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Dang DD, Mugge LA, Awan OK, Gong AD, Fanous AA. Spinal Meningiomas: A Comprehensive Review and Update on Advancements in Molecular Characterization, Diagnostics, Surgical Approach and Technology, and Alternative Therapies. Cancers (Basel) 2024; 16:1426. [PMID: 38611105 PMCID: PMC11011121 DOI: 10.3390/cancers16071426] [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: 02/04/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Spinal meningiomas are the most common intradural, extramedullary tumor in adults, yet the least common entity when accounting for all meningiomas spanning the neuraxis. While traditionally considered a benign recapitulation of their intracranial counterpart, a paucity of knowledge exists regarding the differences between meningiomas arising from these two anatomic compartments in terms of histopathologic subtypes, molecular tumor biology, surgical principles, long-term functional outcomes, and recurrence rates. To date, advancements at the bench have largely been made for intracranial meningiomas, including the discovery of novel gene targets, DNA methylation profiles, integrated diagnoses, and alternative systemic therapies, with few exceptions reserved for spinal pathology. Likewise, evolving clinical research offers significant updates to our understanding of guiding surgical principles, intraoperative technology, and perioperative patient management for intracranial meningiomas. Nonetheless, spinal meningiomas are predominantly relegated to studies considering non-specific intradural extramedullary spinal tumors of all histopathologic types. The aim of this review is to comprehensively report updates in both basic science and clinical research regarding intraspinal meningiomas and to provide illustrative case examples thereof, thereby lending a better understanding of this heterogenous class of central nervous system tumors.
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Affiliation(s)
- Danielle D. Dang
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Luke A. Mugge
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Omar K. Awan
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Andrew D. Gong
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Andrew A. Fanous
- Department of Neurosurgery, Inova Alexandria Hospital, Alexandria, VA 22304, USA
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Sato Y, Mitsuya K, Kakuda Y, Oishi T, Deguchi S, Sugino T, Akiyama Y, Nagashima T, Urakami K, Shimoda Y, Ohshima K, Hayashi N, Yamaguchi K. A Primary Intraosseous Meningioma: A Rare Case of Malignancy with High Proliferative Ability. J Neurol Surg Rep 2023; 84:e103-e108. [PMID: 37901278 PMCID: PMC10611535 DOI: 10.1055/a-2161-7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/06/2023] [Indexed: 10/31/2023] Open
Abstract
Primary intraosseous meningioma (PIM) is a rare tumor that arises in the skull. Histopathologically, it is generally described as a slow-growing, benign lesion. However, on rare occasions, PIM presents as a malignancy with high proliferative ability, which requires maximal resection, adjuvant radiotherapy, and subsequent careful follow-up. Because of the rarity of such cases, they present a diagnostic challenge with unusual pathological findings. Herein, we report a case of a primary intraosseous anaplastic meningioma with extensive invasion inside and outside the skull, along with the results of whole-genome analysis. Histopathological diagnosis was a World Health Organization grade 3 anaplastic meningioma. In the literature, only two cases of anaplastic PIM have been reported, so its characteristics and treatment are poorly understood. Our patient was successfully treated with tumor resection, followed by intensity-modulated radiation therapy. Follow-up imaging studies revealed no recurrence or distant metastasis, including to lung, liver, and bone, at 8 months after the surgery.
