1
|
Li C, Qin J, Xue F, Shen Z, Lin Q, Xue Y, Chen X. Rethinking the effects of adjuvant beam radiation therapy on overall survival in atypical meningioma patients: age considerations. Front Neurol 2024; 15:1360741. [PMID: 38560728 PMCID: PMC10978650 DOI: 10.3389/fneur.2024.1360741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background This study aimed to investigate the effects of adjuvant beam radiation therapy (ABRT) on overall survival (OS) in patients with primary single intracranial atypical meningioma (AM), with a focus on age-related outcomes. Methods We conducted a retrospective study using data from SEER database. Our cohort consisted of patients diagnosed with a primary single intracranial AM tumor and had undergone surgery. The primary endpoint was OS. For survival analysis, univariable and multivariable Cox regression analysis were performed. A multivariable additive Cox model was used to assess the functional relationship between age and OS in patients with or without ABRT. Results Of the 2,759 patients included, 1,650 underwent gross total resection and 833 received ABRT. Multivariable Cox analysis indicated that ABRT did not significantly influence OS across the entire cohort. According to the multivariable generalized additive Cox model, the relative risk of all-cause mortality increased with advancing age in both ABRT-yes and ABRT-no group. ABRT-yes had a lower relative risk than ABRT-no when age ≤ 55 years old while a higher relative risk when age > 55 years old. Subsequent multivariable Cox analysis showed that ABRT was associated with a significant lower risk for all-cause mortality in patients with age ≤ 55 years old while a significant higher risk in patients with age > 55 years old. Conclusion Our study found that ABRT enhanced OS in younger primary single intracranial AM patients. But we also revealed a negative correlation between OS and ABRT in older patients.
Collapse
Affiliation(s)
- Chao Li
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiajun Qin
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fei Xue
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhaoli Shen
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi Lin
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yajun Xue
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianzhen Chen
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
2
|
AlKhoshi AM, AlZahrani AA, Shawli FS, AlJabri AA, AlAnsari AH, Alshuqayfi K, AlSaadi RM, AlYousef MA. Prognostic Factors Affecting Postsurgical Outcomes of Adult Patients with Intracranial Meningioma: A Retrospective Study. World Neurosurg 2023; 180:e281-e287. [PMID: 37741331 DOI: 10.1016/j.wneu.2023.09.055] [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: 06/29/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE To identify the prognostic factors of surgical resection for meningioma and their relationship with patient outcomes. METHODS This retrospective study included 53 patients (≥16 years), who underwent surgical resection for intracranial meningioma at the King Abdulaziz University Hospital from 2012 to 2022. Data regarding tumor location and size, histopathological type, chief complaint, chief complaint duration, admission date, diagnosis, operation, and discharge date were collected. These data were subjected to univariate and bivariate analyses to investigate the relationship between the postsurgical outcomes of the patients with meningioma and the variables of age at surgery, sex, length of hospitalization, chief complaint, Glasgow outcome score, World Health Organization histopathological classification, body mass index, tumor size, and nature of surgical resection. RESULTS The mean age of our study cohort was 49.09 ± 12.64 years, with a female preponderance (75.5%) and mean body mass index of 29.31 ± 5.52 kg/m2. length of hospitalization (mean: 26.92 ± 54.88 days) demonstrated a significant (P = 0.012) impact on prognosis after surgery. In addition, convexity meningiomas (21.2%), which were observed in the maximum number of cases, and mean tumor volume (28.67 ± 48.85 mm) were significantly (P = 0.049) associated with the outcome. Most patients (78.8%) underwent total surgical resection, and histopathological examinations revealed a higher frequency of grade 1 than grade 2 tumors. CONCLUSIONS Short duration of hospitalization and superficial location of the tumor are associated with optimal outcomes after surgical resection for patients with meningioma.
