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Trakolis L, Petridis AK. Interdisciplinary Therapeutic Approaches to Atypical and Malignant Meningiomas. Cancers (Basel) 2023; 15:4251. [PMID: 37686527 PMCID: PMC10486693 DOI: 10.3390/cancers15174251] [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: 06/20/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Meningiomas have the highest incidence among brain tumors. In contrast to benign tumors that constitute the majority of this tumor entity, the treatment of aggressive meningiomas (WHO Grade 2 and 3) is more challenging, requiring gross total removal of the tumor and the affected dura and adjuvant radiotherapy. Sometimes the location and/or the configuration of the tumor do not favor radical surgical resection without endangering the patient's clinical condition after surgery and pharmacological therapy has, until now, not been proven to be a reliable alternative. Discussion: In this narrative review, we discuss the current literature with respect to the management of meningiomas, discussing the importance of the grade of resection in the overall prognosis of the patient and in the planning of adjuvant therapy. Conclusions: According to the location and size of the tumor, radical resection should be taken into consideration. In patients with aggressive meningiomas, adjuvant radiotherapy should be performed after surgery. In cases of skull base meningiomas, a maximal, though safe, resection should take place before adjuvant therapy. An interdisciplinary approach is beneficial for patients with primary or recurrent meningioma.
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Affiliation(s)
- Leonidas Trakolis
- Department of Neurosurgery, Agios Loukas Clinic Thessaloniki, 55236 Thessaloniki, Greece;
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Evaluating diagnostic accuracy and determining optimal diagnostic thresholds of different approaches to [ 68Ga]-DOTATATE PET/MRI analysis in patients with meningioma. Sci Rep 2022; 12:9256. [PMID: 35661809 PMCID: PMC9166786 DOI: 10.1038/s41598-022-13467-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple approaches with [68Ga]-DOTATATE, a somatostatin analog PET radiotracer, have demonstrated clinical utility in evaluation of meningioma but have not been compared directly. Our purpose was to compare diagnostic performance of different approaches to quantitative brain [68Ga]-DOTATATE PET/MRI analysis in patients with suspected meningioma recurrence and to establish the optimal diagnostic threshold for each method. Patients with suspected meningioma were imaged prospectively with [68Ga]-DOTATATE brain PET/MRI. Lesions were classified as meningiomas and post-treatment change (PTC), using follow-up pathology and MRI as reference standard. Lesions were reclassified using the following methods: absolute maximum SUV threshold (SUV), SUV ratio (SUVR) to superior sagittal sinus (SSS) (SUVRsss), SUVR to the pituitary gland (SUVRpit), and SUVR to the normal brain parenchyma (SUVRnorm). Diagnostic performance of the four methods was compared using contingency tables and McNemar’s test. Previously published pre-determined thresholds were assessed where applicable. The optimal thresholds for each method were identified using Youden’s J statistics. 166 meningiomas and 41 PTC lesions were identified across 62 patients. SUV, SUVRsss, SUVRpit, and SUVRnorm of meningioma were significantly higher than those of PTC (P < 0.0001). The optimal thresholds for SUV, SUVRsss, SUVRpit, and SUVRnorm were 4.7, 3.2, 0.3, and 62.6, respectively. At the optimal thresholds, SUV had the highest specificity (97.6%) and SUVRsss had the highest sensitivity (86.1%). An ROC analysis of SUV, SUVRsss, SUVRpit, and SUVRnorm revealed AUC of 0.932, 0.910, 0.915, and 0.800, respectively (P < 0.0001). Developing a diagnostic threshold is key to wider clinical translation of [68Ga]-DOTATATE PET/MRI in meningioma evaluation. We found that the SUVRsss method may have the most robust combination of sensitivity and specificity in the diagnosis of meningioma in the post-treatment setting, with the optimal threshold of 3.2. Future studies validating our findings in different patient populations are needed to continue optimizing the diagnostic performance of [68Ga]-DOTATATE PET/MRI in meningioma patients. Trial registration: ClinicalTrials.gov Identifier: NCT04081701. Registered 9 September 2019. https://clinicaltrials.gov/ct2/show/NCT04081701.
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Ivanidze J, Roytman M, Skafida M, Kim S, Glynn S, Osborne JR, Pannullo SC, Nehmeh S, Ramakrishna R, Schwartz TH, Knisely JPS, Lin E, Karakatsanis NA. Dynamic 68Ga-DOTATATE PET/MRI in the Diagnosis and Management of Intracranial Meningiomas. Radiol Imaging Cancer 2022; 4:e210067. [PMID: 35275019 DOI: 10.1148/rycan.210067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose To evaluate dynamic gallium 68 (68Ga) tetraazacyclododecane tetraacetic acid octreotate (DOTATATE) brain PET/MRI as an adjunct modality in meningioma, enabling multiparametric standardized uptake value (SUV) and Patlak net binding rate constant (Ki) imaging, and to optimize static acquisition period. Materials and Methods In this prospective study (ClinicalTrials.gov no. NCT04081701, DOMINO-START), 68Ga-DOTATATE PET/MRI-derived time-activity curves (TACs) were measured in 84 volumes of interest in 19 participants (mean age, 63 years; range, 36-89 years; 13 women; 2019-2021) with meningiomas. Region- and voxel-specific Ki were determined using Patlak analysis with a validated population-based reference tissue TAC model built from an independent data set of nine participants. Mean and maximum absolute and relative-to-superior-sagittal-sinus SUVs were extracted from the entire 50 minutes (SUV50) and last 10 minutes (SUV10) of acquisition. SUV versus Ki Spearman correlation, SUV and Ki meningioma versus posttreatment-change Mann-Whitney U tests, and SUV50 versus SUV10 Wilcoxon matched-pairs signed rank tests were performed. Results Absolute and relative maximum SUV50 demonstrated a strong positive correlation with Patlak Ki in meningioma (r = 0.82, P < .001 and r = 0.85, P < .001, respectively) and posttreatment-change lesions (r = 0.88, P = .007 and r = 0.83, P = .02, respectively). Patlak Ki images yielded higher lesion contrast by mitigating nonspecific background signal. All SUV50 and SUV10 metrics differed between meningioma and posttreatment-change regions (P < .001). Within the meningioma group, SUV10 attained higher mean scores than SUV50 (P < .001). Conclusion Combined SUV and Patlak K i 68Ga-DOTATATE PET/MRI enabled multiparametric evaluation of meningioma, offering the potential to enhance lesion contrast with Ki imaging and optimize the SUV measurement postinjection window. Keywords: Molecular Imaging-Clinical Translation, Neuro-Oncology, PET/MRI, Dynamic, Patlak ClinicalTrials.gov registration no. NCT04081701 © RSNA, 2022.