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Affiliation(s)
- Yoshiki Sato
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Koichi Mitsuya
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Yuko Kakuda
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Takuma Oishi
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Shoichi Deguchi
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Takashi Sugino
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Yasuto Akiyama
- Division of Immunotherapy, Shizuoka Cancer Center Research Institute, Nagaizumi, Shizuoka, Japan
| | - Takeshi Nagashima
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Nagaizumi, Shizuoka, Japan
- SRL, Tokyo, Japan
| | - Kenichi Urakami
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Nagaizumi, Shizuoka, Japan
| | - Yuji Shimoda
- Division of Immunotherapy, Shizuoka Cancer Center Research Institute, Nagaizumi, Shizuoka, Japan
- SRL, Tokyo, Japan
| | - Keiichi Ohshima
- Division of Medical Genetics Division, Shizuoka Cancer Center Research Institute, Nagaizumi, Shizuoka, Japan
| | - Nakamasa Hayashi
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
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Benign Meningioma With Rare Radiological and Behavioral Features. J Craniofac Surg 2022; 33:e837-e840. [PMID: 35882350 DOI: 10.1097/scs.0000000000008766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Meningiomas are usually dura-based primary nonmalignant neoplasms of the central nervous system. It is extremely rare that a meningioma is located at the convexity of the brain, but shows no dura attachment and causes osteolysis of the skull. CASE PRESENTATION A 57-year-old woman presented with an incidentally discovered scalp lump on the head. Neurological deficits were not found. Radiological examination revealed a localized osteolytic lesion in the right parietal bone, which was initially diagnosed as a bone tumor and was surgically resected. At surgery, a tumor mass was found located at the brain convexity without dura attachment. It was tightly attached to the brain parenchyma and had no distinct boundary from the brain. The mass was rather small, but resulted in significant osteolysis of the skull and destruction of the dura. Simpson grade I resection of the tumor was performed. Histological and immunohistochemical results indicated a meningothelial meningioma. CONCLUSIONS Both preoperative and intraoperative diagnoses are difficult for this case. Knowledge of this case is crucial for clinicians to be aware of this entity because it can be easily confused with bone tumors. Further research on the relationship between meningioma and bone metabolism is required to investigate the mechanism of osteolysis.
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Ahmed N, Ferini G, Haque M, Umana GE, Scalia G, Chaurasia B, Vats A, Rahman A. Primary Intraosseous Osteolytic Meningioma with Aggressive Clinical Behaviour: Clinico-Pathologic Correlation and Proposed New Clinical Classification. Life (Basel) 2022; 12:life12040548. [PMID: 35455037 PMCID: PMC9025523 DOI: 10.3390/life12040548] [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: 12/31/2021] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Introduction: Primary intraosseous osteolytic meningiomas (PIOM) are non-dural-based tumors predominantly presenting an osteolytic component with or without hyperostotic reactions. They are a subset of primary extradural meningiomas (PEM). In this study, we present a peculiar case with a systematic literature review and propose a new classification considering the limitations of previous classification systems. (2) Materials and Methods: Using a systematic search protocol in Google Scholar, PubMed, and Scopus databases, we extracted all case studies on PIOM published from inception to December 2020. A 46-year-old female patient form Dhaka, Bangladesh, was also described. The search protocol was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. (3) Results: Here, we present a 46-year-old female patient with PIOM who successfully underwent bifrontal craniotomy and gross total removal (GTR) of the tumor. At 6-month follow-up, no tumor recurrence was shown. Including our new case, 55 total cases from 47 articles were included in the analysis. PIOMs were in closer frequency among males (56.4%) and females (43.6%). The most common tumor location was the frontal and parietal calvarium, most commonly in the frontal bone (29.1%). Surgical resection was the predominant modality of treatment (87.3%); only 1.8% of patients were treated with radiotherapy, and 5.4% received a combination of surgery and radiotherapy. Gross total resection (GTR) was achieved in 80% of cases. Extracranial extension was reported in 41.8% of cases, dural invasion in 47.3%, and recurrence in 7.3%. Whole-body 68 Ga-DOTATOC PET/CT has also been reported as a useful tool both for differential diagnosis, radiotherapy contouring, and follow-up. Current treatments such as hydroxyurea and bevacizumab have variable success rates. We have also suggested a new classification which would provide a simple common ground for further research in this field. (4) Conclusions: Surgical resection, especially GTR, is the treatment of choice for PIOM, with a high GTR rate and low risk of complications and mortality. More research is needed on the differential diagnosis and specific treatment of PIOM.
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Affiliation(s)
- Nazmin Ahmed
- Department of Neurosurgery, Ibrahim Cardiac Hospital and Research Institute (A Centre for Cardiovascular, Neuroscience and Organ Transplant Units), Shahbag, Dhaka 1000, Bangladesh;
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Catania, Italy;
| | - Moududul Haque
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh; (M.H.); (A.R.)
| | - Giuseppe Emmanuele Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95100 Catania, Italy
- Correspondence:
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95126 Catania, Italy;
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj 44300, Nepal;
| | - Atul Vats
- Neurosurgery Department, James Cook University Hospital, Middlesbrough TS4 3BW, UK;
| | - Asifur Rahman
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh; (M.H.); (A.R.)