Collapse
Affiliation(s)
- Abdulaziz M AlKhoshi
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Abdulaziz A AlZahrani
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faris S Shawli
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A AlJabri
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulwahab H AlAnsari
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid Alshuqayfi
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Raad M AlSaadi
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed A AlYousef
- Division of Neurosurgery, Department of Surgery, Assistant professor, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
3
|
Maiuri F, Corvino S, Lorenzetti M, Franca RA, Esposito F, Del Basso De Caro M. Intracranial Meningiomas in Patients Aged ≥80 Years: Pathological Features and Surgical Problems. World Neurosurg 2023; 173:e498-e508. [PMID: 36841531 DOI: 10.1016/j.wneu.2023.02.086] [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: 01/16/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Patients aged >80 years frequently have intracranial meningiomas. In the present study, we have discussed the pathological features, comorbidities, and surgical complications for this age group from a surgical series and literature review. METHODS In the present study, we reviewed a surgical series of 354 intracranial meningiomas and compared the oldest age group (age, ≥80 years) of 17 patients with 73 patients aged 70-79 years and 264 patients aged <70 years. From a literature review, we selected 10 studies of meningiomas in patients aged ≥80 years. The analyzed factors included sex, meningioma location, World Health Organization grade, Ki-67 MIB1, progesterone receptor expression, comorbidities, American Society of Anesthesiologists class, Karnofsky performance scale score, postoperative complications, and death. RESULTS Patients aged ≥80 years had had higher rates of World Health Organization grade II meningioma, higher rates of Ki-67 expression of >4% and <20%, and progesterone receptor expression <15%. Of the postoperative complications, only neurological deficits and acute bronchopneumonia were significantly more frequent in patients aged ≥80 years. The incidence of intracerebral hematoma, lung embolism, acute heart ischemia, and death were not significantly different between the patients aged ≥80 years and those aged 70-79 years and <70 years. CONCLUSIONS Patients aged ≥80 years must be considered a true elderly group with higher rates of comorbidities. The very old age is not a limitation to surgery; however, careful patient selection is necessary. In addition, for the oldest age group, the surgical decision should not be delayed because of advancing age.
Collapse
Affiliation(s)
- Francesco Maiuri
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy.
| | - Sergio Corvino
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Marco Lorenzetti
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Raduan Ahmed Franca
- Department of Advanced Biomorphological Sciences, Section of Pathology, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Felice Esposito
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomorphological Sciences, Section of Pathology, School of Medicine, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
4
|
Combined Exoscopic and Endoscopic Two-Step Keyhole Approach for Intracranial Meningiomas. Curr Oncol 2022; 29:5370-5382. [PMID: 36005164 PMCID: PMC9406588 DOI: 10.3390/curroncol29080426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
The advantages of neuroendoscopic surgery are the wide viewing angle and the freedom of an axis of view with minimal surgical trauma. With the advent of the exoscope, which has similar advantages to endoscopy, such as a small body and ergonomically superior heads-up surgery, it has become possible to add a field of view that is similar to that of microsurgery to endoscopic surgery. By taking advantage of the features of these scopes, we report the usefulness of the minimally invasive combined exoscopic and endoscopic two-step keyhole approach (EEKA) for various types of meningiomas. We reviewed data from 34 consecutive cases of EEKA for various types of intracranial meningiomas compared with that of conventional microsurgery. All of the tumors were resected as planned without severe complications. Significantly better outcome data were obtained in terms of the blood loss and the surgical time in the EEKA group, in addition to the craniotomy size. The well-illuminated fine vision in the deep corners by the endoscope enabled radical resection of the tumors with minimum burden on the patients. This technique has the potential for minimally invasive surgery in intracranial meningioma patients, including the older population.
Collapse
|
5
|
Picart T, Dumot C, Guyotat J, Pavlov V, Streichenberger N, Vasiljevic A, Fenouil T, Durand A, Jouanneau E, Ducray F, Jacquesson T, Berhouma M, Meyronet D. Clinical and pathological impact of an optimal assessment of brain invasion for grade 2 meningioma diagnosis: lessons from a series of 291 cases. Neurosurg Rev 2022; 45:2797-2809. [PMID: 35488071 DOI: 10.1007/s10143-022-01792-6] [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: 01/10/2022] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
Brain invasion has not been recognized as a standalone criterion for atypical meningioma by the WHO classification until 2016. Since the 2007 edition suggested that meningiomas harboring brain invasion could be classified as grade 2, brain invasion study was progressively strengthened in our center, based on a strong collaboration between neurosurgeons and neuropathologists regarding sample orientation and examination. Practice changes were considered homogeneous enough in 2011. The aim of the present study was to evaluate the impact of gross practice change on the clinical and pathological characteristics of intracranial meningiomas classified as grade 2.The characteristics of consecutive patients with a grade 2 meningioma surgically managed before (1998-2005, n = 125, group A) and after (2011-2014, n = 166, group B) practices changed were retrospectively reviewed.Sociodemographical and clinical parameters were comparable in groups A and B, and the median age was 62 years in both groups (p = 0.18). The 5-year recurrence rates (23.2% vs 29.5%, p = 0.23) were similar. In group A, brain invasion was present in 48/125 (38.4%) cases and was more frequent than in group B (14/166, 8.4%, p < 0.001). In group A, 33 (26.4%) meningiomas were classified as grade 2 solely based on brain invasion (group ASBI), and 92 harbored other grade 2 criteria (group AOCA). Group ASBI meningiomas had a similar median progression-free survival compared to groups AOCA (68 vs 80 months, p = 0.24) and to AOCA and B pooled together (n = 258, 68 vs 90 months, p = 0.42).An accurate assessment of brain invasion is mandatory as brain invasion is a strong predictor of meningioma progression.