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Affiliation(s)
- Jana Ivanidze
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Michelle Roytman
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Myrto Skafida
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Sean Kim
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Shannon Glynn
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Joseph R Osborne
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Susan C Pannullo
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Sadek Nehmeh
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Rohan Ramakrishna
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Theodore H Schwartz
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Jonathan P S Knisely
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Eaton Lin
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
| | - Nicolas A Karakatsanis
- From the Departments of Radiology (J.I., M.R., M.S., J.R.O., S.N., E.L., N.A.K.), Neurologic Surgery (S.C.P., R.R., T.H.S.), and Radiation Oncology (J.P.S.K.), NewYork-Presbyterian/Weill Cornell Medical Center, 515 E 71st St, S-120, New York, NY 10021; Weill Cornell Medical College, New York, NY (S.K., S.G.); and Department of Biomedical Engineering, Cornell University, Ithaca, NY (S.C.P.)
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Darshan HR, Patel BK, Singh A, Nair P, Poyuran R, Easwer HV. Simultaneous trigonal and spinal meningioma with varied histology: A rare case report. Surg Neurol Int 2021; 12:611. [PMID: 34992927 PMCID: PMC8720455 DOI: 10.25259/sni_1051_2021] [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: 10/15/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Meningioma is one of the most common neoplasms of the central nervous system. Multiple meningiomas without neurofibromatosis are not a usual occurrence. Intraventricular meningioma with spinal meningioma is rare and not been reported in the literature. Case Description: We report a case of a 63-year-old male with the left trigonal and spinal meningioma. Both the meningiomas were resected in different settings. The histological examination of tumors revealed to be of varied histology, that is, meningothelial and atypical meningioma, respectively. Conclusion: Although various cases with multiple cranial and spinal meningiomas are described, this is the first case of an intraventricular and spinal meningioma. With varied histology, the case also reaffirms the theory of polyclonal origin of multiple meningiomas.
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Affiliation(s)
- H. R. Darshan
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Biren Khimji Patel
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Ajit Singh
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - H. V. Easwer
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
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Colli BO, Machado HR, Carlotti CG, Assirati JA, Oliveira RSD, Gondim GGP, Santos ACD, Neder L. Epidemiological features of meningiomas: a single Brazilian center's experience with 993 cases. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:705-715. [PMID: 34550193 DOI: 10.1590/0004-282x-anp-2020-0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Meningiomas are the most frequent primary central nervous system (CNS) tumors. Their geographical and ethnic characteristics need to be known, in order to enable rational treatment. OBJECTIVE To investigate clinical and epidemiological aspects in a series of patients with meningiomas. METHODS Retrospective analysis on the demographic profile, location and histopathology of 993 patients with meningiomas (768 operated and 225 not operated). RESULTS Meningiomas represented 43.8% of the primary CNS tumors; 6.8% were multiple tumors (14.7% with neurofibromatosis 2) and 0.6% were radiation-induced tumors. The mean ages were 53.0 and 63.9 years for operated and non-operated patients and the female/male ratios were 3.2:1 and 6.3:1. Diagnosis was made later among females. The peak incidences were in the 6th and 7th decades respectively for operated and non-operated patients. The incidence was low at early ages and higher among patients aged 70+ years. The meningiomas were intracranial in 96.5% and most were WHO grade I (88.9%) and transitional. In the spinal canal (3.5%), they occurred mainly in the dorsal region (all grade I; mostly transitional). The racial distribution was 1.0% in Asian-Brazilians, 87% in Caucasians and 12% in African-Brazilians. 83.4% and 51.6% of the patients were estimated to be recurrence-free at 10 and 20 years, and the mortality rate was 3%. CONCLUSIONS Most of the demographic data were similar to what has been observed in other western centers. Differences were higher incidence of meningiomas, female and older predominance in non-operated patients, predominance in Caucasian, and higher association with neurofibromatosis 2.
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Affiliation(s)
- Benedicto Oscar Colli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil
| | - Hélio Rubens Machado
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil
| | - Carlos Gilberto Carlotti
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil
| | - João Alberto Assirati
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil
| | - Ricardo Santos De Oliveira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil
| | - Guilherme Gozzoli Podolsky Gondim
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil
| | - Antonio Carlos Dos Santos
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Imagem Médica, Hematologia e Oncologia Clínica, Ribeirão Preto SP, Brazil
| | - Luciano Neder
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Patologia, Ribeirão Preto SP, Brazil
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Hong CS, Erson-Omay EZ, Moliterno J. Multiple meningiomas arising within the same hemisphere associated with Li-Fraumeni syndrome. Surg Neurol Int 2021; 12:99. [PMID: 33880204 PMCID: PMC8053471 DOI: 10.25259/sni_125_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background: While meningiomas are some of the most common intracranial tumors, the presence of multiple ones at the time of presentation is rare and can most commonly be observed in patients with well-described syndromes (i.e., neurofibromatosis type 2) or those with prior cranial radiation history. In others, however, the pathophysiology remains unclear. Case Description: A 49-year-old female with no significant personal or familial oncologic medical history presented with a generalized seizure and was found to have ten meningiomas arising within the right hemisphere. She underwent a two-staged resection of all tumors, with pathology revealing the World Health Organization Grade I meningioma. Whole-exome sequencing revealed somatic NF2 mutations and heterozygous deletion of chromosome 22 overlapping with NF2, and analysis of the germline uncovered mutations of TP53, rendering a diagnosis of Li-Fraumeni Syndrome. Conclusions: This case represents a novel presentation of multiple meningiomas in a patient with newly diagnosed Li-Fraumeni syndrome, suggesting meningioma may be considered as part of this tumor-predisposed patient population.
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Affiliation(s)
- Christopher S Hong
- Department of Neurosurgery, Yale University School of Medicine, 20 York Street, LCI 8, New Haven, Connecticut, United States
| | - E Zeynep Erson-Omay
- Department of Neurosurgery, Yale University School of Medicine, 20 York Street, LCI 8, New Haven, Connecticut, United States
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale University School of Medicine, 20 York Street, LCI 8, New Haven, Connecticut, United States
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Multiple meningiomas: does quantity matter? a population-based survival analysis with underlined age and sex differences. J Neurooncol 2020; 149:413-420. [PMID: 32986140 DOI: 10.1007/s11060-020-03620-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/10/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Intracranial meningiomas rarely present with multiple lesions. To the best of our knowledge, current literature regarding meningiomatosis (MM) is mostly comprised of small case series and individual reports. Hence, survival outcome data are limited. The Objective of this study is to explore the influence of sex, age, and number of lesions on overall survival (OS) in patients with MM. METHODS We obtained demographic and clinical data from the surveillance, epidemiology, and end results program (SEER) on adult patients diagnosed with meningiomas from 1975 to 2017. Univariable and multivariable analyses were conducted to assess whether number of lesions, age, and sex had a significant influence on OS. RESULTS 99,918 cases were included. Results showed that MM patients had a significantly decreased OS when compared to patients with a single lesion (median OS of 94 and 180 months, respectively; p < 0.001). Further analysis showed a progressive decrease on OS for every additional lesion; 2 (HR 1.659 [CI 95% 1.612-1.708], p < 0.001), 3 (HR 1.877 [CI 95% 1.773-1.988], p < 0.001), and ≥ 4 (HR 2.116 [CI 95% 1.886-2.373], p < 0.001). When assessing for sex differences, female patients had increased OS (HR 0.778 [CI 95% 0.743-0.815], p < 0.001) and decreased risk of developing MM (HR 0.809 [CI 95% 0.784-0.835], p < 0.001). CONCLUSION Increasing number of meningiomas has a significant negative impact on OS, with a progressive decrease on survival for every additional lesion. Furthermore, female patients had increased OS and decreased risk to develop MM.
