Abdulsalam Alfaifi

Meningiomas are the most common primary intracranial tumors, but the role of traumatic brain injury (TBI) as a risk factor remains unclear. This study aimed to systematically review and quantitatively synthesize the available observational evidence on the association between TBI and subsequent meningioma risk. We conducted a systematic review and meta-analysis of observational studies following PRISMA guidelines. PubMed, Scopus, Web of Science, and Cochrane databases were searched through December 5, 2025. Studies comparing meningioma incidence in individuals with and without a history of TBI were included. Risk of bias was assessed using the Newcastle-Ottawa scale. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects models. Heterogeneity and sensitivity analyses were performed. In results, 10 observational studies (seven case-control and three cohort studies) were included in the systematic review, with eight contributing to the quantitative synthesis. The pooled analysis demonstrated a statistically significant association between TBI and meningioma (OR, 1.96; 95% CI, 1.31 to 2.95; p=0.0012) with moderate heterogeneity (I2=65.6%). Sensitivity analyses confirmed the robustness of the findings, although funnel plot asymmetry suggested potential publication bias. We concluded that although a statistical association between prior TBI and meningioma diagnosis was observed, the current evidence does not support a clear causal relationship. The pooled effect appears to be driven mainly by retrospective case-control studies, which are particularly vulnerable to recall and detection bias, whereas cohort studies provide less consistent support for a direct etiological link. Further largescale prospective studies with long-term follow-up are needed to clarify this relationship.