# FOXC1 expression and radiological predictors of peritumoral brain edema in meningiomas

## TL;DR

This study links low FOXC1 expression and certain tumor features to peritumoral brain edema in meningiomas, which could help improve surgical planning.

## Contribution

The study identifies FOXC1 as a novel molecular predictor of peritumoral brain edema in meningiomas.

## Key findings

- Low FOXC1 expression is significantly associated with peritumoral brain edema (p = 0.015).
- WHO grade 2/3 meningiomas and higher MIB-1 index are also strongly linked to PTBE.
- Combining molecular and radiological data may enhance neurosurgical planning for meningioma patients.

## Abstract

Peritumoral brain edema (PTBE) is a frequent finding in meningiomas and can significantly affect perioperative outcomes. In addition to well-established clinical, radiological, and histopathological risk factors, molecular markers such as Forkhead Box C1 (FOXC1) may also play a crucial role in the development of PTBE.

We conducted a retrospective, single-center study including 86 patients with histopathologically confirmed meningiomas. Preoperative MRI datasets were analyzed for tumor characteristics using 3D Slicer and ImageJ. FOXC1 expression was assessed immunohistochemically and dichotomized based on receiver operating characteristic (ROC) curve analysis. Univariate analyses were performed to evaluate associations between clinical, radiological, and histopathological variables and the presence of PTBE.

PTBE was significantly associated with low FOXC1 expression (p = 0.015). Furthermore, WHO grade 2/3 meningiomas (p = 0.012), perioperative seizures (p = 0.024), subtype (p = 0.016), tumor laterality (p = 0.04), higher MIB-1 index (p < 0.001) and tumor volume (p = 0.01) were also significantly associated with PTBE. Tumor localization (skull base vs. non-skull-base) and sex showed no significant correlation.

Combining molecular and radiological parameters could improve neurosurgical planning and perioperative management. Further studies are needed regarding the assessment of the response to anti-edematous therapies in low and high FOXC1 expressing meningiomas.

The online version contains supplementary material available at 10.1007/s11060-026-05441-6.