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Nowak A, Maj E, Marchel A, Kunert P. Risk of Tumor Progression after Microsurgery for Parasellar Meningioma Invading the Cavernous Sinus. Cancers (Basel) 2024; 16:2217. [PMID: 38927924 PMCID: PMC11202088 DOI: 10.3390/cancers16122217] [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: 05/15/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Parasellar meningiomas, which may invade the cavernous sinus, pose a significant challenge to neurosurgeons due to the high risk of postoperative neurological deficits associated with aggressive resection of the intracavernous part of the tumour. Therefore, subtotal tumour removal followed by observation or radiotherapy for the residual meningioma in the cavernous sinus is recommended. This retrospective study aimed to identify prognostic factors influencing recurrence and progression-free survival (PFS) in parasellar meningiomas invading the cavernous sinus after incomplete surgical treatment. METHODS This study included adult patients diagnosed with benign parasellar meningioma (WHO Grade I) invading the cavernous sinus, treated at our institution between 2006 and 2020, and with a postsurgical follow-up of at least 3 years. Surgical treatment involved near-total resection (NTR) with an intracavernous residual tumour or subtotal resection (STR) with additional extracavernous tumour left in place. Kaplan-Meier analysis estimated PFS rates, and Cox regression tested survival time differences between groups. RESULTS Among the 32 patients, the estimated median PFS was 11 years. Radiotherapy improved 5-year PFS only in patients with STR (p = 0.003). The univariate analysis identified preoperative tumour size, low preoperative Karnofsky Performance Score (KPS), and marked brain oedema as significant factors affecting meningioma progression after surgery. The multivariate analysis confirmed tumour size as an independent factor for progression (p = 0.012). CONCLUSIONS For patients with parasellar meningioma invading the cavernous sinus, extracavernous tumour removal followed by close radiological surveillance of the residual intracavernous meningioma is a safe and appropriate strategy. When an extracavernous tumour component is left, adjuvant stereotactic radiotherapy or radiosurgery is recommended to control tumour growth.
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Affiliation(s)
- Arkadiusz Nowak
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.M.); (P.K.)
| | - Edyta Maj
- 2nd Department of Clinical Radiology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.M.); (P.K.)
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.M.); (P.K.)
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Albakr A, Baghdadi A, Karmur BS, Lama S, Sutherland GR. Meningioma recurrence: Time for an online prediction tool? Surg Neurol Int 2024; 15:155. [PMID: 38840600 PMCID: PMC11152515 DOI: 10.25259/sni_43_2024] [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] [Received: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 06/07/2024] Open
Abstract
Background Meningioma, the most common brain tumor, traditionally considered benign, has a relatively high risk of recurrence over a patient's lifespan. In addition, with the emergence of several clinical, radiological, and molecular variables, it is becoming evident that existing grading criteria, including Simpson's and World Health Organization classification, may not be sufficient or accurate. As web-based tools for widespread accessibility and usage become commonplace, such as those for gene identification or other cancers, it is timely for meningioma care to take advantage of evolving new markers to help advance patient care. Methods A scoping review of the meningioma literature was undertaken using the MEDLINE and Embase databases. We reviewed original studies and review articles from September 2022 to December 2023 that provided the most updated information on the demographic, clinical, radiographic, histopathological, molecular genetics, and management of meningiomas in the adult population. Results Our scoping review reveals a large body of meningioma literature that has evaluated the determinants for recurrence and aggressive tumor biology, including older age, female sex, genetic abnormalities such as telomerase reverse transcriptase promoter mutation, CDKN2A deletion, subtotal resection, and higher grade. Despite a large body of evidence on meningiomas, however, we noted a lack of tools to aid the clinician in decision-making. We identified the need for an online, self-updating, and machine-learning-based dynamic model that can incorporate demographic, clinical, radiographic, histopathological, and genetic variables to predict the recurrence risk of meningiomas. Conclusion Although a challenging endeavor, a recurrence prediction tool for meningioma would provide critical information for the meningioma patient and the clinician making decisions on long-term surveillance and management of meningiomas.