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Araújo Pereira BJ, Nogueira de Almeida A, Pires de Aguiar PH, Paiva WS, Teixeira MJ, Nagahashi Marie SK. Multiple Intracranial Meningiomas: A Case Series and Review of the Literature. World Neurosurg 2018; 122:e1536-e1541. [PMID: 30471445 DOI: 10.1016/j.wneu.2018.11.097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the published data to create a more comprehensive natural history of multiple meningiomas (MM). METHODS A review of MM published until now was carried out through a Medline search up to August 2018. The use of the "multiple meningiomas" keyword returned 278 articles, and the characteristics analyzed in our present cohort were searched on those publications. Articles without detailed description of clinical findings, neuroimaging confirmation of tumor multiplicity, follow-up at least of 5 years, and clear description of clinical findings were excluded. We added series to this review. RESULTS 293 patients with MM were analyzed: 220 women and 73 men, with a total of 932 tumors (3.1 tumors per patient). The majority of tumors were located in the convexity (653% to 74.5%). The total number of tumors treated was 429 (43.9%): 338 (78.8%) by surgical resection and 91 (21.2%) by radiotherapy. Histopathologic description was available in 303 of 429 cases, being grade I in 272 (90.3%) cases, with a predominance of the meningothelial subtype (30.7%). Tumor recurrence was described in 32 (8.07%) among 397 and only 10 deaths (3.4%) of 281 reported cases, where this characteristic was evaluated. CONCLUSIONS World Health Organization grade I predominance was observed among multiple meningiomas in similarity to single meningiomas. Only a fraction of MM patients (43.89%) needed treatment. A benign tumor behavior was corroborated by the observed low frequency of recurrence and mortality.
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Affiliation(s)
| | - Antônio Nogueira de Almeida
- Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil; Divisão de Neurocirurgia Funcional IPQ, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil
| | | | - Wellingson Silva Paiva
- Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil
| | - Manoel Jacobsen Teixeira
- Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil
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Tsermoulas G, Turel MK, Wilcox JT, Shultz D, Farb R, Zadeh G, Bernstein M. Management of multiple meningiomas. J Neurosurg 2017; 128:1403-1409. [PMID: 28731398 DOI: 10.3171/2017.2.jns162608] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple meningiomas account for 1%-10% of meningiomas. This study describes epidemiological aspects of the disease and its management, which is more challenging than for single tumors. METHODS A consecutive series of adult patients with ≥ 2 spatially separated meningiomas was reviewed. Patients with neurofibromatosis Type 2 were excluded. The authors collected clinical, imaging, histological, and treatment data to obtain information on epidemiology, management options, and outcomes of active treatment and surveillance. RESULTS A total of 133 consecutive patients were included over 25 years, with a total of 395 synchronous and 53 metachronous meningiomas, and a median of 2 tumors per patient. One hundred six patients had sporadic disease, 26 had radiation-induced disease, and 1 had familial meningiomatosis. At presentation, half of the patients were asymptomatic. In terms of their maximum cross-sectional diameter, the tumors were small (≤ 2 cm) in 67% and large (> 4 cm) in 11% of the meningiomas. Fifty-four patients had upfront treatment, and 31 had delayed treatment after an observation period (mean 4 years). One in 4 patients had ≥ 2 meningiomas treated. Overall, 64% of patients had treatment for 142 tumors-67 with surgery and 18 with radiotherapy alone. The mean follow-up was 7 years, with 13% of treated patients receiving salvage therapy. Approximately 1 in 4 patients who underwent surgery had ≥ 1 WHO Grade II or III meningioma. Meningiomas of different histological subtypes and grades in the same patient were not uncommon. CONCLUSIONS Multiple meningiomas are often asymptomatic, probably because the majority are small and a significant proportion are induced by radiation. Approximately two-thirds of patients with multiple meningiomas require therapy, but only one-third of all meningiomas need active treatment. The authors recommend surveillance for stable and asymptomatic meningiomas and therapy for those that are symptomatic or growing.
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Affiliation(s)
| | | | | | - David Shultz
- 2Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Méningiomes multiples. Neurochirurgie 2016; 62:128-35. [DOI: 10.1016/j.neuchi.2015.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 11/20/2022]
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Sommerauer M, Burkhardt JK, Frontzek K, Rushing E, Buck A, Krayenbuehl N, Weller M, Schaefer N, Kuhn FP. 68Gallium-DOTATATE PET in meningioma: A reliable predictor of tumor growth rate? Neuro Oncol 2016; 18:1021-7. [PMID: 26865086 DOI: 10.1093/neuonc/now001] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/03/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND DOTATATE-based radionuclides have added new options in the diagnosis and treatment of meningiomas; however, a reliable predictor of tumor growth has still not been established. METHODS We analyzed 64 meningiomas imaged with (68)Ga-DOTATATE PET. Tumor growth rates were calculated by volumetric analysis of sequential MRI scans. Maximums of standardized uptake values (SUVmax) were correlated with tumor growth and covariates. RESULTS World Health Organization (WHO) grades I and II meningiomas showed a correlation of SUVmax and tumor growth rate (meningiomas limited to the intracranial compartment: r = 0.757, P < .001, and transosseous growing meningiomas: r = 0.819, P = .024). SUVmax was significantly higher and the slope of the linear regression significantly steeper in transosseous compared with intracranial meningiomas (both P < .001). The association remained significant in multivariate analysis, and the prediction of tumor growth rate was independent of WHO grade. Anaplastic meningiomas showed no significant correlation of SUVmax and tumor growth. CONCLUSIONS (68)Ga-DOTATATE PET is a reliable predictor of tumor growth in WHO grades I and II meningiomas and provides additional information to conventional cross-sectional imaging modalities. Hence, (68)Ga-DOTATATE PET can assist in selecting the time point for treatment initiation. Furthermore, meningiomas with fast tumor growth and transosseous expansion elicit the highest DOTATATE binding; therefore, they might be especially suited for DOTATATE-based therapy.
