The histological grade is crucial for therapeutic management, and its reliable preoperative detection can significantly influence treatment approach. Lacking established risk factors, this study identifies preoperative predictors of high-grade skull base meningiomas and discusses the implications of non-invasive detection. A multicentric study was conducted on 552 patients with skull base meningiomas who underwent primary surgical resection between 2014 and 2019. Data were gathered from clinical, surgical and pathology records and radiological diagnostics. The predictive factors of higher WHO grade were analysed in univariate analysis and multivariate stepwise selection logistic regression analysis. Histological analysis revealed 511 grade 1 (92.6%) and 41 grade 2 (7.4%) meningiomas. A prognostic model predicting the probability of WHO grade 2 skull base meningioma (AUC 0.79; SE 0.04; 95% Wald Confidence Limits (0.71; 0.86)) based on meningioma diameter, presence of an arachnoid plane and cranial nerve palsy was built. Accurate preoperative detection of WHO grade in skull base meningiomas is essential for effective treatment planning. Our logistic regression model, based on diameter, cranial nerve palsy, and arachnoid plane, is tailored for detecting WHO grade 2 skull base meningiomas, even in outpatient settings.

1st Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital U Vojenske nemocnice 1200 Prague 169 02 Czech Republic

Department of Neurosurgery Ceske Budejovice Hospital Ceske Budejovice Czech Republic

Department of Neurosurgery Liberec Hospital Liberec Czech Republic

Department of Neurosurgery Pilsen University Hospital Pilsen Czech Republic

Department of Neurosurgery The University Hospital Brno Brno Czech Republic

Department of Neurosurgery University Hospital Olomouc Olomouc Czech Republic

Department of Neurosurgery University Hospital Ostrava Ostrava Czech Republic

Department of Radiodiagnostics Military University Hospital Prague Czech Republic

Institute of Computer Science The Czech Academy of Sciences Prague Czech Republic

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