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Valencia-Ramos C, Arroyo Del Castillo JG, Aragon JF, Eguiluz-Mendez AG, Guinto-Nishimura GY, Sangrador-Deitos MV, Gómez Amador JL. Prognostic Factors in the Surgery of Clinoidal Meningiomas. Cureus 2023; 15:e40122. [PMID: 37435264 PMCID: PMC10332639 DOI: 10.7759/cureus.40122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Clinoidal meningiomas are currently among the intracranial meningiomas with the greatest neurosurgical complexity, morbidity, and mortality associated with their resection. The worldwide literature has described tumor size (>4 cm3), patient age (>60 years), and invasion of the cavernous sinus as factors associated with a worse clinical outcome following surgery. METHODS We describe the series of cases of patients with clinoidal meningiomas who underwent microsurgical resection at our institution between January 2014 and March 2019. The intention was to analyze the multiple preoperative variables, such as the patient's demographic, tumor, and surgical characteristics, such as the Al-Mefty Classification to find a relationship with the patient's clinical outcome during their postoperative follow-up. Results: Death occurred in 4.8% of the cases. Postoperative morbidity was documented in 42.9%, the most frequent being ophthalmoparesis, followed by worsening of visual acuity, and new onset motor deficits. Radiological characteristics were assessed based on preoperative MRI. The maximum diameter, midline shift, invasion of the cavernous sinus, arterial encasement, and peritumoral edema were evaluated. Average intraoperative bleeding was 1.3 L. The most frequent histological grade was World Health Organization (WHO) grade 1 in 85.6% of the cases. Complete resection was obtained in 52.4% of the cases; 42.8% received fractionated stereotactic radiotherapy after surgery for disease control, and one received radiosurgery. Recurrence occurred in 33.3%. The average follow-up in months was 23.8. Conclusions: Demographic factors and tumor characteristics in clinoidal meningioma surgery are related to the subtype of meningioma according to the Al-Mefty Classification and impact directly the degree of resection, progression of the disease, and degree of postoperative complications. To achieve maximal resection while minimizing morbidity and mortality, these factors must be considered to decide on an appropriate approach and specific plan for each case.
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Affiliation(s)
- Cristopher Valencia-Ramos
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Jorge F Aragon
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Aldo G Eguiluz-Mendez
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Marcos V Sangrador-Deitos
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Luis Gómez Amador
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Chen LH, Xia Y, Wei F, Sun K, Huang HZ, Xu RX. The factors influencing postoperative efficacy of anterior clinoidal meningioma treatment and an analysis of best-suited surgical strategies. Front Neurol 2023; 14:1097686. [PMID: 37006494 PMCID: PMC10060889 DOI: 10.3389/fneur.2023.1097686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveTo explore the influence of the type of anterior clinoidal meningioma on surgical strategy planning, surgical approach selection, and postoperative efficacy.Patients and methodsWe conducted a retrospective analysis of the clinical data of 63 cases, including data on visual function, extent of tumor resection, and postoperative follow-up. Grade I and II approaches were selected according to the type of tumor. A univariate analysis of the factors influencing the extent of tumor resection, postoperative visual function, and postoperative relapse and complications was conducted.ResultsSimpson Grade I–II total resection was seen in 48 cases (76.2%), with an overall relapse/progression rate of 12.7%. The tumor type and texture and the relationship between the tumors and adjacent structures were the main factors influencing total tumor resection (P < 0.01). The overall postoperative visual acuity improvement, stabilization rate, and deterioration rate were 76.2, 15.9, and 7.9%, respectively. Postoperative visual acuity level was significantly correlated with preoperative visual acuity level and tumor type (P < 0.01).ConclusionsDetermining the type of tumor at a preoperative level and whether the optic canal and cavernous sinus are invaded can aid in the planning of detailed individualized surgical strategies.