Collapse
Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France. .,Claude Bernard University, Lyon 1, Lyon, France. .,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.
| | - Chloé Dumot
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - Jacques Guyotat
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France
| | - Vladislav Pavlov
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France
| | - Nathalie Streichenberger
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France.,CNRS UMR 5310 - INSERM U1217, Institut NeuroMyogène, Lyon, France
| | - Alexandre Vasiljevic
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Tanguy Fenouil
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Anne Durand
- Department of Neurosurgery, Medipole Lyon Villeurbanne MHP, Villeurbanne, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CNRS UMR5286, Inserm U1052, Cancer Research Center of Lyon, Lyon, France
| | - François Ducray
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Neurooncology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Timothée Jacquesson
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,Laboratory of Anatomy, Faculty of Medicine Lyon Est, University Claude Bernard Lyon 1, Lyon, France
| | - Moncef Berhouma
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CREATIS Laboratory, Inserm U1206, UMR 5220, Université de Lyon, Villeurbanne, France
| | - David Meyronet
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| |
Collapse
|
6
|
Liu F, Tang X, Wang X, Chen J, Zhou L. High-grade meningiomas in octogenarian and elderly patients: A population-based SEER analysis. J Clin Neurosci 2021; 89:165-170. [PMID: 34119263 DOI: 10.1016/j.jocn.2021.04.041] [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: 08/31/2020] [Revised: 12/30/2020] [Accepted: 04/30/2021] [Indexed: 02/08/2023]
Abstract
Knowledge on high-grade meningiomas in octogenarian and elderly patients is limited. We aimed to analyze the outcomes and identify factors that influence overall survival (OS) in this population, using data from the Surveillance, Epidemiology, and End Results (SEER) database.Patients (≥80 years old) diagnosed with high-grade meningiomas between 1990 and 2016 were retrieved from the SEER database. According to treatments received, patients were classified into three groups: observation, radiation only, and surgery (with or without radiation). A Cox proportional hazards regression model was used for univariate and multivariate analyses. Based on the inclusion criteria, 678 patients with high-grade meningiomas were included.Surgery was the most common treatment modality. The median OS was 32 months for patients who received surgery, compared with 20 months for observation (p = 0.001).The factors significantly associated with OS on multivariate analysis included increasing age (hazard ratio [HR] 1.353, p < 0.001), diagnosis after 2008 (HR 0.693, p = 0.022), and surgical treatment (HR 0.807, p = 0.028). Further analysis revealed increasing age (HR 1.451, p = 0.003), and subtotal resection (HR 1.275, p = 0.043) were significantly associated with worse OS following surgery. This is the largest clinical study of high-grade meningiomas in octogenarian and elderly patients conducted thus far. Age, treatment modality, and year of diagnosis were associated with OS in octogenarian and elderly patients with high-grade meningiomas. Patients who received subtotal resection had a worse prognosis than gross total resection.