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Affiliation(s)
- Michael Sommerauer
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
| | - Jan-Karl Burkhardt
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
| | - Karl Frontzek
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
| | - Elisabeth Rushing
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
| | - Alfred Buck
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
| | - Niklaus Krayenbuehl
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
| | - Michael Weller
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
| | - Niklaus Schaefer
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
| | - Felix P Kuhn
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (M.S., A.B., N.S., F.P.K.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.S., M.W.); Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland (J.-K.B., N.K.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (K.F., E.R.); Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland (N.S.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (F.P.K.)
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Yudoyono F, Sidabutar R, Arifin MZ, Faried A. Multiple meningiomas consisting of fibrous meningioma, transitional meningioma, and meningotheliomatous meningioma in one adult patient. Asian J Neurosurg 2015; 10:348-9. [PMID: 26425174 PMCID: PMC4558821 DOI: 10.4103/1793-5482.162729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple histopathology of meningioma is a condition in which the patient has more than one histopathology feature of meningioma in different intracranial locations, with or without sign of neurofibromatosis. Meningiomas are the most common, non-glial, primitive intracranial tumors; their prevalence among operated tumors is around 13–19%. They may occur at any age, but have a peak incidence around 45 years of age. The incidence of multiple intracranial meningiomas varies from 1% to 10% in different series, and the frequency of multiple meningiomas without neurofibromatosis was reported to be <3%.
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Affiliation(s)
- Farid Yudoyono
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Roland Sidabutar
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Muhammad Zafrullah Arifin
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Ahmad Faried
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
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Ohla V, Scheiwe C. Meningiomatosis restricted to the left cerebral hemisphere with acute clinical deterioration: Case presentation and discussion of treatment options. Surg Neurol Int 2015; 6:64. [PMID: 25949852 PMCID: PMC4405890 DOI: 10.4103/2152-7806.155447] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/28/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND True multiple meningiomas are defined as meningiomas occurring at several intracranial locations simultaneously without the presence of neurofibromatosis. Though the prognosis does not differ from benign solitary meningiomas, the simultaneous occurrence of different grades of malignancy has been reported in one-third of patients with multiple meningiomas. Due to its rarity, unclear etiology, and questions related to proper management, we are presenting our case of meningiomatosis and discuss possible pathophysiological mechanisms. CASE DESCRIPTION We illustrate the case of a 55-year-old female with multiple meningothelial meningeomas exclusively located in the left cerebral hemisphere. The patient presented with acute vigilance decrement, aphasia, and vomiting. Further deterioration with sopor and nondirectional movements required oral intubation. Emergent magnetic resonance imaging (MRI) with MR-angiography disclosed a massive midline shift to the right due to widespread, plaque-like lesions suspicious for meningeomatosis, purely restricted to the left cerebral hemisphere. Emergency partial tumor resection was performed. Postoperative computed tomography (CT) scan showed markedly reduction of cerebral edema and midline shift. After tapering the sedation a right-sided hemiparesis resolved within 2 weeks, leaving the patient neurologically intact. CONCLUSION Although multiple meningeomas are reported frequently, the presence of meningeomatosis purely restricted to one cerebral hemisphere is very rare. As with other accessible and symptomatic lesions, the treatment of choice is complete resection with clean margins to avoid local recurrence. In case of widespread distribution a step-by-step resection with the option of postoperative radiation of tumor remnants may be an option.
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Affiliation(s)
- Victoria Ohla
- Department of Neurosurgery, University of Freiburg, Breisacherstr. 64. 79106 Freiburg, Germany
- Department of Neurosurgery, University of Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, University of Freiburg, Breisacherstr. 64. 79106 Freiburg, Germany
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Smith MJ. Germline and somatic mutations in meningiomas. Cancer Genet 2015; 208:107-14. [PMID: 25857641 DOI: 10.1016/j.cancergen.2015.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 02/07/2023]
Abstract
Meningiomas arise from the arachnoid layer of the meninges that surround the brain and spine. They account for over one third of all primary central nervous system tumors in adults and confer a significant risk of location-dependent morbidity due to compression or displacement. A significant increase in risk of meningiomas is associated with neurofibromatosis type 2 (NF2) disease through mutation of the NF2 gene. In addition, approximately 5% of individuals with schwannomatosis disease develop meningiomas, through mutation of the SWI/SNF chromatin remodeling complex subunit, SMARCB1. Recently, a second SWI/SNF complex subunit, SMARCE1, was identified as a cause of clear cell meningiomas, indicating a wider role for this complex in meningioma disease. The sonic hedgehog (SHH)-GLI1 signaling pathway gene, SUFU, has also been identified as the cause of hereditary multiple meningiomas in a large Finnish family. The recent identification of somatic mutations in components of the SHH-GLI1 and AKT1-MTOR signaling pathways indicates the potential for cross talk of these pathways in the development of meningiomas. This review describes the known meningioma predisposition genes and their links to the recently identified somatic mutations.
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Affiliation(s)
- Miriam J Smith
- Manchester Centre for Genomic Medicine, St Mary's Hospital, University of Manchester, Manchester, UK.
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15
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Multiple intracranial meningiomas: a review of the literature and a case report. Case Rep Surg 2013; 2013:131962. [PMID: 24069543 PMCID: PMC3773437 DOI: 10.1155/2013/131962] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/29/2013] [Indexed: 11/30/2022] Open
Abstract
Multiple intracranial meningiomas are a condition where there is more than one meningioma in several intracranial locations in the same patient without signs of neurofibromatosis. Incidence varies from 1 to 10%. The prognosis of multiple intracranial meningioma does not differ from benign solitary meningiomas despite the multiplicity. However, the simultaneous occurrence of different grades of malignancy is observed in one-third of multiple meningiomas. Surgery remains the best option for treatment of symptomatic lesions. Our case review aims to present and discuss a 75-year-old female patient diagnosed with multiple intracranial meningiomas, describing their clinical, radiological, histological characteristics. It also highlights the fact that the patient had two tumours, underwent surgery, and so far has a good quality of life.
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Huang H, Buhl R, Hugo HH, Mehdorn HM. Clinical and Histological Features of Multiple Meningiomas Compared with Solitary Meningiomas. Neurol Res 2013; 27:324-32. [PMID: 15845217 DOI: 10.1179/016164105x39932] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Between 1991 and 2002, 456 patients with an intracranial meningioma were treated. Thirty-nine of these had more than one meningioma (8.6%). The mean age was 58 years (27-85 years). Sex distribution was 8.8:1 (35 female, four male). There was no associated spinal meningioma. No patient had neurofibromatosis. In 19 patients all meningiomas were removed. Twelve showed the same histology, seven had different histological features. In the remaining 20 patients only the symptomatic meningioma was removed. Recurrences occurred in 11 patients (28.2%). Six patients died during follow-up. Multiple meningiomas have their own clinical features. Besides a high female preponderance, PR expression was stronger in multiple meningiomas than in solitary meningiomas while p53 status and MIB-1 LI were similar between the two groups. Progesterone receptor, p53 status and MIB-1 LI were valuable markers for predicting a patient's outcome in multiple meningiomas. The number of meningiomas is growing in patients with recurrent meningiomas.