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Affiliation(s)
- Li-Hua Chen
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Neurosurgery, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- *Correspondence: Li-Hua Chen
| | - Yong Xia
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Neurosurgery, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Fan Wei
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Neurosurgery, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Kai Sun
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong-Zhi Huang
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Neurosurgery, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Ru-Xiang Xu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Neurosurgery, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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Godano U. Letter to the Editor regarding "Supraorbital Keyhole Craniotomy via Eyebrow Incision: A Systematic Review and Meta-Analysis". World Neurosurg 2022; 166:296-300. [PMID: 36192856 DOI: 10.1016/j.wneu.2022.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Umberto Godano
- Department of Neurosurgery, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
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Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2021; 163:3387-3400. [PMID: 34398339 PMCID: PMC8599327 DOI: 10.1007/s00701-021-04964-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/04/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The optimal management of clinoidal meningiomas (CMs) continues to be debated. METHODS We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of these tumors. The data from the literature along with contemporary practice patterns were discussed within the task force to generate consensual recommendations. RESULTS AND CONCLUSION This article represents the consensus opinion of the task force regarding pre-operative evaluations, patient's counselling, surgical classification, and optimal surgical strategy. Although this analysis yielded only Class B evidence and expert opinions, it should guide practitioners in the management of patients with clinoidal meningiomas and might form the basis for future clinical trials.
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El-Bahy K, Ibrahim AM, Abdelmohsen I, Sabry HA. Extradural anterior clinoidectomy in surgical management of clinoidal meningiomas. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our institution experience in the surgical treatment of anterior clinoidal meningiomas highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection. This is a prospective observational study conducted on 33 consecutive patients with clinoidal meningiomas. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications.
Results
The study included 5 males and 28 females with mean age 49.48 ± 11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), and cavernous sinus invasion in 8 (24.2%). Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient (3%) suffered postoperative new visual deterioration. Gross total resection was achieved in 24 patients (72.7%). The main factors precluding total removal were cavernous sinus involvement and ICA encasement. Mortality rate was 6.1%; mean follow-up period was 27 ± 13 months.
Conclusions
In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved the extent of resection in clinoidal meningioma patients.
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Balasa A, Hurghis C, Tamas F, Chinezu R. Surgical Strategies and Clinical Outcome of Large to Giant Sphenoid Wing Meningiomas: A Case Series Study. Brain Sci 2020; 10:brainsci10120957. [PMID: 33317116 PMCID: PMC7764378 DOI: 10.3390/brainsci10120957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
Large to giant sphenoid wing meningiomas (SWMs) remain surgically challenging due to frequent vascular encasement and a tendency for tumoral invasion of the cavernous sinus and optic canal. We aimed to study the quality of resection, postoperative clinical evolution, and recurrence rate of large SWMs. This retrospective study enrolled 21 patients who underwent surgery between January 2014 and December 2019 for SWMs > 5 cm in diameter (average 6.3 cm). Tumor association with cerebral edema, extension into the cavernous sinus or optic canal, degree of encasement of the major intracranial arteries, and tumor resection grade were recorded. Cognitive decline was the most common symptom (65% of patients), followed by visual decline (52%). Infiltration of the cavernous sinus and optical canal were identified in five and six patients, respectively. Varying degrees of arterial encasement were seen. Gross total resection was achieved in 67% of patients. Long-term follow-up revealed improvement in 17 patients (81%), deterioration in two patients (9.5%), and one death (4.7%) directly related to the surgical procedure. Seven patients displayed postoperative tumor progression and two required reintervention 3 years post initial surgery. Tumor size, vascular encasement, and skull base invasion mean that, despite technological advancements, surgical results are dependent on surgical strategy and skill. Appropriate microsurgical techniques can adequately solve arterial encasement but tumor progression remains an issue.
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Affiliation(s)
- Adrian Balasa
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Tîrgu Mureș, Romania; (A.B.); (C.H.); (F.T.)
- Department of Neurosurgery, Tîrgu Mureș Emergency Clinical County Hospital, 540136 Tîrgu Mureș, Romania
| | - Corina Hurghis
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Tîrgu Mureș, Romania; (A.B.); (C.H.); (F.T.)
- Department of Neurosurgery, Tîrgu Mureș Emergency Clinical County Hospital, 540136 Tîrgu Mureș, Romania
| | - Flaviu Tamas
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Tîrgu Mureș, Romania; (A.B.); (C.H.); (F.T.)
- Department of Neurosurgery, Tîrgu Mureș Emergency Clinical County Hospital, 540136 Tîrgu Mureș, Romania
| | - Rares Chinezu
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Tîrgu Mureș, Romania; (A.B.); (C.H.); (F.T.)