Collapse
Affiliation(s)
- Fujun Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyu Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
7
|
Meningioma Surgery in Patients ≥70 Years of Age: Clinical Outcome and Validation of the SKALE Score. J Clin Med 2021; 10:jcm10091820. [PMID: 33922009 PMCID: PMC8122404 DOI: 10.3390/jcm10091820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Along with increasing average life expectancy, the number of elderly meningioma patients has grown proportionally. Our aim was to evaluate whether these specific patients benefit from surgery and to investigate a previously published score for decision-making in meningioma patients (SKALE). Of 421 patients who underwent primary intracranial meningioma resection between 2009 and 2015, 71 patients were ≥70 years of age. We compared clinical data including World Health Organization (WHO) grade, MIB-1 proliferation index, Karnofsky Performance Status Scale (KPS), progression free survival (PFS) and mortality rate between elderly and all other meningioma patients. Preoperative SKALE scores (Sex, KPS, ASA score, location and edema) were determined for elderly patients. SKALE ≥8 was set for dichotomization to determine any association with outcome parameters. In 71 elderly patients (male/female 37/34) all data were available. Postoperative KPS was significantly lower in elderly patients (p < 0.0001). Pulmonary complications including pneumonia (10% vs. 3.2%; p = 0.0202) and pulmonary embolism (12.7% vs. 6%; p = 0.0209) occurred more frequently in our elderly cohort. Analyses of the Kaplan Meier curves revealed differences in three-month (5.6% vs. 0.3%; p = 0.0033), six-month (7% vs. 0.3%; p = 0.0006) and one-year mortality (8.5% vs. 0.3%; p < 0.0001) for elderly patients. Statistical analysis showed significant survival benefit in terms of one-year mortality for elderly patients with SKALE scores ≥8 (5.1 vs. 25%; p = 0.0479). According to our data, elderly meningioma patients face higher postoperative morbidity and mortality than younger patients. However, resection is reasonable for selected patients, particularly when reaching a SKALE score ≥ 8.
Collapse
|
8
|
Predictors of Survival in Subtotally Resected WHO Grade I Skull Base Meningiomas. Cancers (Basel) 2021; 13:cancers13061451. [PMID: 33810089 PMCID: PMC8004937 DOI: 10.3390/cancers13061451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although gross total resection (GTR) is the goal in meningioma surgery, this can sometimes be difficult to achieve in skull base meningiomas. We analyzed clinical outcomes and predictors of survival for subtotally resected benign meningiomas. METHODS A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between 1990-2010 were investigated. RESULTS Median age was 57.7 [IQR 18.8] years, median preoperative Karnofsky performance status (KPS) was 80.0 [IQR 20.0], 75 patients (35.4%) had posterior fossa meningioma. After a median follow-up of 6.2 [IQR 7.9] years, retreatment (either radiotherapy or repeated surgery) rate was 16% at 1-year, 27% at 3-years, 34% at 5-years, and 38% at 10-years. Ten patients (4.7%) died perioperatively, 9 (3.5%) had postoperative hematomas, and 2 (0.8%) had postoperative infections. Neurological outcome at final visit was improved/stable in 122 patients (70%). Multivariable analysis identified advanced age and preoperative KPS < 70 as negative predictors for overall survival (OS). Patients who underwent retreatment had no significant reduction of OS. CONCLUSIONS Advanced age and preoperative KPS were independent predictors of OS. Retreatments did not prolong nor shorten the OS. Clinical outcomes in STR skull base meningiomas were generally worse compared to cohorts with high rates of GTR.
Collapse
|
9
|
Guo H, Liang H, Wang J, Wen S, Wang Y, Wang Y, Ma Z. Giant Intraparenchymal Meningioma in a Female Child: Case Report and Literature Review. Cancer Manag Res 2021; 13:1989-1997. [PMID: 33658857 PMCID: PMC7920497 DOI: 10.2147/cmar.s294224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Intraparenchymal meningiomas without dural attachment are extremely rare, especially in female children. To our knowledge, fibrous intraparenchymal meningioma located in the temporal lobe has never been reported in female children. The significance in the differential diagnosis of lesions in the temporal lobe should be emphasized. CASE PRESENTATION A 12-year-old girl was admitted to our hospital, complaining of recurrent generalized seizures for 2 months. Magnetic resonance imaging demonstrated a solid lesion located in the temporal lobe. The lesion underwent gross total resection. Histopathological examination indicated that the lesion was a fibrous meningioma. Postoperative rehabilitation was uneventful. CONCLUSION This case report presents an extremely unusual intraparenchymal fibrous meningioma of the temporal lobe with peritumoral edema and reviewed 21 intraparenchymal meningioma cases in children and to discuss the clinical presentation and treatment, differential diagnosis, and radiological features.