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Kumar M, Joshi A, Meena RK, Nalin S. Atypical intradiploic meningioma: A case report and review of the literature. Surg Neurol Int 2022; 13:46. [PMID: 35242412 PMCID: PMC8888296 DOI: 10.25259/sni_774_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Intradiploic meningiomas with osteolytic bony changes are rarely reported in the literature. Intradiploic meningiomas are usually slow-growing benign lesions but atypical histopathology predicts aggressive behavior. Atypical intradiploic meningiomas (WHO Grade II) have some controversies in the management which are highlighted in this article. Case Description: A 40-year-old male, with a history of trauma to the head 12 years back, presented with a hard, slow-growing painless swelling exactly at the site of trauma. On imaging, lesion was intradiploic one with osteolytic margins and homogeneously enhancing on contrast magnetic resonance imaging. Biopsy was that of atypical meningioma (WHO Grade II). Conclusion: Atypical meningiomas with osteolytic changes are rarely reported in the literature. Because of potential aggressive behavior, they need a regular follow-up with radiological imaging.
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Affiliation(s)
- Mukesh Kumar
- Department of Neurosurgery, Dr. Rajendra Prasad Government Medical College, Tanda Medical College, Kangra, Himachal Pradesh, India
| | - Amit Joshi
- Department of Neurosurgery, Dr. Rajendra Prasad Government Medical College, Tanda Medical College, Kangra, Himachal Pradesh, India
| | - Rajesh Kumar Meena
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shrish Nalin
- Department of Neurosurgery, Dr. Rajendra Prasad Government Medical College, Tanda Medical College, Kangra, Himachal Pradesh, India
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Delgado R, Bahmad HF, Bhatia V, Kantrowitz AB, Vincentelli C. Intraosseous meningioma mimicking osteosarcoma. Autops Case Rep 2021; 11:e2021332. [PMID: 34805004 PMCID: PMC8597780 DOI: 10.4322/acr.2021.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022]
Abstract
Background Predominantly intraosseous meningiomas are rare entities that include true primary intraosseous meningiomas (PIM), as well as meningiomas that may show extensive bone involvement, such as en plaque meningiomas. Different hypotheses have been proposed to decipher the origin of PIMs, such as ectopic arachnoid cap cell entrapment during birth or after trauma. Surgical resection is the treatment of choice of such lesions. Case presentation We present a case of a 65-year-old man with an enlarging mass in the parieto-occipital region that grew slowly and progressively over 13 years, following head trauma during a motor vehicle accident. One year prior to presentation, he started experiencing daily holocranial headaches and blurry vision. CT and MRI studies revealed a permeative midline calvarial lesion measuring 14 cm in greatest dimension with extensive periosteal reaction, extension into the subcutaneous soft tissues, subjacent dural thickening and intracranial extension with invasion of the superior sagittal sinus. The favored pre-operative clinical diagnosis was osteosarcoma. The abnormal calvarium was excised and histopathological examination confirmed the diagnosis of a predominantly intraosseous calvarial meningioma, WHO grade I. Conclusions The present case highlights the importance of histopathologic diagnosis in guiding therapeutic decisions and reiterates the necessity of considering PIM or meningiomas with extensive intraosseous component in the differential diagnosis of calvarial masses, even when imaging suggests a neoplasm with aggressive behavior, such as osteosarcoma.
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Affiliation(s)
- Ruben Delgado
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Hisham F Bahmad
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Vinay Bhatia
- Mount Sinai Medical Center, Department of Diagnostic Radiology, Miami Beach, FL, USA
| | - Allen B Kantrowitz
- Mount Sinai Medical Center, Division of Neurosurgery, Miami Beach, FL, USA
| | - Cristina Vincentelli
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA.,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
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Ho UC, Chang K, Lin YH, Huang YC, Tsuang FY. Primary intraosseous meningioma of the vertebra: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21362. [PMID: 35855279 PMCID: PMC9281493 DOI: 10.3171/case21362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary intraosseous meningiomas (PIMs) are rare, and PIMs of the vertebrae have not yet been reported. The authors report a case of primary meningioma arising from the vertebrae. OBSERVATIONS A 49-year-old man presented with lower back pain and numbness in both lower extremities. Lumbar spine magnetic resonance imaging revealed an L2 pathological fracture with epidural and paraspinal invasion. The patient had undergone a first palliative decompression and fixation surgery, and the diagnosis turned out to be a World Health Organization grade III anaplastic meningioma based on histopathology. The tumor had progressed after first operation and radiation therapy, and the patient was referred to the authors’ institute for excision. The patient had an uneventful postoperative course after a revisional total en bloc spondylectomy of L2. LESSONS The authors present a rare case of PIM of the vertebrae with epidural and paraspinal invasion. Careful preoperative assessment and surgical planning is crucial for successful patient management.