- Department of Neurosurgery, Tîrgu Mureș Emergency Clinical County Hospital, 540136 Tîrgu Mureș, Romania
- Correspondence:
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Wong AK, Eddelman DB, Kramer DE, Munich SA, Byrne RW. Surgical Resection of Clinoidal Meningiomas without Routine Use of Clinoidectomy. World Neurosurg 2020; 146:e467-e472. [PMID: 33130137 DOI: 10.1016/j.wneu.2020.10.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Meningiomas of the anterior clinoid process (ACP) present significant surgical challenges given their anatomic relation to critical neurovascular structures. Routine anterior clinoidectomy is often described as a critical step in the resection of these tumors to reduce recurrence and improve visual outcomes. Anterior clinoidectomy, however, is not without risk and its benefits have not been clearly delineated. We present the outcomes of our series of surgically managed ACP meningiomas in which an anterior clinoidectomy was not routinely employed. METHODS A retrospective review of all ACP meningiomas operated on between August 1997 and March 2019 was conducted. Patients with a recurrent tumor or with <6 months of follow-up were excluded. Resection was typically carried out via a frontotemporal craniotomy followed by intradural removal of the tumor. Anterior clinoidectomy was only performed if hyperostosis of the ACP caused mass effect on the optic nerve. RESULTS Twenty-nine patients were included in this study. Anterior clinoidectomy was performed in 3 patients (10.3%). Gross total resection was achieved in 22 patients (75.9%). Of the 21 patients (72.4%) who presented with visual deficits, vision improved in 18 patients (85.7%) and worsened in 2 (9.5%). Tumor recurrence occurred in 5 patients (17.2%) at a mean follow-up of 64.9 months. Perioperative morbidity was 10.3%. Permanent morbidity and mortality were 6.9% (vision deterioration) and 0%, respectively. CONCLUSIONS Resection of ACP meningiomas without routine anterior clinoidectomy minimizes potential risk while achieving gross total resection, recurrence, and visual improvement rates comparable with those in previously reported series.
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Affiliation(s)
- Andrew K Wong
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | | | - Dallas E Kramer
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | - Stephan A Munich
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA.
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Xu T, Yan Y, Evins AI, Gong Z, Jiang L, Sun H, Cai L, Wang H, Li W, Lu Y, Zhang M, Chen J. Anterior Clinoidal Meningiomas: Meningeal Anatomical Considerations and Surgical Implications. Front Oncol 2020; 10:634. [PMID: 32547937 PMCID: PMC7278713 DOI: 10.3389/fonc.2020.00634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/06/2020] [Indexed: 01/20/2023] Open
Abstract
Objective: Surgical removal of anterior clinoidal meningiomas (ACMs) remains a challenge because of its complicated relationship with surrounding meninges, major arteries and cranial nerves. This study aims to define the meningeal structures around the anterior clinoid process (ACP) and its surgical implications. Methods: Five dry skulls and 19 cadavers were used in the anatomical study. Cadavers were prepared as transverse, coronal, and sagittal plastinated sections, and the meningeal architecture around the ACP was studied with dissecting and confocal microscopies. The database of meningiomas in one single center was retrospectively reviewed, and the patients with ACMs were collected for clinical analysis. Results: The superior, lateral, medial surfaces, and the tip of ACP were covered by different layers and types of meninges. The ACMs were classified into four main types based on the sites of origin, possible extending pathways following meningeal dura. In the retrospective cohort of 131 ACMs, the percentage of types I, IIa, IIb, III, and IV were 42.0% (55/131), 19.8% (26/131), 9.2% (12/131), 16.8% (22/131), and 12.2% (16/131), respectively. We found that types IIa and I had higher chances for achieving Simpson grade 1–2 resection (92.3 and 85.4%, respectively), followed by type III (54.5%) and type IV (31.3%), while type IIb showed little chance of Simpson grade 1–2 resection. Univariate and multivariate analyses revealed ACM classification and tumor size (<3 cm) to be independent risk factors for achieving more extensive resection. Conclusion: The meningeal architecture around the ACP may guide and determine the origin and extension of ACMs. The classification based on the meningeal architecture helps to understand surgical anatomy as well as predicting surgical outcomes.
