Factors Associated with Prolonged Symptom Duration Prior to Diagnosis of Intracranial Meningiomas in Hawaii

Background: Meningiomas are the most common primary intracranial tumors in adults and frequently present with slowly progressive or nonspecific neurological symptoms, such as headaches, seizures, visual disturbances, and cognitive changes. Due to their indolent growth patterns, meningiomas may remain undiagnosed for prolonged time periods, which can contribute to increased tumor burden at presentation and greater neurologic morbidity. Recent retrospective studies in Hawaii demonstrated differences in meningioma size at diagnosis, with Native Hawaiian and Pacific Islander (NHPI) patients presenting with significantly larger tumors compared to White patients. Similar disparities in tumor burden at presentation have been observed in other racial and ethnic populations nationally. However, the factors contributing to these differences remain to be explored.

Methods: This retrospective, single-center chart review included adults ≥ 18 years of age diagnosed with intracranial meningioma between July 2025 and July 2026. Eligible patients were identified using ICD-10 diagnostic codes D32.0, D32.9, D42.0, D42.9, C70.0, and C70.9. Demographic data (age, sex, race/ethnicity, insurance status, BMI), comorbidities, clinical presentation, and diagnostic timeline were collected from electronic health records. Tumor characteristics were collected from corresponding MRI reports and included size, location, laterality, edema, mass effect, and midline shift. Patient characteristics were summarized descriptively and Spearman correlation, Mann-Whitney U tests, and multiple linear regressions will be used to explore associations between symptom duration and tumor characteristics at diagnosis.

Results: A total of 21 participants were included. The median age was 66 years (IQR: 62-75) and 71% of the participants were female. The median BMI was 27.9 kg/m2 (IQR: 24.7-35.3 kg/m2) and the median of the largest tumor diameter was 12 mm (IQR: 10-22 mm). There was an equal distribution of tumors located between the left and right cerebral hemispheres. Mass effect was observed in 40% of participants, while peritumoral edema was present in only 5%. Symptom duration data have not yet been fully abstracted and thus, inferential statistics have not yet been completed.

Conclusion: In this preliminary cohort of 21 participants with intracranial meningioma, patients presented at a median age and sex distribution consistent with established meningioma epidemiology, with mass effect evident in a substantial minority at diagnosis. These descriptive findings establish a baseline for ongoing analyses examining whether symptom duration prior to diagnosis is associated with greater tumor burden. Characterizing this relationship may help clarify modifiable, care-pathway-related contributors to the disparities in tumor size at presentation previously reported among NHPI and other populations. Full abstraction of symptom duration data and planned inferential analyses are underway and will be needed to test these associations. If confirmed, findings may inform strategies to reduce diagnostic delays and mitigate downstream neurologic morbidity in at-risk groups.