Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia. Demographic data, presenting symptoms, tumor location (cranial base vs. non-skull base, with convexity, parasagittal, falcine, and intraventricular tumors grouped as the non-skull base/convexity category), Simpson grade of resection (I-V), and WHO histopathological grade were extracted from medical records. Pearson's chi-square test was used to assess associations between categorical variables and tumor location. Results: A total of 531 patients were included. The majority were female (92.1%) with a median age of 45 years (range 18-82). Cranial base meningiomas accounted for 77.2% of cases. Female gender (p=0.037), age <60 years (p<0.001), WHO grade I tumor (p<0.001), a higher proportion of Simpson grade III-V resection (p<0.001), cranial nerve deficits (p<0.001), and visual field deficits (p=0.010) were significantly more frequent in cranial base meningiomas. In contrast, decreased consciousness (p<0.001), headache (p=0.023), motor deficits (p<0.001), sensory deficits (p=0.009), and seizures (p<0.001) were significantly more frequent in non-skull base/convexity meningiomas. Conclusion: Tumor location in meningioma is associated with specific clinical manifestations and histopathological grade. Cranial base tumors tend to present with cranial nerve-related and visual symptoms, whereas non-skull base tumors are more likely to cause seizures, motor deficits, and decreased consciousness. Higher-grade tumors are more commonly found in non-skull base locations. The disproportionately high female-to-male ratio observed in this Indonesian surgical cohort should be interpreted with caution, as selection and referral bias may have contributed; it warrants confirmation in population-based studies that include molecular profiling and prospectively collected hormonal-exposure data.