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Affiliation(s)
- Tao Xu
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yong Yan
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Alexander I Evins
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States
| | - Zhenyu Gong
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lei Jiang
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Huaiyu Sun
- Department of Neurosurgery, Tiemei General Hospital, Liaoning, China
| | - Li Cai
- Arkansas Neuroscience Institute, St. Vincent Hospital, Little Rock, AR, United States
| | - Hongxiang Wang
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Weiqing Li
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yicheng Lu
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Juxiang Chen
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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Low Expression of Phosphatase and Tensin Homolog and High Expression of Ki-67 as Risk Factors of Prognosis in Cranial Meningiomas. World Neurosurg 2019; 136:e196-e203. [PMID: 31887465 DOI: 10.1016/j.wneu.2019.12.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the expression characteristics, correlations with clinical factors, and prognostic values of phosphatase and tensin homolog (PTEN) and Ki-67 in cranial meningiomas. METHODS The expression of PTEN and Ki-67 at the mRNA level was analyzed in 34 frozen meningiomas. Clinical data collection, follow-up, correlations, and survival analyses were performed. RESULTS Twenty-two men and 12 women were included in the study, with a median age of 52.72 ± 11.72 years on admission. The average expression levels of PTEN and Ki-67 were 2.71 ± 1.73 and 0.50 ± 0.57, respectively. The World Health Organization grade III meningiomas exhibited significantly lower levels of PTEN (P = 0.037), whereas grade I meningiomas expressed significantly lower levels of Ki-67 (P = 0.001). For recurrent lesions, the mean Ki-67 expression level was 0.97 ± 0.76, which was significantly greater than that of primary meningiomas with a mean value of 0.25 ± 0.13 (P < 0.001). The Ki-67 expression level was positively correlated with the tumor volume (P < 0.01) and negatively correlated with preoperative Karnofsky Performance Status scale (KPS, P < 0.01), postoperative KPS (P < 0.05), and follow-up KPS (P < 0.01). However, the PTEN expression level did not correlate with these variables. Based on the multivariate Cox analysis, Ki-67 expression level (P < 0.001, hazard ratio [HR] 8.16, 95% confidence interval [CI] 2.86-23.29), and PTEN expression level (P = 0.018, HR 0.47, 95% CI 0.25-0.88) were independent prognostic factors for tumor recurrence. Ki-67 (P = 0.001, HR 19.73, 95% CI 3.65-106.61) and PTEN expression levels (P = 0.024, HR 0.36, 95% CI 0.15-0.88) were also independent prognostic factors for mortality. CONCLUSIONS A low PTEN expression and a high Ki-67 expression could predict malignancy in cranial meningiomas.
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Surgery for Clinoidal Meningiomas: Case Series and Meta-Analysis of Outcomes and Complications. World Neurosurg 2019; 129:e700-e717. [DOI: 10.1016/j.wneu.2019.05.253] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/25/2023]
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Ma J, Li D, Chen Y, Zhang Y, Song L, Tian K, Yang Y, Chen L, Weng J, Cao X, Hao S, Wang L, Wu Z, Zhang J. Low Transforming Growth Factor–β3 Expression Predicts Tumor Malignancy in Meningiomas. World Neurosurg 2019; 125:e353-e360. [DOI: 10.1016/j.wneu.2019.01.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
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Corniola MV, Lemée JM, Da Broi M, Joswig H, Schaller K, Helseth E, Meling TR. Posterior fossa meningiomas: perioperative predictors of extent of resection, overall survival and progression-free survival. Acta Neurochir (Wien) 2019; 161:1003-1011. [PMID: 30859321 DOI: 10.1007/s00701-019-03862-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior fossa meningiomas (PFMs) often represent surgical challenges due to their proximity to neurovascular structures. Factors predicting the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS) were identified and integrated in a prediction tool to offer evidence-based personalized therapeutic strategies. METHODS All meningiomas managed surgically from 1990 to 2010 from a single-center were reviewed. A classification tree was created using the classification and regression tree recursive partitioning analysis that incorporated patient and tumor data available before surgery in order to predict the rates of gross total resection (GTR). RESULTS A total of 198 patients were identified (female-to-male ratio, 2.7; mean age, 59.1 years) and compared with 1271 supratentorial meningiomas (STMs) operated in the same institution during the same time period. GTR was achieved less often (59.6% versus 81.9%; p < 0.01) in PFMs than STMs. Preoperative neurological symptoms were predictive of higher Simpson grades (OR, 2.19 [1.05; 4.58]; p = 0.04). Age was associated with reduced OS (OR, 1.08 [1.04;1.12]; p < 0.001). A KPS ≥ 70 was associated with higher survival rates (OR, 2.70 [2.19;2.92]; p = 0.02). Higher WHO grades were associated with reduced OS (OR, 3.56 [1.02;12.47]; p = 0.05). The GTR rate varies from 80% in patients without a preoperative deficit to 40% patients with a preoperative deficit, younger than 60 years old, and with adjacent bone invasion. CONCLUSIONS This study provides a classification tree of the predictors of EOR in PFMs, based upon preoperative demographic, clinical, and radiological variables. An evidence-based management protocol with estimated EORs may guide the decision-making process in PFMs.