Collapse
Affiliation(s)
- Huachao Guo
- Department of Neurosurgery, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Hao Liang
- Department of Neurosurgery, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Jiaguang Wang
- Department of Neurosurgery, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Shuo Wen
- Department of Neurosurgery, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Yong Wang
- Department of Neurosurgery, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Yushe Wang
- Department of Neurosurgery, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Zhen Ma
- Department of Neurosurgery, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| |
Collapse
|
10
|
Sá-Marta E, Alves JL, Rebelo O, Barbosa M. World Health Organization Grade III Meningiomas: A Retrospective Study at an Academic Medical Center. World Neurosurg 2021; 149:e877-e893. [PMID: 33516862 DOI: 10.1016/j.wneu.2021.01.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Meningiomas are the most common primary brain tumors and are generally considered benign. However, a rare subgroup of meningiomas, classified as World Health Organization (WHO) grade III meningiomas, can show extremely aggressive behavior and high rates of recurrence. Despite ongoing research, data on the clinical outcome of this subgroup of meningiomas are still limited. METHODS Medical records of patients with WHO grade III meningiomas diagnosed between 2000 and 2018 at the Coimbra University Hospital Center were retrospectively reviewed and several variables of interest and their relation to patients' survival were analyzed. RESULTS Of the 26 patients included in the final analysis, 23 had anaplastic meningiomas, 2 had papillary meningiomas, and 1 had a rhabdoid meningioma. Median overall survival and median progression-free survival were 2.45 and 1.22 years, respectively. Overall survival at 1, 2 and 5 years was 73%, 57%, and 35%, respectively. Adjuvant radiotherapy correlated with improved survival for subtotally resected meningiomas but not for gross totally resected meningiomas. There was a trend toward improved overall survival with gross total resection versus subtotal resection, but this difference failed to reach statistical significance. CONCLUSIONS This study provides insight into the clinical outcomes of WHO grade III meningiomas and suggests that adjuvant radiotherapy may not be beneficial for patients who underwent gross total resection. This rare subset of meningiomas still portends a devastating prognosis and the impact of extent of resection and adjuvant therapies in these patients needs further clarification.
Collapse
Affiliation(s)
- Eduarda Sá-Marta
- Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - José Luís Alves
- Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Olinda Rebelo
- Neuropathology Laboratory, Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marcos Barbosa
- Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| |
Collapse
|
11
|
Amano T, Nakamizo A, Michiwaki Y, Matsuo S, Fujioka Y, Nagata S. Surgical outcome in elderly patients with intracranial meningioma. J Clin Neurosci 2018; 56:63-66. [PMID: 30031568 DOI: 10.1016/j.jocn.2018.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/11/2018] [Accepted: 07/08/2018] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine the utility of surgical management of intracranial meningioma in elderly patients. A total of 138 patients with intracranial meningiomas who underwent surgery from 2008 to 2017 were divided into elderly (≥75 years old, n = 34) and younger (<75 years old, n = 104) groups. Clinical and radiological data were retrospectively analyzed. Total tumor removal was achieved in 79% of elderly patients, which was similar to that in young patients (85%, p = .81). The average preoperative Karnofsky performance scale score in elderly patients was significantly lower than that in young patients (70.6 vs. 90.4, respectively; p < .0001). However, the average change in the Karnofsky performance scale score after surgery was similar between the two groups (0.3 vs. -0.4, respectively; p = .36). Histopathological grading revealed that the incidence of malignant meningioma (World Health Organization grades II and III) was significantly higher in elderly patients than that in young patients (44% vs. 14%, respectively; p = .004). Among meningiomas showing chronological progression, World Health Organization grade II and III meningiomas accounted for 67% of tumors in elderly patients, but only 23% in younger patients (p = .01). These data suggest that surgical removal of meningiomas may be a safe and useful treatment strategy in elderly patients.