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Affiliation(s)
- Hongguang Huang
- Department of Neurosurgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China
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17
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Mocker K, Holland H, Ahnert P, Schober R, Bauer M, Kirsten H, Koschny R, Meixensberger J, Krupp W. Multiple meningioma with different grades of malignancy: case report with genetic analysis applying single-nucleotide polymorphism array and classical cytogenetics. Pathol Res Pract 2011; 207:67-72. [PMID: 20926204 DOI: 10.1016/j.prp.2010.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/06/2010] [Accepted: 09/03/2010] [Indexed: 11/30/2022]
Abstract
Multiple meningiomas with synchronous tumor lesions represent only 1-9% of all meningiomas and usually show a uniform histology. The simultaneous occurrence of different grades of malignancy in these nodules is observed in only one third of multiple meningiomas. We report a case of a sporadic multiple meningioma presenting with different histopathological grades (WHO I and II). The tumor genome of both nodules was analyzed by GTG-banding, spectral karyotyping (SKY), locus-specific FISH, and single nucleotide polymorphism array (SNP-A) karyotyping. GTG-banding and SKY revealed 25 structural and 33 numerical aberrations with a slightly increased aberration frequency in the WHO grade II nodule. We could confirm terminal deletions on chromosomes 1p [ish del(1)(p36)(p58-,pter-) 16.5% WHO grade I and 20.9% WHO grade II], partial deletions on 22q, and/or monosomy 22 (monosomy 22 14% WHO grade I and 34% WHO grade II) as the most frequent aberrations in both meningioma nodules. In the meningioma WHO grade II, in addition, a de novo paracentric inversion within chromosomal band 1p36 was detectable. Furthermore, for meningiomas de novo, dicentric chromosomes 4 could be identified in both tumor nodules. We also detected previously published segmental uniparental disomy regions 1p31.1, 6q14.1, 10q21.1, and 14q23.3 in normal control DNA of the patient and in both tumor nodules. Taken together, we describe a very rare case of multiple meningioma with overlapping but also distinct genetic aberration patterns in two nodules of different WHO grades of malignancy.
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Affiliation(s)
- Kristin Mocker
- Department of Neurosurgery, University of Leipzig, Liebigstrasse 20, D-04103 Leipzig, Germany
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18
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Shen Y, Nunes F, Stemmer-Rachamimov A, James M, Mohapatra G, Plotkin S, Betensky RA, Engler DA, Roy J, Ramesh V, Gusella JF. Genomic profiling distinguishes familial multiple and sporadic multiple meningiomas. BMC Med Genomics 2009; 2:42. [PMID: 19589153 PMCID: PMC2716362 DOI: 10.1186/1755-8794-2-42] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 07/09/2009] [Indexed: 11/27/2022] Open
Abstract
Background Meningiomas may occur either as familial tumors in two distinct disorders, familial multiple meningioma and neurofibromatosis 2 (NF2), or sporadically, as either single or multiple tumors in individuals with no family history. Meningiomas in NF2 and approximately 60% of sporadic meningiomas involve inactivation of the NF2 locus, encoding the tumor suppressor merlin on chromosome 22q. This study was undertaken to establish whether genomic profiling could distinguish familial multiple meningiomas from sporadic solitary and sporadic multiple meningiomas. Methods We compared 73 meningiomas presenting as sporadic solitary (64), sporadic multiple (5) and familial multiple (4) tumors using genomic profiling by array comparative genomic hybridization (array CGH). Results Sporadic solitary meningiomas revealed genomic rearrangements consistent with at least two mechanisms of tumor initiation, as unsupervised cluster analysis readily distinguished tumors with chromosome 22 deletion (associated with loss of the NF2 tumor suppressor) from those without chromosome 22 deletion. Whereas sporadic meningiomas without chromosome 22 loss exhibited fewer chromosomal imbalance events overall, tumors with chromosome 22 deletion further clustered into two major groups that largely, though not perfectly, matched with their benign (WHO Grade I) or advanced (WHO Grades II and III) histological grade, with the latter exhibiting a significantly greater degree of genomic imbalance (P < 0.001). Sporadic multiple meningiomas showed a frequency of genomic imbalance events comparable to the atypical grade solitary tumors. By contrast, familial multiple meningiomas displayed no imbalances, supporting a distinct mechanism for the origin for these tumors. Conclusion Genomic profiling can provide an unbiased adjunct to traditional meningioma classification and provides a basis for exploring the different genetic underpinnings of tumor initiation and progression. Most importantly, the striking difference observed between sporadic and familial multiple meningiomas indicates that genomic profiling can provide valuable information for differential diagnosis of subjects with multiple meningiomas and for considering the risk for tumor occurrence in their family members.
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Affiliation(s)
- Yiping Shen
- Molecular Neurogenetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Peptide receptor radionuclide therapy with 90Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging 2009; 36:1407-16. [DOI: 10.1007/s00259-009-1115-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 03/02/2009] [Indexed: 10/21/2022]
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Lynch JC, Ferreira LAS, Welling L, Schulz RC. Multiple intracranial meningiomas: diagnosis, biological behavior and treatment. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:702-7. [PMID: 18949266 DOI: 10.1590/s0004-282x2008000500018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 08/08/2008] [Indexed: 11/21/2022]
Abstract
UNLABELLED Multiple intracranial meningiomas (MIM) are a rare pathology when not associated with neurofibromatosis. The prevalence rate of those tumors varied from 2.3 to 8.9% of all intracranial meningiomas. OBJECTIVE To present, analyze and discuss the cases of seven patients diagnosed with multiple intracranial meningiomas, describing their clinical and histological characteristics, as well as their biological behavior. METHOD The patients records, surgical descriptions, imaging studies and the histopathological exams were retrospectively reviewed. This is the largest series of MIM publisted in Brazil. RESULTS This sample consists of five women and two men. The age varied from 42 to 84 (average 53.8). Twenty-two meningiomas were identified and varied from 1.5 to 192 cm(3), with an 62.8 cm(3) average volume. The number of procedures varied from 1 to 5 per patient. No surgical death occurred in this series. CONCLUSION Despite the multiplicity of tumors, number of recurrences, the new tumors, repeated operations and re-operations, radiotherapy and a number of postoperative complications, the patients experienced a long survival in conjunction with a fairly good quality of life.
