1
|
Nguyen A, Brown NJ, Gendreau J, Nguyen BA, Pennington Z, Zhang A, Harris MH, Chakravarti S, Douse DM, Van Gompel JJ. The association of thromboembolic complications and the use of tranexamic acid during resection of intracranial meningiomas: systematic review and meta-analysis of randomized controlled trials. J Neurosurg 2024; 140:1008-1018. [PMID: 37856372 DOI: 10.3171/2023.7.jns23849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/24/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Antifibrinolytics, such as tranexamic acid (TXA), have been shown to decrease intraoperative blood loss across multiple surgical disciplines. However, they carry the theoretical risk of thromboembolic events secondary to induced hypercoagulability. Therefore, the aim of this study was to systematically review the available literature and perform a meta-analysis on the use of TXA in meningioma resection to assess thromboembolic risks. METHODS The PubMed, Web of Science, and Google Scholar databases were reviewed for all randomized controlled trials presenting primary data on TXA use during resection of intracranial meningiomas. Data were gathered on operative duration, venous thromboembolic complications, deep venous thrombosis, use of allogeneic blood transfusion, estimated blood loss (EBL), and postoperative hemoglobin. Patients who received TXA were compared with controls who did not receive TXA intraoperatively using random-effects models. RESULTS A total of 508 unique articles were identified, of which 493 underwent full-text review. Ultimately, 6 studies with 381 total patients (190 receiving TXA) were included in the final analysis. All 6 trials were randomized, blinded, and placebo controlled with a TXA administration rate of a 20-mg/kg load followed by a 1-mg/kg/hr infusion. All studies were performed in lower-middle-income countries. There were no reported instances of venous thromboembolism (VTE) in the TXA and non-TXA cohorts. Patients receiving TXA exhibited fewer allogeneic transfusions (21.5% vs 41.6% [OR 0.26, 95% CI 0.09-0.77], p = 0.02) and lower EBL (MD -282.48 mL [95% CI -367.77 to -197.20 mL], p < 0.001) compared with patients who did not receive TXA, and they also had lower rates of perioperative complications (10.7% vs 19.9% [OR 0.47, 95% CI 0.2-0.95], p = 0.04). CONCLUSIONS Current literature suggests that TXA is not associated with increased risk for VTE when administered during resection of intracranial meningioma. TXA appears to decrease intraoperative blood loss and allogeneic transfusion requirements during meningioma resection and thus may improve the safety of surgical management of this pathology.
Collapse
Affiliation(s)
- Andrew Nguyen
- 1Department of Neurological Surgery, University of Florida School of Medicine, Gainesville, Florida
| | - Nolan J Brown
- 2Department of Neurological Surgery, University of California, Irvine, Orange, California
| | - Julian Gendreau
- 3Johns Hopkins Whiting School of Engineering, Baltimore, Maryland
| | - Brandon A Nguyen
- 4Department of Neurologic Surgery, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | - Angie Zhang
- 2Department of Neurological Surgery, University of California, Irvine, Orange, California
| | - Mark H Harris
- 2Department of Neurological Surgery, University of California, Irvine, Orange, California
| | | | - Dontre' M Douse
- 6Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
2
|
Romano A, Moltoni G, Dellepiane F, Palizzi S, Romano A, Guarnera A, Stoppacciaro A, Aqui M, Ius T, Miscusi M, Raco A, Bozzao A. Dural Tail Sign and Middle Meningeal Artery Hypertrophy in Glioblastoma: A Rarity? World Neurosurg 2023; 176:e240-e245. [PMID: 37201790 DOI: 10.1016/j.wneu.2023.05.038] [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: 04/15/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Dural tail sign and increased caliber of branches of the external carotid artery (ECA) are common findings in meningioma and they have been rarely reported in intra-axial lesions. Anyway, some cases of glioblastoma (GBM) are reported in the literature, mostly superficially localized, characterized by these 2 findings and therefore, misdiagnosed with meningioma. The aim of this study is to verify the prevalence of dural tail sign and hypertrophy of middle meningeal artery (MMA) in a large cohort of GBMs. METHODS 180 GBM patients were retrospectively evaluated. Deep or superficial localization of GBM was established and the presence of dural tail sign and hypertrophy of the ipsilateral MMA were assessed. The rate of tumor necrosis and the incidence of dural metastases during the radiological follow-up were also evaluated. Inter-rater reliability was calculated using Cohen's K-test. RESULTS Dural tail sign and enlarged MMA were evident in 30% and 19% of 96 superficial GBM, respectively. Deep GBM did not present those signs. Only one patient developed dural metastasis at follow-up and no differences in terms of tumor necrosis and hypoxic biomarkers expression were evident among GBMs with and without dural and vessel signs. CONCLUSIONS Dural tail sign and hypertrophy of the MMA in superficial GBM are more common than expected. They probably represent reactive rather than a neoplastic infiltration. Knowing these radiological signs may be important in terms of neurosurgery planning and avoiding excessive bleeding. Anyway, this hypothesis should be confirmed by a prospective neurosurgery studio.
