Preoperative Magentice Resonance Imaging Predictors of Tumor Consistency and Vascularity in Meningioma Surgery

Abstract Accurate preoperative assessment of tumor consistency and vascularity in meningioma surgery can significantly influence surgical strategy and outcomes. To improve surgical precision and patient outcomes by giving neurosurgeons a more thorough grasp of how magnetic resonance imaging (MRI) might inform surgical decision making. The present prospective observational study analyzed 31 patients with intracranial meningiomas to investigate the correlation between MRI signal characteristics and intraoperative findings. Preoperative imaging, including T1-weighted (T1W), T2-weighted (T2W), contrast-enhanced, and diffusion-weighted imaging (DWI) sequences with apparent diffusion coefficient (ADC) mapping, was evaluated against intraoperative tumor consistency, vascularity, and histopathological subtype. Most tumors appeared isointense on T1W (90.3%) and T2W (67.7%) images, while diffusion restriction was more frequent in firmer tumors, especially fibroblastic and psammomatous variants. Although statistical significance was not reached (p > 0.05), trends suggested that certain MRI features, such as restricted diffusion and T2 heterogeneity, may relate to increased firmness and vascular complexity. The majority of tumors were resected with Simpson Grade 2 excision and, histologically, the transitional and meningothelial types predominated. While MRI alone may not definitively predict tumor consistency or vascularity, combining imaging findings with histopathological insights may improve preoperative planning and guide intraoperative expectations in meningioma surgery.