1
|
Gendreau JL, Kuo CC, Patel NA, Brown NJ, Pennington Z, Bui NE, Reardon T, Lien BV, Prevedello DM, Kuan EC, Hsu FP, Mohyeldin A. Staged Resection of Difficult-to-Treat Intracranial Meningiomas: A Systematic Review of the Indications, Surgical Approaches, and Postoperative Outcomes. J Neurol Surg B Skull Base 2024; 85:131-144. [PMID: 38449578 PMCID: PMC10914469 DOI: 10.1055/a-2015-8238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction Meningiomas-the most common extra-axial tumors-are benign, slow-growing dural-based lesions that can involve multiple cranial fossae and can progress insidiously for years until coming to clinical attention secondary to compression of adjacent neurovascular structures. For complex, multicompartmental lesions, multistaged surgeries have been increasingly shown to enhance maximal safe resection while minimizing adverse sequela. Here, we systematically review the extant literature to highlight the merits of staged resection. Methods PubMed, Scopus, and Web of Science databases were queried to identify articles reporting resections of intracranial meningiomas using a multistaged approach, and articles were screened for possible inclusion in a systematic process performed by two authors. Results Of 118 identified studies, 36 describing 169 patients (mean age 42.6 ± 21.3 years) met inclusion/exclusion criteria. Petroclival lesions comprised 57% of cases, with the most common indications for a multistaged approach being large size, close approximation of critical neurovascular structures, minimization of brain retraction, identification and ligation of deep vessels feeding the tumor, and resection of residual tumor found on postoperative imaging. Most second-stage surgeries occurred within 3 months of the index surgery. Few complications were reported and multistaged resections appeared to be well tolerated overall. Conclusions Current literature suggests multistaged approaches for meningioma resection are well-tolerated. However, there is insufficient comparative evidence to draw definitive conclusions about its advantages over an unstaged approach. There are similarly insufficient data to generate an evidence-based decision-making framework for when a staged approach should be employed. This highlights the need for collaborative efforts among skull base surgeons to establish an evidentiary to support the use of staged approaches and to outline those indications that merit such an approach.
Collapse
Affiliation(s)
- Julian L. Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, United States
| | - Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, United States
| | - Neal A. Patel
- School of Medicine, Mercer University School of Medicine, Savannah, Georgia, United States
| | - Nolan J. Brown
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Nicholas E. Bui
- Loma Linda University School of Medicine, Loma Linda, California, United States
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Brian V. Lien
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
| | - Edward C. Kuan
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
- Department of Otolaryngology, University of California, Irvine, Orange, California, United States
| | - Frank P.K. Hsu
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| | - Ahmed Mohyeldin
- Department of Neurosurgery, University of California, Irvine, Orange, California, United States
| |
Collapse
|
2
|
Liang Q, Ge P, Liu Y, Zhu X, Lu S, Pan C, Ji Z, Wang Q, Wang Y. Central nervous system clear cell meningioma: a systematic literature review. Neurosurg Rev 2024; 47:35. [PMID: 38183517 DOI: 10.1007/s10143-023-02251-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
Clear cell meningiomas are a rare histological subtype of World Health Organization (WHO) grade II meningioma. Despite its relatively low frequency, clear cell meningioma has attracted considerable attention because of its unique pathological characteristics, clinical behavior, and challenging management considerations. The purpose of our systematic review is to provide clinicians with a better understanding of this rare disease. PubMed was searched for articles in the English language published from 1988 to 2023 June. The keywords were as follows: "clear cell meningioma," "clear cell" and "meningioma." We analyzed clinical manifestations, radiological manifestations, pathological features, comprehensive treatment strategies, and prognosis to determine the factors influencing recurrence-free survival (RFS). Recurrence-free survival curves of related factors were calculated by the Kaplan‒Meier method. The log-rank test and Cox univariate analysis were adopted to assess the intergroup differences and seek significant factors influencing prognosis and recurrence. Fifty-seven papers met the eligibility criteria, including 207 cases of clear cell meningioma (CCM), which were confirmed by postoperative pathology. The fifty-seven articles involved 84 (40.6%) males and 123 (59.4%) females. The average age at diagnosis was 27.9 years (range, 14 months to 84 years). Among the symptoms observed, headache, neurologic deficit, and hearing loss were the most commonly reported clinical manifestations. Most tumors (47.8%) were located in the skull base region. Most tumors showed significant enhancement, and homogeneous enhancement was more common. A total of 152 (74.1%) patients underwent gross total resection (GTR), and 53 (25.9%) patients underwent subtotal resection (STR). During the follow-up, the tumor recurred in 80 (39.4%) patients. The log-rank test and the Cox univariate analysis revealed that tumor resection range (GTR vs. STR) and adjuvant treatment (YES vs. NO) were significant predictors of recurrence-free survival (RFS). Clear cell meningioma is a rare type of meningioma with challenging diagnosis and therapy. The prognosis of this disease is different from that of regular meningiomas. Recurrence remains a possibility even after total tumor resection. We found that the surgical resection range and adjuvant treatment affected the recurrence period. This finding provides significant guidance for the treatment of clear cell meningioma.