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Affiliation(s)
- Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, and
| | | | - Yen-Heng Lin
- Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yu-Cheng Huang
- Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
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Intraosseous metaplastic meningioma: A case report. Radiol Case Rep 2021; 16:3300-3303. [PMID: 34484535 PMCID: PMC8403703 DOI: 10.1016/j.radcr.2021.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 01/03/2023] Open
Abstract
Metaplastic meningioma is a rare World Health Organization Grade I meningioma subtype, accounting for 0.2%-1.6% of all meningiomas. Primary extradural meningiomas represent less than 2% of all meningiomas, with intraosseous meningioma as a subtype of primary extradural meningiomas. Herein, we report the case of a 65-year-old male presenting with headache. His computed tomography scans showed an osteolytic left parietal bone mass, and magnetic resonance imaging revealed hyperintense dots in the mass on T1-weighted images. The mass was then resected and diagnosed on histopathological examination as an intraosseous metaplastic meningioma.
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Microsurgical Resection of a Primary Intraosseous Meningioma Encasing the Superior Sagittal Sinus. J Craniofac Surg 2021; 31:2012-2014. [PMID: 32657980 DOI: 10.1097/scs.0000000000006701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary intraosseous meningiomas (PIMs) are an infrequent variant of meningiomas characterized by hyperostosis and brain compression. En bloc surgical resection of giant PIMs involving critical structures such as venous sinuses or cranial nerves could be associated with significant morbidity. The objective of this report is to demonstrate the safety and feasibility of piecemeal resection of PIMs involving the superior sagittal sinus and frontal sinus. A 54-year-old female with a large 5 cm thick bifrontal primary intra-osseous meningioma encasing the anterior segment of the superior sagittal sinus and frontal sinus underwent a bifrontal craniotomy with piecemeal microsurgical resection of the lesion, complete frontal sinus exoneration, and a synthetic cranioplasty. Clinical outcome was measured by extent of resection, preservation of cortical draining veins and postoperative course. A Simpson grade I resection of the lesion was achieved following piecemeal resection of the giant PIM without clinical or radiographic evidence of venous infarct or injury. The postoperative course was uncomplicated, and the patient was discharged home 3 days after cranioplasty. A complete resection of a giant bifrontal PIM with superior sagittal sinus encasement and frontal sinus involvement can be achieved safely via a piecemeal approach without significant intra-operative morbidity.
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Guinto-Nishimura GY, Gómez-Amador JL, Kerik-Rotenberg N, Uribe-Pacheco R, Sangrador-Deitos MV, Martínez-Manrique JJ. 68Ga-DOTATOC-PET/CT-guided resection of a primary intraosseous meningioma: technical note. Neurosurg Focus 2021; 50:E6. [PMID: 33386007 DOI: 10.3171/2020.10.focus20771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
Primary intraosseous meningiomas (PIMs) are rare tumors that present with a variable radiological appearance and a clinical behavior that is considerably different from that of intracranial meningiomas. Treatment of PIMs consists of complete resection, which may be difficult to achieve due to the lack of clear tumor margins on conventional imaging studies. PET/CT using 68Ga-DOTA-conjugated peptides has been used for the diagnosis and treatment planning of different types of meningiomas due to these tracers' affinity to somatostatin receptors, which are found in most meningiomas. However, this imaging modality's use as an intraoperative adjunct has not been reported for PIMs. In this technical note, the authors describe a [68Ga-DOTA0-Tyr3]octreotide (68Ga-DOTATOC)-PET/CT-guided resection of a PIM. In this case, the area of increased uptake in the 68Ga-DOTATOC-PET/CT study extended well beyond the tumor margins identified on MRI. The patient's pathology report confirmed the presence of tumor cells within peripheral bone, which macroscopically appeared normal. The authors propose 68Ga-DOTATOC-PET/CT as a valuable adjunct in the surgical management of PIMs and offer a reasonable justification for its use based on current evidence. Its use for intraoperative image guidance may aid neurosurgeons in achieving a complete resection, thus minimizing the risk of recurrence of this complex pathological entity.
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Affiliation(s)
| | | | - Nora Kerik-Rotenberg
- 2PET/CT Unit, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
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