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Chen Z, Lin T, Liu D, Zeng Y, Zhang X, Deng B, Guo D, Shi T, Lu M. Comparison of Short-Term Surgery Outcomes and Clinical Characteristics Between Elderly and Non-Elderly Patients with Middle Third Parasagittal and Parafalcine Meningiomas. Neuropsychiatr Dis Treat 2023; 19:2331-2340. [PMID: 37928167 PMCID: PMC10624188 DOI: 10.2147/ndt.s428341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aims to compare the short-term surgery outcomes of the resection of meningiomas and clinical characteristics between elderly and non-elderly patients. Patients and Methods This retrospective study included patients who underwent a resection of middle third parasagittal and parafalcine meningiomas between January 2011 and December 2020. All lesions arise from the middle third of the parafalcine or infiltrate superior sagittal sinus (SSS). The clinical characteristics studied included neurological deficit, peritumoral brain edema (PTBE), SSS invasion, tumor size, and symptoms; perioperative complications, and short-term surgery outcomes including neurological deficit, operative blood loss, postoperative hospitalization duration, and WHO classification were compared. Results A total of 43 elderly patients and 63 non-elderly patients were included. Compared with non-elderly patients, elderly patients had larger lesions (P = 0.013) and presented with a larger PTBE (P = 0.019). SSS blockage was identified in 28.57% of elderly patients and 19.57% of non-elderly patients. Compared with non-elderly patients, elderly patients tended to suffer from more aggressive lesions (WHO II/III meningioma 6 vs 3, P = 0.154) and presented with longer postoperative hospital stays (17.25 ± 5.8 vs 13.50 ± 3.8, P = 0.009); conversely, while the non-elderly patients experienced more blood loss (P = 0.022) and had more perioperative reoperations (3 vs 1). No significant difference in neurological deficit was detected between the two groups (P = 0.97). After total tumor resection, patients with neurological deficits in both groups can recover during the follow-up period. Conclusion Among the 106 patients with middle third parasagittal and falx meningiomas in our hospital, elderly patients had larger lesions, presented with more severe PTBE, and had longer postoperative hospital stays than younger patients. Conversely, younger patients had more blood loss and serious complications than elderly patients. Postoperative neurological dysfunction in elderly patients was similar to that in middle-aged and young patients.
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Affiliation(s)
- Zhijie Chen
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Tao Lin
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Da Liu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Yongqin Zeng
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Xubiao Zhang
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Bin Deng
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Dongliang Guo
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Tao Shi
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Ming Lu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
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Zhang G, Wang J, Wang P, Wu N. Endoscopic Ipsilateral Interhemispheric Approach for Middle-Third Falcine Meningioma: A Case Report and Literature Review. Brain Sci 2023; 13:1085. [PMID: 37509015 PMCID: PMC10377495 DOI: 10.3390/brainsci13071085] [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: 04/16/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Middle-third falcine meningiomas (FMs) are usually hidden deep under the eloquent cortex and abundant bridging veins, which represent the main hindrances to surgical access. The endoscopic approach has the advantages of wide visualization and free visual axis without areas of visual blindness, which allows for the resection of FMs with good visualization in a narrow space, especially in deep operations. Here, we report a case of a middle-third FM treated using the endoscopic ipsilateral interhemispheric approach. A 55-year-old female who had suffered a headache for 6 months without other remarkable symptoms was diagnosed with middle-third FM combined with imaging evaluation. According to the imaging performance and anatomical features, we scheduled the endoscopic ipsilateral interhemispheric approach to access and remove the tumor. Consequently, gross total tumor resection was achieved without surgery-related complications. After the surgery, the patient had an uneventful recovery and was discharged with no neurological deficit. During the 24-month follow-up, the patient's condition remained favorable, with no tumor recurrence. In our opinion, the endoscopic ipsilateral interhemispheric approach is a feasible surgical strategy for FMs, which deserves further exploration as a treatment option.
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Affiliation(s)
- Gang Zhang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
- Graduate Institute, Chongqing Medical University, Chongqing 400016, China
| | - Junwei Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
| | - Pan Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
| | - Nan Wu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
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Sakaeyama Y, Morisako H, Ohata H, Nakajo K, Valenzuela JC, Fernandez-Miranda JC, Goto T. In Reply to the Letter to the Editor Regarding: "Endoscopic Contralateral Interhemispheric Transfalcine Keyhole Approach for Large Falcine Meningiomas". World Neurosurg 2023; 173:292-293. [PMID: 37189314 DOI: 10.1016/j.wneu.2023.01.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Yuki Sakaeyama
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Stanford University, Palo Alto, California, USA.