Collapse
Affiliation(s)
- Qi Liang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Pengfei Ge
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yanhua Liu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Xiaoxi Zhu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Shan Lu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Chengliang Pan
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Zhilin Ji
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Qingxuan Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China.
| |
Collapse
|
3
|
Tan X, Wang Y, Jiang W, Cao Y, Teng Y, Zhao G. Paediatric supra- and infratentorial multiple giant clear cell meningioma: A report of a rare case and review of the literature. Childs Nerv Syst 2021; 37:2661-2665. [PMID: 33216172 DOI: 10.1007/s00381-020-04975-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/12/2020] [Indexed: 12/01/2022]
Abstract
Clear cell meningiomas (CCMs) account for only approximately 0.2% of all meningiomas and are classified as grade II tumours by the World Health Organisation. Most of the previously described intracranial CCMs are single tumour entities. Multiple intracranial CCMs are extremely rare, and due to their low incidence, information on multiple CCM remains limited; hence, researchers and practitioners also have a limited understanding of its aetiology, clinical manifestations, and treatment options. Herein, we report a case of sporadic multiple intracranial CCM in a child that presented with a 3-month history of gait instability and mild dysphagia. Brain magnetic resonance imaging showed one lesion in the right frontoparietal lobe and another giant lesion on the ventral side of the brainstem, extending to the middle fossa. The lesions were completely resected in two stages. Postoperative histopathological examination confirmed CCM. The patient was followed up for 2 years without recurrence. To the best of our knowledge this is the first reported case of paediatric sporadic multiple intracranial CCM. In addition, we reviewed the relevant literature to discuss the pathogenesis, imaging findings, and treatment methods of this rare disease.
Collapse
Affiliation(s)
- Xuanyu Tan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Wei Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Yue Cao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yongliang Teng
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Gang Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
4
|
Rombi B, Ruggi A, Sardi I, Zucchelli M, Scagnet M, Toni F, Cammelli S, Giulietti G, Fabbri VP, Gianno F, Amichetti M, Yock TI, Morganti AG, Pession A, Melchionda F. Proton therapy: A therapeutic opportunity for aggressive pediatric meningioma. Pediatr Blood Cancer 2021; 68:e28919. [PMID: 33682333 DOI: 10.1002/pbc.28919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 11/12/2022]
Abstract
Meningiomas are an extremely rare histology among pediatric brain tumors, and there is a shortage of literature on their management. Proton therapy is currently used safely and effectively for many types of both pediatric and adult cancer, and its main advantage is the sparing of healthy tissues from radiation, which could translate in the reduction of late side effects. We review the literature on radiotherapy and proton therapy for pediatric meningiomas and report clinical outcomes for two aggressive pediatric meningiomas we treated with protons. Proton therapy might be a safe and effective therapeutic option for this rare subgroup of tumors.