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Affiliation(s)
| | | | - Brij S. Karmur
- Department of Clinical Neurosciences, Project neuroArm, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Engelhardt J, Montalibet V, Saut O, Loiseau H, Collin A. Evaluation of four tumour growth models to describe the natural history of meningiomas. EBioMedicine 2023; 94:104697. [PMID: 37413890 PMCID: PMC10345245 DOI: 10.1016/j.ebiom.2023.104697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The incidence of newly diagnosed meningiomas, particularly those diagnosed incidentally, is continually increasing. The indication for treatment is empirical because, despite numerous studies, the natural history of these tumours remains difficult to describe and predict. METHODS This retrospective single-centre study included 294 consecutive patients with 333 meningiomas who underwent three or more brain imaging scans. Linear, exponential, power, and Gompertz models were constructed to derive volume-time curves, by using a mixed-effect approach. The most accurate model was used to analyse tumour growth and predictors of rapid growth. FINDINGS The Gompertz model provided the best results. Hierarchical clustering at the time of diagnosis and at the end of follow-up revealed at least three distinct groups, which can be described as pseudoexponential, linear, and slowing growth with respect to their parameters. Younger patients and smaller tumours were more frequent in the pseudo-exponential clusters. We found that the more "aggressive" the cluster, the higher the proportion of patients with grade II meningiomas and who have had a cranial radiotherapy. Over a mean observation period of 56.5 months, 21% of the tumours moved to a cluster with a lower growth rate, consistent with the Gompertz's law. INTERPRETATION Meningiomas exhibit multiple growth phases, as described by the Gompertz model. The management of meningiomas should be discussed according to the growth phase, comorbidities, tumour location, size, and growth rate. Further research is needed to evaluate the associations between radiomics features and the growth phases of meningiomas. FUNDING No funding.
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Affiliation(s)
- Julien Engelhardt
- Service de Neurochirurgie B, CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux Cédex 33076, France; Univ. Bordeaux, Inria Bordeaux-Sud-Ouest, Bordeaux INP, CNRS, IMB, UMR 5251, Talence F-33400, France.
| | - Virginie Montalibet
- Univ. Bordeaux, Inria Bordeaux-Sud-Ouest, Bordeaux INP, CNRS, IMB, UMR 5251, Talence F-33400, France
| | - Olivier Saut
- Univ. Bordeaux, Inria Bordeaux-Sud-Ouest, Bordeaux INP, CNRS, IMB, UMR 5251, Talence F-33400, France
| | - Hugues Loiseau
- Service de Neurochirurgie B, CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux Cédex 33076, France
| | - Annabelle Collin
- Univ. Bordeaux, Inria Bordeaux-Sud-Ouest, Bordeaux INP, CNRS, IMB, UMR 5251, Talence F-33400, France
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Thomann P, Häni L, Vulcu S, Schütz A, Frosch M, Jesse CM, El-Koussy M, Söll N, Hakim A, Raabe A, Schucht P. Natural history of meningiomas: a serial volumetric analysis of 240 tumors. J Neurosurg 2022; 137:1639-1649. [PMID: 35535829 DOI: 10.3171/2022.3.jns212626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The management of asymptomatic intracranial meningiomas is controversial. Through the assessment of growth predictors, the authors aimed to create the basis for practicable clinical pathways for the management of these tumors. METHODS The authors volumetrically analyzed meningiomas radiologically diagnosed at their institution between 2003 and 2015. The primary endpoint was growth of tumor volume. The authors used significant variables from the multivariable regression model to construct a decision tree based on the exhaustive Chi-Square Automatic Interaction Detection (CHAID) algorithm. RESULTS Of 240 meningiomas, 159 (66.3%) demonstrated growth during a mean observation period of 46.9 months. On multivariable logistic regression analysis, older age (OR 0.979 [95% CI 0.958-1.000], p = 0.048) and presence of calcification (OR 0.442 [95% CI 0.224-0.872], p = 0.019) had a negative predictive value for tumor growth, while T2-signal iso-/hyperintensity (OR 4.415 [95% CI 2.056-9.479], p < 0.001) had a positive predictive value. A decision tree model yielded three growth risk groups based on T2 signal intensity and presence of calcifications. The median tumor volume doubling time (Td) was 185.7 months in the low-risk, 100.1 months in the intermediate-risk, and 51.7 months in the high-risk group (p < 0.001). Whereas 0% of meningiomas in the low- and intermediate-risk groups had a Td of ≤ 12 months, the percentage was 8.9% in the high-risk group (p = 0.021). CONCLUSIONS Most meningiomas demonstrated growth during follow-up. The absence of calcifications and iso-/hyperintensity on T2-weighted imaging offer a practical way of stratifying meningiomas as low, intermediate, or high risk. Small tumors in the low- or intermediate-risk categories can be monitored with longer follow-up intervals.