| | - Hiroki Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Nakajo
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | - Takeo Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Sakaeyama Y, Morisako H, Ohata H, Nakajo K, Valenzuela JC, Fernandez-Miranda JC, Goto T. Endoscopic Contralateral Interhemispheric Transfalcine Keyhole Approach for Large Falcine Meningiomas. World Neurosurg 2022; 166:e237-e244. [PMID: 35809843 DOI: 10.1016/j.wneu.2022.06.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Falcine meningioma is usually approached ipsilaterally, and the technique for tumor removal has traditionally been performed under microscopy. We report a surgical procedure for large falcine meningioma by an endoscopic contralateral interhemispheric transfalcine keyhole approach. METHODS The study period was from September 2019 to March 2021. Study participants were patients with World Health Organization grade I meningioma showing falx attachment, excluding neurofibromatosis, who underwent initial surgery at our institution. The surgical procedure begins with a small contralateral craniotomy of about 3 cm, followed by insertion of an endoscope. The tumor attachment to the falx is excised, exposing the tumor. Internal decompression is performed, and the lesion is dissected from the surrounding brain before removal through the falx. RESULTS An endoscopic contralateral interhemispheric transfalcine keyhole approach was used to resect 4 cases of large falcine meningioma. The mean operation time was 265 minutes (range: 216-294 minutes), achieving Simpson grade I removal in all cases. No evidence of cerebral infarction, cerebral edema, or new neurological complaints related to impaired venous return was seen using this surgical method. CONCLUSIONS In the case of falcine meningioma, the endoscopic keyhole contralateral technique allows detachment of the tumor from the falx and safe manipulation in a minor field of view. In addition, because the craniotomy is smaller and the operation time is shorter, this procedure offers a less-invasive approach for the patient. This technique is thus, in our opinion, quite advantageous.
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Affiliation(s)
- Yuki Sakaeyama
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Stanford University, Palo Alto, California, USA.
| | - Hiroki Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Nakajo
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | - Takeo Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Song K, Lee H, Jeong J, Roh Y. Multiple Meningioma Resection by Bilateral Extended Rostrotentorial Craniotomy with a 3D-Print Guide in a Cat. Vet Sci 2022; 9:vetsci9100512. [PMID: 36288124 PMCID: PMC9609023 DOI: 10.3390/vetsci9100512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Meningioma is the most common intracranial neoplasia in cats. Treatments for meningiomas—including complete surgical resection, debulking, irradiation, or palliative therapy—have been reported in veterinary medicine. However, multiple meningiomas (two or more meningiomas in the same patient, separated by anatomical location) have been reported to affect the complication rate and prognosis. Moreover, the characteristics of neurosurgery—such as accurate localization and awareness of the anatomical structures of the lesions—make the surgery especially difficult for inexperienced surgeons. Surgical navigation systems have been developed, but recently, patient-specific three-dimensional(3D)-printed models and guides have also been used in orthopedics and neurosurgeries for treating many disorders with good results. A 13-year-old castrated male domestic shorthair cat was referred with multiple meningiomas located within the right frontal and occipital lobes. The cat suffered from generalized tonic–clonic seizures and mild proprioceptive ataxia. After removing both of the tumors, the cat showed a favorable clinical outcome and no neurological abnormalities throughout long-term follow-up. With a patient-specific 3D guide technology, a craniotomy for multiple meningiomas can be performed safely and accurately. Abstract A 13-year-old castrated male domestic shorthair cat was referred for the surgical removal of multiple meningiomas. The cat experienced generalized tonic–clonic seizures, altered mentation, mild proprioceptive ataxia, and circling. Magnetic resonance imaging (MRI) revealed two round, solitary, well-delineated, space-occupying lesions suggestive of multiple meningiomas in the right frontal and occipital lobes. Before surgery, patient-specific three-dimensional (3D) printed models and guides were produced using a 3D program based on MRI and computed tomography (CT), and a rehearsal surgery was performed. With a 3D guide to find the location of the craniotomy lines, bilateral extended rostrotentorial craniotomy allowed en bloc resection of multiple meningiomas. The bone fragment was replaced and secured to the skull with a craniofacial plate and screws with an artificial dura. All of the surgical steps were performed without complications. The preoperative presenting signs were resolved by the time of follow-up examinations 2 weeks after surgery. Twelve months after the removal of the multiple meningiomas, the cat survived without further neurological progression. For the resection of multiple meningiomas, surgery can result in large bone defects and risk of massive hemorrhage. For this challenging surgery, patient-specific 3D models and guides can be effective for accurate and safe craniotomies.
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Affiliation(s)
- Kyohyuk Song
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Haebeom Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Jaemin Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Yoonho Roh
- Division of Small Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty University of Bern, 63012 Bern, Switzerland
- Correspondence:
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Armocida D, Catapano A, Palmieri M, Arcidiacono UA, Pesce A, Cofano F, Picotti V, Salvati M, Garbossa D, D’Andrea G, Santoro A, Frati A. The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie. Brain Sci 2022; 12:brainsci12070817. [PMID: 35884624 PMCID: PMC9313316 DOI: 10.3390/brainsci12070817] [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: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Giant intracranial meningiomas (GIMs) are a subgroup of meningiomas with huge dimensions with a maximum diameter of more than 5 cm. The mechanisms by which a meningioma can grow to be defined as a “giant” are unknown, and the biological, radiological profile and the different outcomes are poorly investigated. We performed a multi-centric retrospective study of a series of surgically treated patients suffering from intracranial meningioma. All the patients were assigned on the grounds of the preoperative imaging to giant and medium/large meningioma groups with a cut-off of 5 cm. We investigated whether the presence of large diameter and peritumoral brain edema (PBE) on radiological diagnosis indicates different mortality rates, grading, characteristics, and outcomes in a multi-variate analysis. We found a higher risk of developing complications for GIMs (29.9% versus 14.8%; p < 0.01). The direct proportional relationship between PBE volume and tumor volume was present only in the medium/large group (Pearson correlation with p < 0.01) and not in the GIM group (p = 0.47). In conclusion, GIMs have a higher risk of developing complications in the postoperative phase than medium/large meningioma without higher risk of mortality and recurrence.
