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Fiani B, Jarrah R, Bhandarkar AR, De Stefano F, Amare A, Aljameey UA, Reardon T. Peritumoral edema in meningiomas: pathophysiology, predictors, and principles for treatment. Clin Transl Oncol 2023; 25:866-872. [PMID: 36427121 DOI: 10.1007/s12094-022-03009-0] [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: 07/01/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Abstract
Meningiomas is a tumor of the meninges and is among the most common intracranial neoplasms in adults, accounting for over a third of all primary brain tumors in the United States. Meningiomas can be associated with peritumoral brain edema (PTBE) which if not managed appropriately can lead to poor clinical outcomes. In this review, we summarize the relevant pathophysiology, predictors, and principles for treatment of PTBE. The results of various case-reports and case-series have found that meningioma-associated PTBE have patterns in age, tumor size, and hormone receptor positivity. Our study describes how increased age, increased tumor size, tumor location in the middle fossa, and positive expression of hormone receptors, VEGF, and MMP-9 can all be predictors for worse clinical outcomes. We also characterize treatment options for PTBE such as glucocorticoids and VEGF inhibitors along with the ongoing clinical trials attempting to alleviate PTBE in meningioma cases. The trends summarized in this review can be used to better predict the behavior of meningioma-associated PTBE and establish prognosis models to identify at risk patients.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Weill Cornell Medical Center/NewYork Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA.
| | - Ryan Jarrah
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Frank De Stefano
- Department of Neurosurgery, University of Kansas Medical Center, Kansas, MO, USA
| | - Abrham Amare
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
| | - Usama A Aljameey
- Lincoln Memorial DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
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Atypical and Fibrous Meningioma with Differential Cerebral Blood Volume on Magnetic Resonance Imaging: A Case Report. J UOEH 2021; 43:415-419. [PMID: 34897170 DOI: 10.7888/juoeh.43.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Magnetic resonance imaging (MRI) features of meningiomas typically reveal a well-circumscribed and contrast-enhancing dural mass. Here we discuss the differences in MRI findings between typically benign and atypical meningioma, and their clinical implications. An MRI of a 67-year-old man revealed a substantial homogeneous enhancing tumor nodule. The MRI also showed two components in the tumor, and the regional cerebral blood volume (rCBV) was higher in the lateral than in the medial mass. A pathological examination also revealed features of both benign and atypical meningiomas. The Ki-67 labeling index was 1% on the medial side and 5% on the lateral side. There were clearly two components within the tumor mass, and the MRI revealed differential rCBV in the tumor. The results indicated a nontypical MRI of meningiomas, allowing for predictability of atypical meningiomas using MRI before surgical resection.
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Kulanthaivelu K, Lanka V, Chandran C, Nandeesh BN, Tiwari S, Mahadevan A, Prasad C, Saini J, Bhat MD, Chakrabarti D, Pruthi N, Vazhayil V, Sadashiva N, Srinivas D. Microcystic Meningiomas: MRI-Pathologic Correlation. J Neuroimaging 2020; 30:704-718. [PMID: 32521093 DOI: 10.1111/jon.12743] [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: 05/04/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND PURPOSE Microcystic meningiomas (MM) are a distinctive, rare subtype of Grade I meningiomas with limited radiological descriptions. We intend to identify unique imaging phenotypes and seek radiopathological correlations. METHODS Retrospective analysis of histopathologically proven MM was undertaken. Clinicodemographic profiles, imaging, and histopathological characteristics were recorded. Spearman rank correlations among radiological and pathological attributes were performed. RESULTS Twenty-eight cases were analyzed (mean age = 45.5 years; M:F = 1:1.54; mean volume = 50.1 mL; supratentorial n = 27). Most lesions were markedly T2 hyperintense (higher than peritumoral brain edema-a unique finding) (89.3%) and showed invariable diffusion restriction, severe peritumoral brain edema (edema index >2 in 64.3%), a "storiform" pattern on T2-weighted images (T2WI) (75%), reticular pattern on postcontrast T1 (78.6%)/diffusion-weighted images (DWI) (65.4%), hyperperfusion, T1 hypointensity (84.6%), and absence of blooming on susceptibility-weighted image (80.9%). Storiform/reticular morphology correlated with large cysts on histopathology (ρ = .56; P = .005753). Lesion dimension positively correlated with reticular morphology on imaging (ρ = .59; P = .001173), higher flow voids (ρ = .65; P = .00027), and greater microcystic changes on histopathology (ρ = .51; P = .006778). Peritumoral brain edema was higher for lesions demonstrating greater angiomatous component (ρ = .46; P = .014451). CONCLUSIONS We have elucidated varied neuroimaging features and highlighted pathological substrates of crucial imaging findings of MM. MM ought to be considered as an imaging possibility in an extra-axial lesion with a marked hypodensity on noncontrast computed tomography, markedly T2-hyperintense/T1-hypointense signal, and a storiform/reticular pattern on T2W/GdT1w//DWI.