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Affiliation(s)
- Pascal Thomann
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Levin Häni
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sonja Vulcu
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Alessa Schütz
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Maximilian Frosch
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.,2Institute of Neuropathology, Medical Center-University of Freiburg, Germany
| | - Christopher Marvin Jesse
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marwan El-Koussy
- 3Department of Radiology and Neuroradiology, Hospital of Emmental, Burgdorf, Switzerland; and
| | - Nicole Söll
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Arsany Hakim
- 4Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andreas Raabe
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Philippe Schucht
- 1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Zong C, Yu X, Liu J, Liu Y. Dural Venous Sinuses: What We Need to Know. Curr Med Imaging 2020; 16:1259-1270. [PMID: 32101130 DOI: 10.2174/1573405616666200226102642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The dural venous sinuses (DVS), in general, are frequently asymmetrical and display far more anatomical variations than arterial systems. A comprehensive study of the anatomy and variants of the DVS can help surgeons in the preoperative evaluation and management as well as minimizing possible complications in the following treatment. METHODS The current review was designed to provide a general overview of the normal anatomy and notable variants of the cerebral venous system as surveyed from the available literature. The pros and cons of different multimodal imaging methods for investigating DVS are also outlined. Finally, cases of various pathological entities are illustrated from our clinical practice. CONCLUSION There are many anatomical variations and lesions involving the DVS. MRI examination can provide essential information both on anatomical variation and morphological or functional change of the offending DVS in most circumstances. Multimodal non-invasive venography protocols may become a feasible alternative to the classical digital subtraction angiography and would improve the diagnostic accuracy in future studies.
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Affiliation(s)
- Changqing Zong
- Department of Imaging, Tianjin Union Medical Center, Tianjin, China
| | - Xiang Yu
- Department of Imaging, Tianjin Union Medical Center, Tianjin, China
| | - Jun Liu
- Department of Imaging, Tianjin Union Medical Center, Tianjin, China
| | - Yawu Liu
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
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Materi J, Mampre D, Ehresman J, Rincon-Torroella J, Chaichana KL. Predictors of recurrence and high growth rate of residual meningiomas after subtotal resection. J Neurosurg 2020; 134:410-416. [PMID: 31899874 DOI: 10.3171/2019.10.jns192466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The extent of resection has been shown to improve outcomes in patients with meningiomas. However, resection can be complicated by constraining local anatomy, leading to subtotal resections. An understanding of the natural history of residual tumors is necessary to better guide postsurgical management and minimize recurrence. This study seeks to identify predictors of recurrence and high growth rate following subtotal resection of intracranial meningiomas. METHODS Adult patients who underwent primary surgical resection of a WHO grade I meningioma at a tertiary care institution from 2007-2017 were retrospectively reviewed. Volumetric tumor measurements were made on patients with subtotal resections. Stepwise multivariate proportional hazards regression analyses were performed to identify factors associated with time to recurrence, as well as stepwise multivariate regression analyses to assess for factors associated with high postoperative growth rate. RESULTS Of the 141 patients (18%) who underwent radiographic subtotal resection of an intracranial meningioma during the reviewed period, 74 (52%) suffered a recurrence, in which the median (interquartile range, IQR) time