Collapse
Affiliation(s)
- Toshiyuki Amano
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - Akira Nakamizo
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yuhei Michiwaki
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Matsuo
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yutaka Fujioka
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shinji Nagata
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| |
Collapse
|
12
|
Brokinkel B, Hess K, Mawrin C. Brain invasion in meningiomas-clinical considerations and impact of neuropathological evaluation: a systematic review. Neuro Oncol 2018; 19:1298-1307. [PMID: 28419308 DOI: 10.1093/neuonc/nox071] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
With the release of the 2016 edition of the World Health Organization (WHO) Classification of Central Nervous System Tumors, brain invasion in meningiomas has been added as a stand-alone criterion for atypia and can therefore impact grading and indirectly adjuvant therapy. Regarding this rising clinical importance, we have reviewed the current knowledge about brain invasion with emphasis on its implications on current and future clinical practice. We found various definitions of brain invasion and approaches for evaluation in surgically obtained specimens described over the past decades. This heterogeneity is reflected by weak correlation with prognosis and remains controversial. Similarly, associated clinical factors are largely unknown. Preoperative, imaging-guided detection of brain invasion is unspecific, and intraoperative assessment using standard and new high-magnification microscopic techniques remains imprecise. Despite the increasing knowledge about molecular alterations of the tumor/ brain surface, pharmacotherapeutic options targeting brain invasive meningiomas are lacking. Finally, we summarize the impact of brain invasion on histopathological grading in the WHO classifications of brain tumors since 1979.In conclusion, standardized neurosurgical sampling and neuropathological analyses could improve diagnostic reliability and reproducibility of future studies. Further research is needed to improve pre- and intraoperative visualization of brain invasion and to develop adjuvant, targeted therapies.
Collapse
Affiliation(s)
- Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany; Institute of Neuropathology, University Hospital Münster, Münster, Germany; Institute of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Katharina Hess
- Department of Neurosurgery, University Hospital Münster, Münster, Germany; Institute of Neuropathology, University Hospital Münster, Münster, Germany; Institute of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Christian Mawrin
- Department of Neurosurgery, University Hospital Münster, Münster, Germany; Institute of Neuropathology, University Hospital Münster, Münster, Germany; Institute of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| |
Collapse
|
13
|
Dobran M, Marini A, Nasi D, Liverotti V, Benigni R, Iacoangeli M, Scerrati M. Surgical treatment and outcome in patients over 80 years old with intracranial meningioma. Clin Neurol Neurosurg 2018. [PMID: 29518711 DOI: 10.1016/j.clineuro.2018.02.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Study of mortality rate and clinical outcomes in octogenarians patients operated for intracranial meningiomas. PATIENTS AND METHODS Clinical, radiological and surgical data of 25 elderly patients aging over 80 years old operated at our Department from 2013 to 2016 for intracranial meningiomas have been recorded and analyzed. One-month mortality and clinical outcome at six-months after surgery were evaluated. Logistic regression was used for detecting the risk factors influencing mortality and neurological functions. RESULTS The median age at diagnosis was 8185 years (range 80-87). Meningiomas were gross-total removed in 18 cases out of 25 (72%) and partially resected in 7 (28%). One-month post-operative mortality occurred in 2 pts out of 25 (8%). A close correlation was found between operative duration over 240 min and mortality (p = 0,0421). There was a significantly lower mortality in patients with ASA II rather than in patients with ASA III (p = 0,038). The median pre-operative KPS value was 743 (range 50-90) while at six-month follow-up was 82. The surgical time (p = 00,006) and size of the lesion >4 cm (p = 002) were a significant prognostic factors for clinical improvement at six-month follow-up. CONCLUSIONS The operative time and the ASA score are the most important prognostic factors for the mortality and neurological outcome of elderly patients over 80 years old operated for intracranial meningioma. Even if the number of patients is limited, our findings suggest that, after a careful preoperative stratification in elderly patients, it is possible to remove an intracranial meningioma with good results.
Collapse
Affiliation(s)
- Mauro Dobran
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy.