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Affiliation(s)
- Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vivek Lanka
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Chitra Chandran
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bevinhalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Maya D Bhat
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Ye W, Ding-Zhong T, Xiao-Sheng Y, Ren-Ya Z, Yi L. Factors Related to the Post-operative Recurrence of Atypical Meningiomas. Front Oncol 2020; 10:503. [PMID: 32351890 PMCID: PMC7174970 DOI: 10.3389/fonc.2020.00503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
Aim: This study aimed to investigate the relationship between clinicopathological characteristics of atypical meningiomas (AM) and its post-operative recurrence. Materials and Methods: The clinicopathological characteristics and findings from follow up were retrospectively reviewed and compared between AM and benign meningioma (BM) patients. Univariate and multivariate analyses were employed to identify the factors related to the post-operative recurrence of AM. Results: More BM patients were females and received complete resection; the recurrence rate was significantly lower in BM patients as compared to AM patients. The progesterone receptor (PR), E-cadherin protein (E-Ca) and β-catenin positive rates and Ki67 labeling index were significantly different between two groups. Univariate analysis showed the age, tumor size, tumor invasiveness, E-Ca expression, and extent of resection were related to the post-operative recurrence of AM. However, multivariate analysis showed only the extent of resection and tumor invasiveness were the independent factors associated with the post-operative recurrence of AM. Conclusions: The extent of resection and tumor invasiveness are related to the post-operative recurrence of AM. To improve the surgical procedures to maximize the tumor resection is important to improve the prognosis of AM patients.
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Affiliation(s)
- Wu Ye
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Tang Ding-Zhong
- Department of Neurology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Yang Xiao-Sheng
- Department of Neurosurgery, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhan Ren-Ya
- Department of Neurosurgery, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | - Li Yi
- Department of Neurosurgery, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Thenier-Villa JL, Alejandro Galárraga Campoverde R, Ramón DE LA Lama Zaragoza A, Conde Alonso C. Predictors of Morbidity and Cleavage Plane in Surgical Resection of Pure Convexity Meningiomas Using Cerebrospinal Fluid Sensitive Image Subtraction Magnetic Resonance Imaging. Neurol Med Chir (Tokyo) 2016; 57:35-43. [PMID: 27580930 PMCID: PMC5243163 DOI: 10.2176/nmc.oa.2016-0169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Meningiomas are the most common primary intracranial tumors. Since the adhesions in the plane of dissection are of interest in surgical planning, we suggest that digital image subtraction of FLAIR data from the T2 sequence of MRI may represent better the CSF spaces in the brain–tumor interface and may be a predictor of the intraoperative cleavage plane. From 2006 to 2016, 83 convexity meningiomas were resected in the Department of Neurosurgery of the University Hospital Complex of Vigo, an analysis of preoperative MRI was performed to assess peritumoral edema (PTE), tumor volume, among others; a digital subtraction of T2-FLAIR sequences was performed and analyzed in relationship to the cleavage plane described in the intraoperative report and postoperative neurological deficits. Simpson grade 1 resection was achieved in 85.54%, the overall 5-year PFS was 93.75%. Our rate of permanent new neurological deficit was 4.82% and the overall complication rate of 14.46%. The grade of PTE was proportional to tumor volume, 20 ± 2.8, 30 ± 5.3, and 34 ± 4.3 cm3 for grades 1, 2, and 3, respectively, positive cleft sign on image subtraction was predictive of good intraoperative cleavage plane and low grade cleavage plane (P = 0.04), and was a protective factor for postoperative neurological deficit (P = 0.02). Positive cleft sign in T2-FLAIR digital subtraction image is an independent predictor of good intraoperative cleavage plane, PTE is an independent predictor of the bad cleavage plane. Negative cleft sign in the image subtraction and a bad intraoperative cleavage plane are predictors of postoperative neurological deficit.