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Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
- IRCCS “Neuromed”, Neurosurgeon Consultant, Via Atinense, 18, 86077 Pozzilli, IS, Italy;
- Correspondence: ; Tel.: +39-393-287-4496
| | - Antonia Catapano
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Mauro Palmieri
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Umberto Aldo Arcidiacono
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Alessandro Pesce
- Neurosurgery Unit, Ospedale Santa Maria Goretti, Via Guido Reni 1, 04100 Latina, LT, Italy;
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco, 15, 10126 Torino, TO, Italy; (F.C.); (D.G.)
| | - Veronica Picotti
- Neurosurgery Department of Fabrizio Spaziani Hospital, Via Armando Fabi, 03100 Frosinone, FR, Italy; (V.P.); (G.D.)
| | - Maurizio Salvati
- Policlinico Tor Vergata, University Tor Vergata of Rome, Viale Oxford, 81, 00133 Roma, RM, Italy;
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco, 15, 10126 Torino, TO, Italy; (F.C.); (D.G.)
| | - Giancarlo D’Andrea
- Neurosurgery Department of Fabrizio Spaziani Hospital, Via Armando Fabi, 03100 Frosinone, FR, Italy; (V.P.); (G.D.)
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Alessandro Frati
- IRCCS “Neuromed”, Neurosurgeon Consultant, Via Atinense, 18, 86077 Pozzilli, IS, Italy;
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Ryu B, Sato S, Mochizuki T, Shima S, Inoue T, Okada Y, Niimi Y. Angiographic classification of the inferior sagittal sinus based on the venous drainage patterns. Jpn J Radiol 2021; 40:159-166. [PMID: 34529216 DOI: 10.1007/s11604-021-01198-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The inferior sagittal sinus (ISS) and its tributaries have received little attention because of its inconspicuous appearance, and its anatomical variations are also unknown. This study aimed to evaluate the morphological variations of the ISS. MATERIALS AND METHODS We retrospectively reviewed 518 patients in whom cerebral angiography was clinically indicated. The detailed angioarchitecture of the cerebral venous system, including the ISS and their tributaries, and the morphological variations of the ISS were evaluated. Abnormalities of the rostral third superior sagittal sinus (SSS) were also evaluated. RESULTS The ISS was visualized in 270 (52.1%) patients. We proposed an angiographic ISS classification according to the venous drainage patterns: Type 0, not visualized; Type 1, small ISS with faint tributaries; Type 2, moderate ISS with developed tributaries; and Type 3: large ISS with well-developed tributaries, which are responsible for the venous drainage of the anterior frontal lobe. The frequency of each ISS type was as follows: Type 0, 248 (47.9%); Type 1, 211 (40.7%); Type 2, 44 (8.5%); and Type 3, 15 (2.9%). The mean ISS size was significantly larger with an increase in the type of ISS (p < 0.0001). The rostral third SSS hypoplasia was observed in all cases of Type 3. The hypoplasia of the rostral third SSS and development of the ISS were strongly correlated and complementary to each other. CONCLUSION This study provided the angiographic ISS classification, and our proposed angiographic ISS classification could be helpful in better understanding of the ISS anatomy and its venous drainage pattern.
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Affiliation(s)
- Bikei Ryu
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tatsuki Mochizuki
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Shogo Shima
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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Falcine meningiomas. HANDBOOK OF CLINICAL NEUROLOGY 2021; 170:101-106. [PMID: 32586481 DOI: 10.1016/b978-0-12-822198-3.00032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Falcine meningiomas (FMs) are defined as meningiomas arising from the falx, covered by the overlying brain parenchyma, and not involving the superior sagittal sinus (SSS). FMs together with parasagittal meningiomas represent the second most common location of intracranial meningioma. Clinical presentation depends on the dimensions and location of the FM. Surgery for FM removal deserves several considerations related to bridging veins, anterior cerebral artery branches, arterial feeders, SSS involvement, FM locations, and FM dimensions. In this chapter the principal aspects influencing surgical strategy are analyzed together with approaches and management.
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Yu G, Wang X, Zhang X, Quan K, Hua W, Yang Z, Li P, Liu P, Song J, Zhu W. Gravity-Assisted Ipsilateral Paramedian Approach for Parafalcine Meningioma Resection. World Neurosurg 2020; 135:234-240. [DOI: 10.1016/j.wneu.2019.12.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
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