Collapse
Affiliation(s)
- Barbara Rombi
- Proton Therapy Center, Santa Chiara Hospital, Trento, Italy.,Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | | | - Iacopo Sardi
- Pediatric Neuro-Oncology Unit, Meyer Children's Hospital, Florence, Italy
| | - Mino Zucchelli
- Pediatric Neurosurgery, Institute of Neurological Science, IRCCS Bellaria Hospital, Bologna, Italy
| | - Mirko Scagnet
- Department of Neurosurgery, Meyer Children's Hospital, Florence, Italy
| | - Francesco Toni
- Pediatric Neuroradiology of Institute of Neurological Science, IRCCS Bellaria Hospital, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | | | - Viscardo Paolo Fabbri
- Department of Biomedical and Neuromotor Sciences, Pathology Department, University of Bologna, IRCCS Bellaria Hospital, Bologna, Italy
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Torunn Ingrid Yock
- Pediatric Radiation Oncology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alessio Giuseppe Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, University of Bologna, Bologna, Italy
| | | |
Collapse
|
5
|
Clear cell histology portends a worse prognosis than other WHO grade II histologies. J Neurooncol 2021; 151:307-312. [PMID: 33398533 DOI: 10.1007/s11060-020-03668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Clear cell meningioma (CCM) is a rare WHO grade II meningioma variant, characterized by aggressive features and a high tumor recurrence rate. In this study, we compared overall and progression-free survivals between CCMs and other WHO grade II meningiomas. METHODS A retrospective institutional database review was performed to identify all patients who underwent surgical resection of a WHO grade II meningioma between 1997 and 2019. Overall survival and progression-free survival were compared between patients with clear cell meningiomas and patients with other WHO grade II meningiomas. Multivariable Cox proportional-hazards analysis was used to identify independent predictors of tumor recurrence and survival. RESULTS We included a total of 214 patients in this study (43 CCMs, 171 other WHO grade II meningiomas). Patients with CCMs had significantly shorter progression-free (p = 0.001) and overall (p = 0.026) survivals than patients with other grade II meningiomas. In multivariable analysis, clear cell histology was a significant and powerful independent predictor of tumor recurrence (HR 1.93; 95% CI 1.14-3.26) when controlling for tumor location, extent of resection, and adjuvant radiation. In multivariable analysis, clear cell histology correlated with increased mortality (HR 1.96, 95% CI 0.97-3.94), though this was not statistically significant. CONCLUSION This is the first study to compare overall and progression-free survivals between CCMs and other WHO grade II meningiomas. Clear cell histology predicts a higher risk of tumor recurrence and mortality than other grade II histologies. Future studies may help to understand the impact of these findings and the treatment implications.
Collapse
|
6
|
Tsurubuchi T, Matsuda M, Muroi A, Sakamoto N, Ishikawa E, Matsumura A. An Aggressive Extension of Dumbbell-Type Pediatric Skull Base Meningioma: A Case Report with Review of the Literature. World Neurosurg 2020; 139:535-547. [PMID: 32371076 DOI: 10.1016/j.wneu.2020.04.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric meningiomas account for less than 2% of pediatric brain tumors. Pediatric clear cell meningiomas (CCMs) occurring in the posterior fossa are particularly rare. Therapeutic strategies differ among the previous pediatric CCM case reports. Therefore, to clarify the clinical features of pediatric CCMs, we report a rare case of dumbbell-type pediatric CCM and a corresponding literature review. CASE DESCRIPTION A 7-year-old boy with complaints of headache, left facial palsy, dysarthria, and left-sided ataxic gait was emergently admitted to our hospital. His consciousness level was slight stupor, with Glasgow Coma Scale score 3-5-6, and he showed left ptosis, dysarthria, and ataxias of the left trunk and extremities. Magnetic resonance imaging (MRI) scan showed acute obstructive hydrocephalus because of the tumor's compression of the brainstem. The dumbbell-shaped tumor extended from the lateral wall of the cavernous sinus, through the left Meckel's cave, to the cerebellopontine angle. Physical examination and perioperative MRI scan showed no evidence regarding neurofibromatosis type I or II. The tumor was removed in a 2-staged operation. Postoperative proton therapy was done to treat some residual tumors. One year after postoperative proton therapy, there is no recurrence, and apart from left corneal and facial hypesthesia, he is healthy. CONCLUSIONS We reported a rare case of pediatric skull base-type CCM with huge extension originating from the anteromedial wall of Meckel's cave firmly adhered to the cavernous sinus wall to the posterior fossa that was successfully treated with surgery and postoperative proton therapy. CCM has a high recurrence rate; therefore, careful prolonged follow-up is needed.