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Sekine A, Satoh H, Iwasawa T, Tamura K, Hayashihara K, Saito T, Kato T, Arai M, Okudela K, Ohashi K, Ogura T. Prognostic factors for brain metastases from non-small cell lung cancer with EGFR mutation: influence of stable extracranial disease and erlotinib therapy. Med Oncol 2014; 31:228. [PMID: 25208818 DOI: 10.1007/s12032-014-0228-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/02/2014] [Indexed: 11/26/2022]
Abstract
The aim of this study was to explore prognostic factors for non-small cell lung cancer (NSCLC) patients with brain metastases (BM) on the basis of EGFR mutation status. Among 779 consecutive NSCLC patients who underwent EGFR mutation screening, all 197 patients with BM were divided according to the EGFR mutation status. The prognostic factors, including patient characteristics at the time of BM diagnosis, treatment history, and radiologic features, were analyzed. Of 197 patients with BM, 108 had wild-type EGFR and 89 had EGFR mutation. The patients with EGFR mutation presented longer overall survival after BM diagnosis (OS) than those with wild-type EGFR, regardless of whether BM was synchronous or metachronous. For the patients with EGFR mutation, favorable prognostic factors in multivariate analysis were age<65 (p=0.037), good performance status (PS) (p<0.0001), cranial radiotherapy (p=0.020), previous chemotherapy≤1 regimen (p=0.009), stable extracranial disease at BM diagnosis (p=0.022), and erlotinib therapy after BM diagnosis (p=0.0015). On the other hand, favorable prognostic factors for the patients with wild-type EGFR were only good PS (p=0.0037) and cranial radiotherapy (p=0.0005). Among patients treated with erlotinib after BM diagnosis, the patients with exon 19 deletion showed longer OS than those with exon 21 point mutation (p=0.019). The prognostic factors for NSCLC patients with BM were different according to the EGFR mutation status. Particularly in NSCLC patients with EGFR mutation and stable extracranial disease, regular cranial evaluation for detecting asymptomatic BM would lead to good prognosis. In addition, erlotinib therapy would be preferable in NSCLC patients with BM and EGFR mutation, especially those with exon 19 deletion.
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Affiliation(s)
- Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-ku, Yokohama, Japan,
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Lee KJ, Joo WI, Rha HK, Park HK, Chough JK, Hong YK, Park CK. Peritumoral brain edema in meningiomas: correlations between magnetic resonance imaging, angiography, and pathology. ACTA ACUST UNITED AC 2008; 69:350-5; discussion 355. [PMID: 18262249 DOI: 10.1016/j.surneu.2007.03.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 03/08/2007] [Indexed: 12/27/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the radiologic characteristics and pathology related to the formation of peritumoral edema in meningiomas. METHODS Seventy-nine patients with meningioma were examined by MRI and cerebral angiography. The predictive factors possibly related to peritumoral edema, such as patient age, sex, tumor location, tumor size, peritumoral rim (CSF cleft), shape of tumor margin, signal intensity of tumor in T2WI, pial blood supply, and pathology, were evaluated. We defined the edema-tumor volume ratio as EI and used this index to evaluate peritumoral edema. RESULTS Male sex (P = .009), tumor size (P = .026), signal intensity of tumor in T2WI (P = .016), atypical and malignant tumor (P = .004), and pial blood supply (P = .001) correlated with peritumoral edema on univariate analyses. However, in multivariate analyses, pial blood supply was statistically significant as a factor for peritumoral edema in meningioma (P = .029). Male sex (P = .067, P < .1) and hyperintensity in T2WI (P = .075, P < .1) might have statistical probability in peritumoral edema. CONCLUSIONS In our results, male sex, hyperintensity on T2WI, and pial blood supply were associated with peritumoral edema in meningioma that influence the clinical prognosis of patients.
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Affiliation(s)
- Kyung-Jin Lee
- Department of Neurosurgery, The Catholic University of Korea, Seoul, 150-713, South Korea
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Shaman MA, Zak IT, Kupsky WJ. Best cases from the AFIP: Involuted sclerotic meningioma. Radiographics 2003; 23:785-9. [PMID: 12740476 DOI: 10.1148/rg.233025122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark A Shaman
- Department of Diagnostic Radiology, Division of Neuroradiology, Wayne State University School of Medicine, DRH 3L8, 4201 St Antoine, Detroit, MI 48201, USA.
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