to recurrence was 14 (IQR 6-34) months. Among those tumors subtotally resected, the median pre- and postoperative tumor volumes were 17.19 cm3 (IQR 7.47-38.43 cm3) and 2.31 cm3 (IQR 0.98-5.16 cm3), which corresponded to a percentage resection of 82% (IQR 68%-93%). Postoperatively, the median growth rate was 0.09 cm3/year (IQR 0-1.39 cm3/year). Factors associated with recurrence in multivariate analysis included preoperative tumor volume (hazard ratio [HR] 1.008,95% confidence interval [CI] 1.002-1.013, p = 0.008), falcine location (HR 2.215, 95% CI 1.179-4.161, p = 0.021), tentorial location (HR 2.410, 95% CI 1.203-4.829, p = 0.024), and African American race (HR 1.811, 95% CI 1.042-3.146, p = 0.044). Residual volume (RV) was associated with high absolute annual growth rate (odds ratio [OR] 1.175, 95% CI 1.078-1.280, p < 0.0001), with the maximum RV benefit at < 5 cm3 (OR 4.056, 95% CI 1.675-9.822, p = 0.002). CONCLUSIONS By identifying predictors of recurrence and growth rate, this study helps identify potential patients with a high chance of recurrence following subtotal resection, which are those with large preoperative tumor volume, falcine location, tentorial location, and African American race. Higher RVs were associated with tumors with higher postoperative growth rates. Recurrences typically occurred 14 months after surgery.
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Affiliation(s)
- Joshua Materi
- 1Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
| | - David Mampre
- 1Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
| | - Jeff Ehresman
- 1Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
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Li T, Ren J, Ma J, Wu J, Zhang R, Yuan H, Han X. LINC00702/miR-4652-3p/ZEB1 axis promotes the progression of malignant meningioma through activating Wnt/β-catenin pathway. Biomed Pharmacother 2019; 113:108718. [DOI: 10.1016/j.biopha.2019.108718] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 01/17/2023] Open
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The prognostic significance of TERT promoter mutations in meningioma: a systematic review and meta-analysis. J Neurooncol 2018; 142:1-10. [PMID: 30506498 DOI: 10.1007/s11060-018-03067-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mutations in the telomerase reverse transcriptase promoter (TERTp) region have been associated with worse prognosis in some cancers. Meningiomas are the most common type of primary central nervous tumors, and evaluation of the prognostic significance of TERTp mutations across the literature is lacking. The aim of this study was to pool all current evidence to assess for clinical relevance of TERTp mutations in meningioma and survival effect. METHODS Searches of seven electronic databases from inception to September 2018 were conducted following the appropriate guidelines. Two hundred and twenty seven articles were identified for screening. Hazard ratio (HR) and mean difference (MD) statistics were obtained and pooled utilizing both fixed- and random-effect (RE) models. Meta-regression was utilized to determine potential sources of heterogeneity and statistical influence. RESULTS A total of five retrospective observational cohort studies describing 532 meningioma patients satisfied selection criteria. The incidence of TERTp mutations was 8%, and was associated with significantly worse prognosis (HR 3.79; P = 0.005) and significantly shorter overall survival (MD 59.8 months; P = 0.037) by RE modelling. Meningioma grade was not significantly associated with a TERTp mutation effect, however, preliminary meta-regression trends indicated this may be significant once greater statistical power is achieved. CONCLUSION The current evidence indicates the presence of a TERTp mutation in meningioma can be associated with worse prognosis, and shorter overall survival. Routine detection in greater numbers will allow for further validation, as well as delineate the effect across histological grades. By identifying this subgroup of meningioma patients early in management, it may support more frequent follow-up and aggressive management to optimize survival outcomes.
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