Collapse
Affiliation(s)
- Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriaki Sakamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
7
|
Libert DM, Prayson RA. Pediatric clear cell meningioma involving the middle cranial fossa in the context of NF2 and SMARCE1 mutations. Ann Diagn Pathol 2020; 46:151516. [PMID: 32311644 DOI: 10.1016/j.anndiagpath.2020.151516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
Meningiomas are an uncommon entity in children and adolescents. <30 cases of pediatric clear cell meningioma (CCM), a World Health Organization (WHO) Grade II tumor, have been reported in the literature. These tumors are more likely to recur than the more common WHO Grade I meningiomas, especially with incomplete surgical resection. CCMs are most commonly found in the spine and posterior cranial fossa. Recently, SMARCE1 mutations have been linked to the development of CCM. To evaluate the progression of pediatric CCM in the context of emerging genetic knowledge, we reviewed all 45 cases of CCM at our institution for a 23 year period (1997-2019) to identify pediatric cases. Forty-four of the tumors arose in adults from age 34-81 years. The one pediatric case originally presented at age 4 years; the patient was found to have a CCM in the left cavernous sinus projecting into the posterior fossa, associated with a novel germline SMARCE1 mutation and somatic NF1 and DMD mutations. After two years, the patient had a recurrence of the tumor and underwent a second resection. This is the 5th reported case of CCM in the middle cranial fossa, and the only recurrent case, as well as the only reported case of recurrent pediatric CCM associated with a germline SMARCE1 mutation. Further study of the natural history of tumors associated with germline SMARCE1 loss could potentially inform prognosis.
Collapse
Affiliation(s)
- Diane M Libert
- Cleveland Clinic Lerner College of Medicine and Cleveland Clinic Department of Anatomic Pathology, Cleveland, OH, United States of America
| | - Richard A Prayson
- Cleveland Clinic Lerner College of Medicine and Cleveland Clinic Department of Anatomic Pathology, Cleveland, OH, United States of America.
| |
Collapse
|
8
|
Burnett BA, Womeldorff MR, Jensen R. Meningioma: Signaling pathways and tumor growth. HANDBOOK OF CLINICAL NEUROLOGY 2020; 169:137-150. [PMID: 32553285 DOI: 10.1016/b978-0-12-804280-9.00009-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Meningiomas are the most common primary intracranial brain tumor in adult humans; however, our understanding of meningioma tumorigenesis is relatively limited in comparison with the body of research available for other intracranial tumors such as gliomas. Here we briefly describe the current understanding of aberrant signaling pathways and tumor growth mechanisms responsible for meningioma differentiation, cellular growth, development, inhibition, and death. Numerous cellular functions impacted by these signaling pathways are critical for angiogenesis, proliferation, and apoptosis. Ultimately, a further understanding of the signaling pathways involved in meningioma tumorigenesis will lead to better treatment modalities in the future.
Collapse
Affiliation(s)
- Brian Andrew Burnett
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | | | - Randy Jensen
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States.
| |
Collapse
|
9
|
Li J, Deng X, Zhang S, Wang Q, Cheng J, Li X, Ke D, Hui X. Intracranial clear cell meningioma: Clinical study with long-term follow-up in 24 patients. Clin Neurol Neurosurg 2018; 175:74-83. [DOI: 10.1016/j.clineuro.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
|
10
|
Pediatric intracranial clear cell meningioma: a clinicopathological study of seven cases and literature review. Childs Nerv Syst 2017; 33:239-248. [PMID: 27787647 DOI: 10.1007/s00381-016-3269-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In this study, we reported seven cases of pediatric intracranial clear cell meningiomas (CCMs) in our institution and reviewed the relevant literature to investigate the clinicopathological characteristics, treatment options, and prognosis of these rare tumors. METHODS From January 2005 to June 2016, we retrospectively reviewed seven pediatric intracranial CCMs in terms of their clinical data, preoperative MRI features, and prognosis. Moreover, a critical review of the English language literature was also conducted. RESULTS The patients consisted of two males and five females with a median age of 10.5 years (range 6-15 years) at initial surgery. Petroclival and cerebellopontine angle area was the most common location site (5/7). Accordingly, the most common initial manifestation was hearing loss (3/7), and the mean interval from onset of symptoms to admission was 6.8 months (1.5-24 months). Gross total resection was achieved in five patients. Of the six tumors with immunohistochemical records, MIB-1 labeling index varied from 3 to 20 % (mean 8.1 %). During the follow-up period (mean 76.9 months, range 16-180 months), four patients had experienced tumor recurrences and three patients died due to recurrences. CONCLUSIONS Pediatric intracranial CCMs have a tendency to recur. There is a significant relationship between MIB-1 labeling index and recurrence. Gross total resection is recommended; if not available, adjuvant radiotherapy should be used to reduce the recurrent rate. In addition, postoperative MRI follow-up should be monitored at an interval time after resection.