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Affiliation(s)
- José Carlos Lynch
- Serviço de Neurocirurgia, Hospital dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
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[Relation of surgical results and proposed skull base meningioma grading system: analysis of clinical series with 42 patients]. ACTA ACUST UNITED AC 2007; 54:23-8. [PMID: 18044311 DOI: 10.2298/aci0702023t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Anatomical localisation of skull base meningioma link, their growth and relations with neurovascular structures reduce possibility for radical operation, and offten request additional preoperative or postoperative radiotherapy. We compared personal results of extent surgical resection and skull base meningioma treating outcome with predispose factors scale for surgical radicality and postoperative outcome. We present 42 patients, who were operated in Institute of neurosurgery CCS during the period from 2004 to 2006. RESULTS Radical resection was possible in 29 cases, and in 13 cases reduction of tumor mass has been performed. Statistical significant predispose factor for radical resection were: absance of preoperative radiotherapy, intact functions of n.III, n.VI, tumor borders inside one skull base fossa and outside of magistral blood vessels. Karnofsky index at the end of following period statistical significant higher in patients with radical resection of skull base meningeioma. Preoperative radiological finding is singificant guide in planning of therapeutic protocol for skull base meningioma. Growth of tumor and relation with neurovascular structures restrict extent of resection and often request additional postoperative radiotherapy or reoperation.
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Abstract
BACKGROUND Meningiomas are biologically complex and clinically and surgically challenging. These features, combined with the rewarding potential for cure, make them of great interest to neurologists, neurosurgeons, and neuroscientists alike. REVIEW SUMMARY Initially, we review the clinical context of meningiomas, particularly recent changes in histopathological classification, diagnosis, and neuroimaging. Secondly, the underlying basic science as it has evolved over the last decades is summarized. The status of areas recently of intense interest, such as steroid hormone receptors and oncogenic viruses is described. Additionally, emerging areas of great promise, such as cytogenetics and molecular biology are presented. Lastly, we describe recent advances in management. In particular, skull-base surgery, image-guided surgery, and advances in radiotherapy are emphasized. The possible impact of basic research on management and outcome is also outlined. CONCLUSIONS Although usually benign and amenable to cure, meningiomas still present significant diagnostic and treatment challenges. Advances in basic science, surgery, and adjuvant therapy are widening the potential for safe, effective, evidence-based management leading to even better outcomes
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Affiliation(s)
- Katharine J Drummond
- Department of Neurosurgery, The Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Tomita T, Kurimoto M, Yamatani K, Nagai S, Kuwayama N, Hirashima Y, Endo S. Multiple meningiomas consisting of fibrous meningioma and anaplastic meningioma. J Clin Neurosci 2003; 10:622-4. [PMID: 12948473 DOI: 10.1016/s0967-5868(03)00161-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 61-year-old woman presented with progressive dementia over a period of 4 months. Computed tomographic (CT) scans and magnetic resonance (MR) imaging showed 2 meningiomas located at the left parasagittal region and the left sphenoid ridge. These tumors had distinct MRI findings; the left parasagittal tumour showed a clear peritumoral CSF space without brain oedema, but the sphenoid ridge tumour was large with marked peritumoral oedema. Total excision of these 2 tumours was attempted with favourable clinical improvement and histological studies revealed meningiomas of different histological types. The left parasagittal tumour was a fibrous meningioma and the left sphenoid ridge tumour was an anaplastic meningioma with typical brain invasion. These tumours showed a MIB-1 staining index of 1% and 30%, respectively. There was also a difference in the immunohistochemical findings for neurofibromin (NF1 product) expression; the left parasagittal tumour expressed neurofibromin but the left sphenoid ridge tumour lacked neurofibromin expression, suggesting an NF1-gene mutation. This case may be a rare example of the simultaneous occurrence of meningiomas with distinct genotypes.
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Affiliation(s)
- Takahiro Tomita
- Department of Neurosurgery, Toyama Medical and Pharmaceutical University, 2630 Sugitani, 930-0194, Toyama, Japan
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Lomas J, Bello MJ, Alonso ME, Gonzalez-Gomez P, Arjona D, Kusak ME, de Campos JM, Sarasa JL, Rey JA. Loss of chromosome 22 and absence of NF2 gene mutation in a case of multiple meningiomas. Hum Pathol 2002; 33:375-8. [PMID: 11979381 DOI: 10.1053/hupa.2002.32229] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Multiple meningiomas are rare, and only 13 cases have been subjected to molecular genetic analysis to detect mutations of the tumor-suppressor gene neurofibromatosis type 2 (NF2) located on chromosome 22. Most of these cases display NF2 gene mutations parallel to loss of the chromosome 22 homolog, indicating that inactivation of this gene may represent an early event in the development of multiple meningiomas. We report a case of a 61-year-old woman who developed multiple (dorsal and intracranial) meningiomas. Cytogenetic and molecular genetic studies demonstrated the loss of a copy of chromosome 22 in the 5 meningiomas studied and the absence of NF2 gene mutations in 4 of those available for this molecular analysis. These findings, together with similar data from 2 previously reported cases, suggest the participation of a tumor-suppressor gene other than NF2 on chromosome 22 in the pathogenesis of a subgroup of multiple meningiomas.
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Affiliation(s)
- Jesus Lomas
- Department C. Experimental (Laboratorio de Oncogenética Molecular), Hospital Universitario La Paz, Madrid, Spain
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Koh YC, Yoo H, Whang GC, Kwon OK, Park HI. Multiple meningiomas of different pathological features: case report. J Clin Neurosci 2001; 8 Suppl 1:40-3. [PMID: 11386824 DOI: 10.1054/jocn.2001.0875] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Meningioma is a common intracranial tumour and it may occur not infrequently as one of the multiple tumours, especially in patients with neurofibromatosis. The incidence of multiple meningiomas (MMs) without the stigmata of neurofibromatosis is rare, ranging from 1 to 9% of all meningiomas in the literature. Multiple meningiomas with different pathologic features are even rarer, and most of them are benign histologies. The authors report an extremely rare case of MMs which were presented with malignant and benign histological features simultaneously. The underlying mechanism of MM formation is still unclear, however, subarachnoid spread was thought to be the most likely mechanism. The findings of most of MMs showed identical histopathological features and several molecular biologic studies provided evidence for the monoclonal origin of MMs to back up the above hypothesis. However, different histological features among the reported multiple meningioma cases including our particular one, suggests their origin from multicentric neoplastic foci activated by a supposed tumour-producing factor. However, we cannot completely exclude the possibility of independent progression from monoclonal origin.
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Affiliation(s)
- Y C Koh
- Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Korea.