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Affiliation(s)
- Marco V Corniola
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland.
| | - Jean-Michel Lemée
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland
| | | | - Holger Joswig
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland
| | - Karl Schaller
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eirik Helseth
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205, Genève, Switzerland
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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Preoperative embolization of skull base meningiomas: A systematic review. J Clin Neurosci 2019; 59:259-264. [DOI: 10.1016/j.jocn.2018.06.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/06/2018] [Indexed: 11/18/2022]
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Tullos HJ, Conner AK, Baker CM, Briggs RG, Burks JD, Glenn CA, Strickland AE, Rahimi M, Sali G, Sughrue ME. Mini-Pterional Craniotomy for Resection of Parasellar Meningiomas. World Neurosurg 2018; 117:e637-e644. [DOI: 10.1016/j.wneu.2018.06.103] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022]
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Pojskić M, Zbytek B, Arnautović KI. Anterior Clinoid Metastasis Removed Extradurally: First Case Report. J Neurol Surg Rep 2018; 79:e55-e62. [PMID: 29868330 PMCID: PMC5980493 DOI: 10.1055/s-0038-1655773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 04/10/2018] [Indexed: 01/31/2023] Open
Abstract
Background
We report a case of isolated metastasis on the anterior clinoid process (ACP) mimicking meningioma.
Clinical Presentation
A 58-year-old male presented with headaches, right-sided visual disturbances, and blurred and double vision. The cause of double vision was partial weakness of the right III nerve, resulting from compression of the nerve by “hypertrophied” tumor-involved right anterior clinoid. Medical history revealed two primary malignant tumors—male breast cancer and prostate cancer (diagnosed 6 and 18 months prior, respectively). The patient was treated with chemotherapy and showed no signs of active disease, recurrence, or metastasis. Postcontrast head magnetic resonance imaging (MRI) showed extra-axial well-bordered enhancing mass measuring 1.6 × 1.1 × 1 × 1 cm (anteroposterior, transverse, and craniocaudal dimensions) on the ACP, resembling a clinoidal meningioma. Extradural clinoidectomy with tumor resection was performed via right orbitozygomatic pretemporal skull base approach. Visual symptoms improved. Follow-up MRI showed no signs of tumor residual or recurrence.
Conclusion
This is the first case report of a metastasis of any kind on ACP. Metastasis should be included as a part of the differential diagnosis of lesions of the anterior clinoid. Extradural clinoidectomy is a safe and effective method in the treatment of these tumors.
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Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, Philipps University of Marburg, Marburg, Germany
| | - Blazej Zbytek
- Department of Pathology and Laboratory Medicine, Center for Adult Cancer Research, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Pathology Group of the MidSouth, Memphis, Tennessee, United States
| | - Kenan I Arnautović
- Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, United States.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
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Frozen Section Can “Sharpen” or “Sand Off” the Surgeon's Knife: 2 Case Illustrations with Skull Base Meningioma Mimics. World Neurosurg 2017; 107:1051.e1-1051.e6. [DOI: 10.1016/j.wneu.2017.08.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
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