Collapse
Affiliation(s)
- Andrea Romano
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulia Moltoni
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy.
| | - Francesco Dellepiane
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Serena Palizzi
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Allegra Romano
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessia Guarnera
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Antonella Stoppacciaro
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | - Michele Aqui
- NESMOS, Department of Neurosurgery, S.Andrea Hospital, University Sapienza, Rome, Italy; Department of Neurosurgery, University Hospital of Udine, Udine, Italy
| | - Tamara Ius
- NESMOS, Department of Neurosurgery, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Massimo Miscusi
- NESMOS, Department of Neurosurgery, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Antonino Raco
- NESMOS, Department of Neurosurgery, S.Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessandro Bozzao
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy
| |
Collapse
|
4
|
Roytman M, Kim S, Glynn S, Thomas C, Lin E, Feltus W, Magge RS, Liechty B, Schwartz TH, Ramakrishna R, Karakatsanis NA, Pannullo SC, Osborne JR, Knisely JPS, Ivanidze J. PET/MR Imaging of Somatostatin Receptor Expression and Tumor Vascularity in Meningioma: Implications for Pathophysiology and Tumor Outcomes. Front Oncol 2022; 11:820287. [PMID: 35155210 PMCID: PMC8832502 DOI: 10.3389/fonc.2021.820287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Meningiomas, the most common primary intracranial tumor, are vascular neoplasms that express somatostatin receptor-2 (SSTR2). The purpose of this investigation was to evaluate if a relationship exists between tumor vascularity and SSTR2 expression, which may play a role in meningioma prognostication and clinical management. Materials and Methods Gallium-68-DOTATATE PET/MRI with dynamic contrast-enhanced (DCE) perfusion was prospectively performed. Clinical and demographic patient characteristics were recorded. Tumor volumes were segmented and superimposed onto parametric DCE maps including flux rate constant (Kep), transfer constant (Ktrans), extravascular volume fraction (Ve), and plasma volume fraction (Vp). Meningioma PET standardized uptake value (SUV) and SUV ratio to superior sagittal sinus (SUVRSSS) were recorded. Pearson correlation analyses were performed. In a random subset, analysis was repeated by a second investigator, and intraclass correlation coefficients (ICCs) were determined. Results Thirty-six patients with 60 meningiomas (20 WHO-1, 27 WHO-2, and 13 WHO-3) were included. Mean Kep demonstrated a strong significant positive correlation with SUV (r = 0.84, p < 0.0001) and SUVRSSS (r = 0.81, p < 0.0001). When stratifying by WHO grade, this correlation persisted in WHO-2 (r = 0.91, p < 0.0001) and WHO-3 (r = 0.92, p = 0.0029) but not WHO-1 (r = 0.26, p = 0.4, SUVRSSS). ICC was excellent (0.97–0.99). Conclusion DOTATATE PET/MRI demonstrated a strong significant correlation between tumor vascularity and SSTR2 expression in WHO-2 and WHO-3, but not WHO-1 meningiomas, suggesting biological differences in the relationship between tumor vascularity and SSTR2 expression in higher-grade meningiomas, the predictive value of which will be tested in future work.
Collapse
Affiliation(s)
- Michelle Roytman
- Departments of Radiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Sean Kim
- Weill Cornell Medical College, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Shannon Glynn
- Weill Cornell Medical College, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Charlene Thomas
- Weill Cornell Medical College, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Eaton Lin
- Departments of Radiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Whitney Feltus
- Departments of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States
| | - Rajiv S. Magge
- Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Benjamin Liechty
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Theodore H. Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Nicolas A. Karakatsanis
- Departments of Radiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Susan C. Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Joseph R. Osborne
- Departments of Radiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Jonathan P. S. Knisely
- Department of Radiation Oncology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Jana Ivanidze
- Departments of Radiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States
- *Correspondence: Jana Ivanidze,
| |
Collapse
|
5
|
Meningioma-Brain Crosstalk: A Scoping Review. Cancers (Basel) 2021; 13:cancers13174267. [PMID: 34503077 PMCID: PMC8428351 DOI: 10.3390/cancers13174267] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background: In recent years, it has become evident that the tumoral microenvironment (TME) plays a key role in the pathogenesis of various cancers. In meningiomas, however, the TME is poorly understood, and it is unknown if glia cells contribute to meningioma growth and behaviour. Objective: This scoping review investigates if the literature describes and substantiates tumour-brain crosstalk in meningiomas and summarises the current evidence regarding the role of the brain parenchyma in the pathogenesis of meningiomas. Methods: We identified studies through the electronic database PubMed. Articles describing glia cells and cytokines/chemokines in meningiomas were selected and reviewed. Results: Monocytes were detected as the most abundant infiltrating immune cells in meningiomas. Only brain-invasive meningiomas elicited a monocytic response at the tumour-brain interface. The expression of cytokines/chemokines in meningiomas has been studied to some extent, and some of them form autocrine loops in the tumour cells. Paracrine interactions between tumour cells and glia cells have not been explored. Conclusion: It is unknown to what extent meningiomas elicit an immune response in the brain parenchyma. We speculate that tumour-brain crosstalk might only be relevant in cases of invasive meningiomas that disrupt the pial-glial basement membrane.
Collapse
|