| | - Alessandra Marini
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Valentina Liverotti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Roberta Benigni
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Scerrati
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
14
|
Huntoon K, Pluto CP, Ruess L, Boué DR, Pierson CR, Rusin JA, Leonard J. Sporadic pediatric meningiomas: a neuroradiological and neuropathological study of 15 cases. J Neurosurg Pediatr 2017; 20:141-148. [PMID: 28548617 DOI: 10.3171/2017.3.peds16502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sporadic meningiomas have been classified in many different ways. Radiographically, these lesions can be described as occurring in either typical or atypical locations. The purpose of this study was to determine if there are any histopathological differences between sporadic meningiomas that arise in these varying locations in children. METHODS The neuroimaging, histopathological findings, and clinical records in patients with sporadic pediatric meningiomas not associated with neurofibromatosis Type 2 or prior radiation therapy were retrospectively reviewed. Tumors were classified by radiological findings as either typical or atypical, and they were categorized histopathologically by using the latest WHO nomenclature and grading criteria. RESULTS Fifteen sporadic meningiomas in pediatric patients were biopsied or resected at the authors' institution between 1989 and 2013. Five (33%) were typical in radiographic appearance and/or location and 10 (67%) were atypical. Four (80%) typical meningiomas were WHO Grade I tumors. Most (60%) of the atypical meningiomas were WHO Grade II or III. CONCLUSIONS This study is the largest series of sporadic pediatric meningiomas in atypical locations to date. Although sporadic meningiomas are relatively infrequent in children, those with atypical imaging, specifically those with apparently intraparenchymal and intraosseous locations, may be more common than previously recognized. In this study, pediatric sporadic meningiomas arising in atypical locations, in particular intraparenchymal meningiomas, may be of higher histopathological grade. The authors' findings should alert clinicians to the potential for more aggressive clinical behavior in these tumors.
Collapse
Affiliation(s)
| | | | | | - Daniel R Boué
- Pathology, The Ohio State University Wexner Medical Center; Departments of.,Pathology and Laboratory Medicine, and
| | - Christopher R Pierson
- Pathology, The Ohio State University Wexner Medical Center; Departments of.,Pathology and Laboratory Medicine, and.,Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio; and
| | | | - Jeffrey Leonard
- Departments of 1 Neurological Surgery.,Neurosurgery, Nationwide Children's Hospital; and
| |
Collapse
|
15
|
Brokinkel B, Holling M, Spille DC, Heß K, Sauerland C, Bleimüller C, Paulus W, Wölfer J, Stummer W. Surgery for meningioma in the elderly and long-term survival: comparison with an age- and sex-matched general population and with younger patients. J Neurosurg 2017; 126:1201-1211. [DOI: 10.3171/2016.2.jns152611] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The purpose of this study was to compare long-term prognosis after meningioma surgery in elderly and younger patients as well as to compare survival of elderly patients with surgically treated meningioma to survival rates for the general population.
METHODS
Five hundred meningioma patients (median follow-up 90 months) who underwent surgery between 1994 and 2009 were subdivided into “elderly” (age ≥ 65 years, n = 162) and “younger” (age < 65 years, n = 338) groups for uni- and multivariate analyses. Mortality was compared with rates for the age- and sex-matched general population.
RESULTS
The median age at diagnosis was 71 in the elderly group and 51 years in the younger group. Sex, intracranial tumor location, grade of resection, radiotherapy, and histopathological subtypes were similar in the 2 groups. High-grade (WHO Grades II and III) and spinal tumors were more common in older patients than in younger patients (15% vs 8%, p = 0.017, and 12% vs 4%, p = 0.001, respectively). The progression-free interval (PFI) was similar in the 2 groups, whereas mortality at 3 months after surgery was higher and median overall survival (OS) was shorter in older patients (7%, 191 months) than in younger patients (1%, median not reached; HR 4.9, 95% CI 2.75–8.74; p < 0.001). Otherwise, the median OS in elderly patients did not differ from the anticipated general life expectancy (HR 1.03, 95% CI 0.70–1.50; p = 0.886). Within the older patient group, PFI was lower in patients with high-grade meningiomas (HR 24.74, 95% CI 4.23–144.66; p < 0.001) and after subtotal resection (HR 10.57, 95% CI 2.23–50.05; p = 0.003). Although extent of resection was independent of perioperative mortality, the median OS was longer after gross-total resection than after subtotal resection (HR 2.7, 95% CI 1.09–6.69; p = 0.032).
CONCLUSIONS
Elderly patients with surgically treated meningioma do not suffer from impaired survival compared with the age-matched general population, and their PFI is similar to that of younger meningioma patients. These data help mitigate fears concerning surgical treatment of elderly patients in an aging society.