Collapse
|
11
|
Intracranial Clear Cell Meningiomas: Study on Clinical Features and Predictors of Recurrence. World Neurosurg 2017; 97:693-700.e11. [DOI: 10.1016/j.wneu.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/20/2022]
|
12
|
Anunobi CC, Bankole O, Ikeri NZ, Adeleke NA. Suprasellar Clear Cell Meningioma in an Infant. Sultan Qaboos Univ Med J 2016; 16:e364-7. [PMID: 27606120 DOI: 10.18295/squmj.2016.16.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/15/2016] [Accepted: 03/17/2016] [Indexed: 02/04/2023] Open
Abstract
Clear cell meningiomas are an uncommon subtype of meningioma rarely seen in infancy. We report a case of clear cell meningioma in an 8-month-old male infant. He presented at the Lagos University Teaching Hospital, Lagos, Nigeria, in 2015 with persistent vomiting, poor feeding and failure to thrive over a four month period. Generalised hypertonia and hyperreflexia were noted on examination. Computed tomography of the brain revealed a huge largely isodense suprasellar mass with a hypodense core. The tumour, which measured 6 × 5 × 4 cm, enhanced non-uniformly with contrast injection and extended to occlude the third ventricle. The patient underwent a bifrontal craniotomy with subtotal tumour excision. Six hours postoperatively, he went into cardiac arrest and could not be resuscitated. A histological diagnosis of clear cell meningioma was made as the tumour cells were immunoreactive to epithelial membrane antigen, S100 protein and vimentin. This case of clear cell meningioma was unusual due to its early occurrence and supratentorial location.
Collapse
Affiliation(s)
- Charles C Anunobi
- Department of Anatomic & Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olufemi Bankole
- Departments of Neurosurgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nzechukwu Z Ikeri
- Anatomic & Molecular Pathology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nurudeen A Adeleke
- Departments of Neurosurgery, Lagos University Teaching Hospital, Lagos, Nigeria
| |
Collapse
|
13
|
Mourad M, Chan D, Ducic Y. Surgical Management of Extracranial Meningiomas Arising in the Head and Neck. J Oral Maxillofac Surg 2016; 74:1872-8. [PMID: 27087283 DOI: 10.1016/j.joms.2016.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/13/2016] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine outcomes in the management of extracranial meningiomas of the head and neck. PATIENTS AND METHODS This is a retrospective single-surgeon series performed at a tertiary-care referral center. In all, 23 patients met the inclusion criteria, consisting of 12 men and 11 women. The mean age of patients treated was 60.5 years (range, 32 to 71 years). Subsite involvement included the infratemporal fossa (n = 8), greater wing of the sphenoid and orbit (n = 7), clivus (n = 2), and parapharyngeal space (n = 6). RESULTS In all, recurrence occurred in 21% of patients (n = 5) who underwent gross tumor resection. Two patients underwent subtotal resection because of the tumor's location within the clivus with adjuvant CyberKnife therapy (Accuray, Sunnyvale, CA). Both patients had persistent disease with no new neurologic symptoms. Examination showed that 100% of patients (N = 23) had dural involvement. Post-ablative complications occurred in 43% of patients (n = 10). CONCLUSIONS We presently report the largest series of surgical treatment for extracranial meningiomas. Gross tumor resection should be the mainstay of therapy, except in anatomically restricted regions such as the petrous apex and clivus. Adjuvant therapy including CyberKnife therapy may be used in such lesions. All lesions showed dural involvement. A more unified nomenclature is required for the characterization of these lesions.
Collapse
Affiliation(s)
- Moustafa Mourad
- Resident Physician, Division of Facial Plastic Surgery, Department of Otolaryngology-Head & Neck Surgery, The New York Eye & Ear Infirmary, New York, NY
| | - David Chan
- Fellow Physician, Department of Otolaryngology Head and Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX
| | - Yadranko Ducic
- Professor, Department of Otolaryngology Head and Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX.
| |
Collapse
|