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Zhu JJ, Maruyama T, Jacoby LB, Herman JG, Gusella JF, Black PM, Wu JK. Clonal analysis of a case of multiple meningiomas using multiple molecular genetic approaches: pathology case report. Neurosurgery 1999; 45:409-16. [PMID: 10449091 DOI: 10.1097/00006123-199908000-00049] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Multiple meningiomas are uncommon brain tumors occurring concurrently in several intracranial locations in the same patient. In the present study, we determined the clonality, methylation status of deoxyribonucleic acid, and relationship of genetic alterations in eight meningiomas from one female patient. METHODS Six molecular genetic techniques, including two methylation-based clonality assays and one transcription-based clonality assay, methylation analysis of CpG islands by methylation-specific polymerase chain reaction, loss of heterozygosity, microsatellite instability, and mutational analysis of the NF2 gene on chromosome 22, were used in comparative investigations on clonality and genetic alterations. RESULTS The presence of clonal tumor cells was demonstrated by 1) loss of the same copy of chromosome 22 in all eight tumors; 2) transcription of the human AR gene from the same allele in six of eight tumors; 3) a common unmethylated allele at the AR locus in all eight tumors; and 4) the identical single-basepair insertion mutation in exon 9 of the NF2 gene in six of eight tumors. In addition, loss of a copy of the X chromosome in one tumor nodule and microsatellite instability in another nodule were observed. CONCLUSION Taken together, this case of multiple meningiomas was most likely monoclonal in origin. Loss of chromosome 22 was an early event during the development of multiple meningiomas and was followed by mutations at the NF2 locus. Later events, including loss of the X chromosome, variation of AR gene expression, or microsatellite instability, may also have played a role in the development of multiple meningiomas in this patient.
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Affiliation(s)
- J J Zhu
- Neurosurgical Laboratories and Brain Tumor Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Leone PE, Bello MJ, de Campos JM, Vaquero J, Sarasa JL, Pestaña A, Rey JA. NF2 gene mutations and allelic status of 1p, 14q and 22q in sporadic meningiomas. Oncogene 1999; 18:2231-9. [PMID: 10327069 DOI: 10.1038/sj.onc.1202531] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Formation of meningiomas and their progression to malignancy may be a multi-step process, implying accumulation of genetic mutations at specific loci. To determine the relationship between early NF2 gene inactivation and the molecular mechanisms that may contribute to meningioma tumor progression, we have performed deletion mapping analysis at chromosomes 1, 14 and 22 in a series of 81 sporadic meningiomas (54 grade I (typical), 25 grade II (atypical) and two grade III (anaplastic)), which were also studied for NF2 gene mutations. Single-strand conformational polymorphism analysis was used to identify 11 mutations in five of the eight exons of the NF2 gene studied. All 11 tumors displayed loss of heterozygosity (LOH) for chromosome 22 markers; this anomaly was also detected in 33 additional tumors. Twenty-nine and 23 cases were characterized by LOH at 1p and 14q, respectively, mostly corresponding to aggressive tumors that also generally displayed LOH 22. All three alterations were detected in association in seven grade II and two grade III meningiomas, corroborating the hypothesis that the formation of aggressive meningiomas follows a multi-step tumor progression model.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Alleles
- Cell Transformation, Neoplastic/genetics
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 22/genetics
- DNA Mutational Analysis
- DNA, Neoplasm/genetics
- Disease Progression
- Female
- Genes, Neurofibromatosis 2
- Genotype
- Humans
- Loss of Heterozygosity
- Male
- Meningeal Neoplasms/genetics
- Meningeal Neoplasms/pathology
- Meningioma/genetics
- Meningioma/pathology
- Microsatellite Repeats
- Middle Aged
- Polymorphism, Single-Stranded Conformational
- Sequence Deletion
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Affiliation(s)
- P E Leone
- Instituto de Investigaciones Biomédicas (CSIC), Madrid, Spain
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Abstract
BACKGROUND The incidence of multiple skull base meningiomas varies from 1 to 3% in different series. Skull base meningiomas are rare. The pathogenetic role of low-dose radiation seems to be fairly well established in the oncogenesis of meningiomas. Calvarial location and multiplicity seem to be among the distinctive features of radiation-induced meningiomas. Skull base location is a very rare occurrence, mainly because the path of irradiation does not significantly involve this region. CASE REPORT We describe a rare case of simultaneous occurrence of two skull base meningiomas in a 66-year-old female. This patient underwent low-dose irradiation for tinea capitis when she was 8 years old. The patient complained of nuchal pain, paresthesias in both hands, and progressive weakness on her right side. She was admitted to the hospital in September 1994. An MRI showed two masses, one located at the level of the tuberculum sellae and the other at the foramen magnum. These seemed very likely to be multiple meningiomas. The latter lesion, which was more symptomatic and dangerous, was operated on first. Six months later, elective treatment of the suprasellar meningioma was performed with success. CONCLUSION The actual role of previous head irradiation in the oncogenesis of the present meningiomas remains somewhat unclear. Proper management and judicious use of skull base surgery techniques were key factors in the successful treatment of the patient.
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Affiliation(s)
- A Spallone
- Division of Neurosurgery, University of Rome Tor Vergata, Italy
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Altinörs N, Gürses L, Arda N, Türker A, Senveli E, Dönmez T, Sanli M, Bavbek M, Caner H. Intracranial meningiomas. Analysis of 344 surgically treated cases. Neurosurg Rev 1998; 21:106-10. [PMID: 9795943 DOI: 10.1007/bf02389314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The authors present 344 (230 females, 114 males) surgical cases of intracranial meningioma. A total of 370 interventions (344 primary procedures, 10 reexplorations for neurologic deterioration, 16 operations for recurrence) were made. Mean follow-up was 38 months. The overall evaluation revealed that 306 (88.95%) patients were completely normal or in a better condition than before operation. 18 (5.23%) were in a worse condition after operation and 20 (5.81%) died. Results suggested that complications and mortality were mostly related to localization and large volume; we also still have problems with aggressive and malignant meningiomas.
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Affiliation(s)
- N Altinörs
- Neurosurgery Department, Başkent University, Ankara, Turkey.
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Colón GP, Ross DA, Hoff JT. Sequential outer table craniotomy a in hyperossified meningioma. Technical note. J Neurosurg 1998; 88:346-8. [PMID: 9452249 DOI: 10.3171/jns.1998.88.2.0346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A hyperossified meningioma with significant calvarial thickening is fairly common. Craniectomy of the involved region followed by cranioplasty is usually required to resect the bone overgrowth. However, in some cases, the hyperossified calvaria is too thick to allow safe penetration with a craniotome or trephine. In this report, the authors present a technique for preserving the outer calvaria while still resecting the majority of the underlying tumor mass. The key is to perform a craniotomy in a region adjacent to the hyperossified bone and to remove the tumorous, ossified inner table through this "window" by means of a high-speed drill. A second craniotomy can then be performed over the undermined area; this maneuver can be advanced and repeated until the tumor is resected. Frameless stereotactic guidance and microplates are useful in performing this procedure.