Collapse
Affiliation(s)
| | | | | | - Katharina Heß
- 2Institute of Neuropathology, University Hospital Münster; and
| | | | - Caroline Bleimüller
- 4Department of Clinical Radiology, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Werner Paulus
- 2Institute of Neuropathology, University Hospital Münster; and
| | | | | |
Collapse
|
16
|
Fountain DM, Soon WC, Matys T, Guilfoyle MR, Kirollos R, Santarius T. Volumetric growth rates of meningioma and its correlation with histological diagnosis and clinical outcome: a systematic review. Acta Neurochir (Wien) 2017; 159:435-445. [PMID: 28101641 PMCID: PMC5306174 DOI: 10.1007/s00701-016-3071-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/28/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Tumour growth has been used to successfully predict progression-free survival in low-grade glioma. This systematic review sought to establish the evidence base regarding the correlation of volumetric growth rates with histological diagnosis and potential to predict clinical outcome in patients with meningioma. METHODS This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Databases were searched for full text English articles analysing volumetric growth rates in patients with a meningioma. RESULTS Four retrospective cohort studies were accepted, demonstrating limited evidence of significantly different tumour doubling rates and shapes of growth curves between benign and atypical meningiomas. Heterogeneity of patient characteristics and timing of volumetric assessment, both pre- and post-operatively, limited pooled analysis of the data. No studies performed statistical analysis to demonstrate the clinical utility of growth rates in predicting clinical outcome. CONCLUSION This systematic review provides limited evidence in support of the use of volumetric growth rates in meningioma to predict histological diagnosis and clinical outcome to guide future monitoring and treatment.
Collapse
Affiliation(s)
- Daniel M Fountain
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | | | - Tomasz Matys
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mathew R Guilfoyle
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ramez Kirollos
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Santarius
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
17
|
Ohba S, Abe M, Hasegawa M, Hirose Y. Intraparenchymal Meningioma: Clinical, Radiologic, and Histologic Review. World Neurosurg 2016; 92:23-30. [DOI: 10.1016/j.wneu.2016.04.098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022]
|
18
|
Spille DC, Heß K, Sauerland C, Sanai N, Stummer W, Paulus W, Brokinkel B. Brain Invasion in Meningiomas: Incidence and Correlations with Clinical Variables and Prognosis. World Neurosurg 2016; 93:346-54. [PMID: 27344043 DOI: 10.1016/j.wneu.2016.06.055] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In meningioma, correlation of brain invasion with prognosis and clinical variables remains controversial. METHODS Correlation of brain invasion with clinical and histopathologic variables was investigated in 467 patients with primary intracranial meningioma. RESULTS Diffuse (n = 3; 10%), clusterlike (n = 11; 34%) or fingerlike (n = 18; 56%) invasion was detected in 32 patients (7%). Brain invasion was more common in males than in females (13% vs. 5%; odds ratio, 2.75; 95% confidence interval, 1.29-5.89; P = 0.009) and pattern of invasion differed between genders (P = 0.037). Brain invasion was absent in 401 benign meningiomas and present in 48% of 60 atypical (n = 29) and 50% of 6 anaplastic (n = 3) meningiomas (P < 0.001) but was independent of tumor location and extent of resection. Progression occurred in 11% and was more frequent (31% vs. 15%; P = 0.036) in invasive than in noninvasive tumors, but only after gross total resection and in univariate analyses, and independent of invasion pattern. In atypical meningiomas, frequency of adjuvant irradiation was similar comparing invasive and noninvasive tumors and grading solely based on brain invasion (n = 20; 33%), other World Health Organization (WHO) criteria (n = 31; 52%) or a combination of both (n = 9; 15%). Risk of recurrence was lower (hazard ratio, 0.258, 95% confidence interval, 0.09-0.734; P = 0.011) when grading exclusively based on brain invasion than when further WHO criteria were in addition present and the progression-free interval among the first was similar to benign tumors. CONCLUSIONS Brain invasion and its patterns are correlated to gender. In contrast to the current WHO classification, invasion was associated with recurrence only after gross total resection and not independent of further histopathologic criteria of atypia.
Collapse
Affiliation(s)
| | - Katharina Heß
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University Hospital Münster, Münster, Germany
| | - Nader Sanai
- Barrow Brain Tumor Research Center, Barrow Neurological Institute, 350 West Thomas Rd, Phoenix, Arizona, USA
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany.
| |
Collapse
|