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Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives. Cancers (Basel) 2022; 14:cancers14122878. [PMID: 35740543 PMCID: PMC9220797 DOI: 10.3390/cancers14122878] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 12/07/2022] Open
Abstract
Simple Summary Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. Over time, several corridors have been proposed, each one carrying its own pros and cons. During the last decades, the endoscopic endonasal route has been asserted among the classic routes for a growing number of midline and paramedian lesions. Therefore, the aim of our paper is to present a comprehensive review of the indications and techniques for the management of skull base meningiomas, emphasizing the ambivalent and complementary role of the low and high routes. Abstract Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. The state of the art of skull base meningiomas accounts for both transcranial, or high, and endonasal, or low, routes. A comprehensive review of the pertinent literature was performed to address the surgical strategies and outcomes of skull base meningioma patients treated through a transcranial approach, an endoscopic endonasal approach (EEA), or both. Three databases (PubMed, Ovid Medline, and Ovid Embase) have been searched. The review of the literature provided 328 papers reporting the surgical, oncological, and clinical results of different approaches for the treatment of skull base meningiomas. The most suitable surgical corridors for olfactory groove, tuberculum sellae, clival and petroclival and cavernous sinus meningiomas have been analyzed. The EEA was proven to be associated with a lower extent of resection rates and better clinical outcomes compared with transcranial corridors, offering the possibility of achieving the so-called maximal safe resection.
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Hadi I, Biczok A, Terpolilli N, Thorsteinsdottir J, Forbrig R, Albert NL, Yanchovski P, Zollner B, Bodensohn R, Corradini S, Bartenstein P, Belka C, Tonn JC, Schichor C, Niyazi M. Multimodal therapy of cavernous sinus meningioma: Impact of surgery and 68Ga-DOTATATE PET-guided radiation therapy on tumor control and functional outcome. Neurooncol Adv 2021; 3:vdab114. [PMID: 34704034 PMCID: PMC8541706 DOI: 10.1093/noajnl/vdab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Functional preservation in patients with WHO grade I meningioma involving the cavernous sinus (CSM) is crucial for long-term tumor control. Concise data on the functional outcome of an interdisciplinary, multimodal treatment are scarce. We analyzed functional outcome and tumor control in CSM patients following maximal safe resection (MSR), fractionated stereotactic radiotherapy (FSRT), or combination of them, retrospectively. METHODS Patients with WHO grade I CSM treated between 2003 and 2017 were included. Prior to FSRT, a 68Ga-DOTATATE PET/CT was performed for radiation planning. Progression-free survival (PFS) was analyzed using Kaplan-Meier method and log-rank test was performed to test differences between groups. Visual function was analyzed at baseline and follow-up. RESULTS Eighty-five patients were included. MSR alone was performed in 48 patients (group A), MSR followed by FSRT in 25 patients (group B), and FSRT alone in 12 patients (group C). Intracranial tumor volumes were higher in A and B compared to C (median 9.2/10.8/4.3 ccm for A/B/C, P = .023). Median follow-up was 47/46/45 months and PFS at 5 years 55.7%, 100%, and 100% in A/B/C, respectively (P < .001). Optic nerve compression was more common in A (91.7%) and B (84.0%) than C (16.7%), P < .001. Post-therapeutic new onset or deterioration of double vision was observed in 29% (A), 17% (B), and 0% (C). CONCLUSION Personalized treatment strategies for CSM are essential to control space-occupying or functionally compromising lesions. The additional potential side effect of radiotherapy seems to be justified under the aspect of longer tumor control with low functional risk. Without space-occupying effect of CSM, FSRT alone is reasonably possible.
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Affiliation(s)
- Indrawati Hadi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Annamaria Biczok
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Nicole Terpolilli
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Robert Forbrig
- Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Petar Yanchovski
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Barbara Zollner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
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Theodros D, Patel M, Ruzevick J, Lim M, Bettegowda C. Pituitary adenomas: historical perspective, surgical management and future directions. CNS Oncol 2015; 4:411-29. [PMID: 26497533 DOI: 10.2217/cns.15.21] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity.
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Affiliation(s)
- Debebe Theodros
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mira Patel
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jacob Ruzevick
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Lim
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chetan Bettegowda
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Behbehani RS, McElveen T, Sergott RC, Andrews DW, Savino PJ. Fractionated stereotactic radiotherapy for parasellar meningiomas: a preliminary report of visual outcomes. Br J Ophthalmol 2005; 89:130-3. [PMID: 15665338 PMCID: PMC1772522 DOI: 10.1136/bjo.2004.051979] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2004] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Fractionated stereotactic radiotherapy (FSRT) is a new treatment for brain tumours that are close to critical structures, such as the visual apparatus. This study aims to assess the visual outcomes for patients with parasellar meningioma following FSRT. METHODS A retrospective, non-comparative case series of 13 patients with parasellar meningiomas who were treated in one institution with FSRT between January 1995 and January 2001. RESULTS 13 patients (26 eyes) were followed for a mean of 2 years. Visual acuity improved in four eyes (12.5%), remained stable in 18 eyes (75%), and worsened in three eyes (12.5%). Visual field improved in 15 eyes (57%), remained stable in six eyes (23%), and worsened in four eyes (15%). No adverse visual outcome occurred as a result of radiation. CONCLUSION These preliminary findings suggest that FSRT is a safe and effective treatment for parasellar meningiomas.
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Affiliation(s)
- R S Behbehani
- Neuroophthalmology Service, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107, USA.
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Abstract
The use of skull base techniques in the treatment of benign skull base tumors has allowed access to areas of the brain once considered inaccessible. The most common benign skull base tumors encountered in neurosurgical practice are benign meningiomas, schwannomas, and glomus jugulare tumors. Gross total resection of these lesions gives patients the best possible chance of a cure. In this paper, we review the rationale for the use of skull base surgery techniques for benign skull base tumors.
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Affiliation(s)
- Ketan R Bulsara
- Department of Neurosurgery, University of Arkansas Medical Sciences, Little Rock, AR 72205, USA
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