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Affiliation(s)
- G P Colón
- Department of Surgery, University of Michigan Hospitals, Ann Arbor 48109-0338, USA
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Turgut M, Palaoğlu S, Ozcan OE, Gürçay O, Eryilmaz M. Multiple meningiomas of the central nervous system without the stigmata of neurofibromatosis. Clinical and therapeutic study. Neurosurg Rev 1997; 20:117-23. [PMID: 9226671 DOI: 10.1007/bf01138195] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Multiple meningiomas are relatively rare tumors without known neurofibromatosis. In this paper, such eight cases of multiple meningiomas as described by CUSHING and EISENHARDT are presented. Certain aspects of diagnosis and surgical management of this rare condition are discussed with particular emphasis on the importance of the distinction among multiple meningioma, meningiomatosis, or recurrences of these tumors. Fortunately, many of these patients tolerate multiple surgical interventions well, although the removal of these tumors in critical areas is a difficult problem. Thus, we think that it is important to examine and supervise all patients who have had a meningioma for a possible occurrence of a second meningioma.
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Affiliation(s)
- M Turgut
- Department of Neurosurgery, Adnan Menderes University Medical Faculty, Aydin, Turkey
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Larson JJ, Tew JM, Simon M, Menon AG. Evidence for clonal spread in the development of multiple meningiomas. J Neurosurg 1995; 83:705-9. [PMID: 7674021 DOI: 10.3171/jns.1995.83.4.0705] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Meningiomas are common intracranial tumors that arise from the arachnoid cells of the meninges. Occasionally patients develop multiple meningiomas. Because the underlying mechanism of multiple meningioma formation is unknown, the authors examined the pattern of X chromosome inactivation in multiple meningiomas. Fifteen intracranial meningiomas were resected in four patients with multiple meningiomas to determine whether the tumors in patients with multiple meningiomas originate from a common progenitor cell or arise independently. Specimens were examined using polymerase chain reaction assays to detect the pattern of X chromosome inactivation. In each patient, all tumors showed inactivation of the same X chromosome, suggesting that tumors arose from the same clone of cells (p < 0.0005). The authors conclude that multiple meningiomas arise from the uncontrolled spread of a single progenitor cell.
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Affiliation(s)
- J J Larson
- Department of Molecular Genetics, University of Cincinnati College of Medicine, Ohio, USA
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Abstract
The case of a 5-year-old female with an intradural spinal meningioma is presented. She showed slowly progressive muscle weakness of the lower extremities commencing at 3 years. Spinal magnetic resonance imaging (MRI) demonstrated an intradural mass extending from the eleventh thoracic vertebra to the fifth lumbar vertebra, which was excised totally by means of laminoplasty. The surgical procedure brought a gradual improvement in her gait. This case is unusual because of the tumor's location (lumbar) and origin (cauda equina), and because of the onset at a relatively young age.
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Affiliation(s)
- K Fujii
- Department of Pediatrics, Faculty of Medicine, University of Chiba, Japan
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LeKanne Deprez RH, Groen NA, Louz D, Hagemeijer A, van Drunen E, Koper JW, Avezaat CJ, Bootsma D, van der Kwast TH, Zwarthoff EC. Constitutional DNA-level aberrations in chromosome 22 in a patient with multiple meningiomas. Genes Chromosomes Cancer 1994; 9:124-8. [PMID: 7513542 DOI: 10.1002/gcc.2870090208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We describe a patient who developed multiple meningiomas but had no clear evidence of neurofibromatosis type 2. Four of the tumors, derived from three different sites, were analyzed cytogenetically and/or at the DNA level using chromosome 22 specific probes. All four tumors showed loss of the same copy of chromosome 22. On the chromosome that was retained in the tumors, we found two constitutional aberrations, a 1.5 kb deletion and a point mutation. The patient had inherited both alterations from her father. The father has not developed any meningiomas so far but he has been treated for a well-differentiated adenocarcinoma of the lung and a brain metastasis from this tumor. The mother and 75 unrelated individuals did not show any of the chromosome 22 alterations. The multiple tumors found in the patient suggest that she has a predisposing gene for the development of meningiomas. The finding that all investigated tumors lost the same, constitutionally normal copy of chromosome 22 could indicate that the predisposing gene resides on chromosome 22 and was affected by the constitutional mutations.
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Stevenson JC, Choksey MS, McMahon J, Crawford PJ. Multiple cerebral aneurysms, multiple meningiomas and multiple subcutaneous angiolipomas: a case report. Br J Neurosurg 1994; 8:477-81. [PMID: 7811415 DOI: 10.3109/02688699408995118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The simultaneous occurrence of multiple meningiomas, multiple distally located cerebral aneurysms and numerous subcutaneous lipomata in a 48-year-old man is reported. There was no evidence of neurofibromatosis, connective tissue disease or abnormality of collagen synthesis. We propose a possible genetic link between these three disparate conditions in our patient.
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Affiliation(s)
- J C Stevenson
- Department of Surgery, Medical School, University of Newcastle Upon Tyne, UK
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36
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Abstract
This article reviews the recent literature on the pathogenesis and pathology of meningiomas, contemporary techniques of surgical resection, and new nonsurgical treatments, including radiation and hormone therapy. Factors predisposing to meningioma formation include female sex, previous ionizing radiation, and Type 2 neurofibromatosis. The first factor may act through the expression of sex hormone receptors, especially the progesterone receptor, in these tumors; the other two probably act by causing a deletion on Chromosome 22. The pathological classifications of meningiomas include the traditional division into histological subtypes and the World Health Organization classification that selects characteristics that may lead to recurrence. There is an increasing emphasis on proliferative indices and other characteristics that may predict aggressive behavior in these tumors. On computed tomography, meningiomas are enhancing, well-marginated, dural-based lesions that may have considerable surrounding edema; the cause of the edema is uncertain but may result from secretory products of the tumor. Magnetic resonance imaging with enhancement will demonstrate these lesions accurately and can be used for three-dimensional reconstruction as well. Computed tomography and magnetic resonance imaging have largely replaced angiography in the preoperative diagnosis of meningiomas, but angiographic embolization may be a useful operative adjunct. Although meningioma surgery is sometimes thought of as benign and curative, the reported surgical mortality rate is as high as 14.3% and the reported 10-year survival rate after surgery varies from 43 to 77%. Surgery has advanced most in the management of suprasellar, cavernous sinus, clivus, tentorial, and posterior fossa meningiomas, because new approaches and a better understanding of anatomy have allowed more radical resection. There is still substantial morbidity associated with surgery in these regions, however, and the long-term recurrence rates are still unknown for these new radical techniques. For convexity, parasagittal, lateral sphenoid wing, and olfactory groove meningiomas, complete resection should be the goal and operative morbidity appears to be low. There is a high recurrence rate after surgery. With apparent total removal, the recurrence rate varies from 9 to 20% at 10 years, with subtotal resection varying from 18.4 to 50%. The degree of resection appears to be most important in recurrence, but histopathological features are also important. Recently, radiation therapy has been recognized as a useful adjunct to surgery, and with radiosurgical techniques may become more important in the future. Antiprogesterone therapy appears to have had some success as well, and it or other hormonal therapy may be another future option for residual or recurrent meningiomas.
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Affiliation(s)
- P M Black
- Neurosurgical Service, Brigham and Women's Hospital, Children's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
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