Intracranial meningioma with intratumoral hemorrhage: A systematic review of associated features and outcomes.

Intratumoral hemorrhage (ITH) is a rare clinical entity associated with gliomas and rarely with meningiomas. The hemorrhage risk of ITH in meningiomas remains poorly described. Literature suggests that patient age, tumor location, and histology may play some role. In this study, we aim to address ITH risk factors by evaluating patient and tumor characteristics, symptoms, and outcomes of ITH associated with meningioma. PubMed, Web of Science, Ovid EMBASE, and Scopus databases were searched from database inception to December 2024 for cases of meningioma with ITH based on PRISMA guidelines. Patient demographics, presenting symptoms, tumor characteristics, treatments, and survival outcomes were extracted and analyzed. 107 cases from 68 studies were collected. Patients were mostly female (61 %), with an average age of 56 years. The most common comorbidity was hypertension (19 %). Patients often presented awake (47 %) with headache (22 %) or weakness (20 %), 21 % were comatose on admission. Most tumors were WHO grade 1 (85 %), located on the convexity (56 %) with meningothelial histotype (34 %). Single-stage resection with hematoma evacuation was the most common treatment modality (91 %). Embolization (2 %) was rarely performed. 59 % of patients had complete resolution of symptoms, and 88 % survived to last follow-up. Current management favors single-stage resective surgery and hematoma evacuation; pre-operative embolization has a limited role. Postoperatively, the role of anticoagulation for VTE prophylaxis is unclear. Most patients survive with complete resolution of symptoms after operative intervention.