Prognostic factors for olfactory groove meningioma with nasal cavity extension

Nasofrontal meningiomas: retrospective series and review of literature

INTRODUCTION

Lesions affecting the anterior skull base and involving the paranasal sinuses (PNS), nasal cavity (NC), and orbit are infrequent and include predominantly a wide variety of sinonasal malignancies. Less than 3% of intracranial meningiomas extend extracranially and involve PNS and NC. Given their relatively low incidence, little is known about the treatment outcome of this subset of meningiomas.

METHODS

Systematic literature and retrospective review of own institutional series of midline anterior skull base meningiomas with significant PNS and NC involvement were performed.

RESULTS

Overall, 21 patients-16 in the literature review group and 5 of our institutional series-were included. Eleven (52.4%) patients had had a prior surgery for midline anterior skull base meningioma. Of patients having reported WHO grade, two were WHO II. Gross total resection was achieved in 16 (76.2%) of patients, utilizing solely transcranial approach in 15 patients, combined endoscopic and transcranial in five patients and purely endoscopic in one patient. Postoperative radiotherapy was administered in three (14.3%) patients, all after total resection via transcranial route, without a history of prior treatment. A postoperative cerebrospinal fluid leak was reported in four (10%) patients, requiring surgical repair in two. There were no reports of postoperative meningitis. No neurological complications were observed except of a reported worsening of vision in one patient.

CONCLUSION

Midline anterior skull base meningiomas infrequently extend significantly into the PNS and NC. Despite their significant involvement, along with concomitant involvement of orbit, gross total resection is possible in the majority of cases with low morbidity using either purely transcranial or combined endoscopic/transcranial approach.

Skull Base Meningiomas

Skull base meningiomas are among the most challenging meningiomas to treat clinically due to their deep location, involvement or encasement of adjacent essential neurovascular structures (such as key arteries, cranial nerves, veins, and venous sinuses), and their often-large size prior to diagnosis. Although multimodal treatment strategies continue to evolve with advances in stereotactic and fractionated radiotherapy, surgical resection remains the mainstay of treatment for these tumors. Resection of these tumors however is challenging from a technical standpoint, and requires expertise in several skull-base surgical approaches that rely on adequate bony removal, minimization of brain retraction, and respect for nearby neurovascular structures. These skull base meningiomas originate from a variety of different structures including, but are not limited to: the clinoid processes, tuberculum sellae, dorsum sellae, sphenoid wing, petrous/petroclival area, falcotentorial region, cerebellopontine angle, and foramen magnum. In this chapter, we will cover the common anatomical areas in the skull base from which these tumors arise, and the specific or optimal surgical approaches and other treatment modalities for meningiomas in these such locations.

Olfactory groove meningioma: A case report with typical clinical and radiologic features in a 74-year-old Nigerian male

Olfactory groove meningiomas (OGMs) are rare, intracranial tumors located in the anterior cranial fossa that grow along the nerves between the brain and the nose. This report highlights a case in which a 74-year-old Nigerian male presented with clinical features of anosmia and headache as well as pertinent CT and MRI findings that typically occur in female patients. The study reviews the importance of imaging as a means of achieving a timely diagnosis and accurately measuring the size and magnitude of the disease as it serves as a guide to surgeons when planning for intervention.

Cognitive Changes in a Commercial Pilot Secondary to an Olfactory Meningioma

BACKGROUND: Olfactory meningiomas are typically benign, slow-growing intracranial tumors with subtle presentations that result in delayed diagnosis. To date, only a few published reports describe meningiomas in airmen. None specifically mention olfactory meningiomas or detail the associated presence of cognitive impairment.CASE REPORT: This was a 55-yr-old commercial pilot with over 20 yr of flight experience who presented for a fitness-for-duty evaluation due to alarming performance at work and neurocognitive concerns. On examination, the patient had an odd affect and anosmia. Imaging showed a large, frontal, midline intracranial mass consistent with an olfactory meningioma.DISCUSSION: Fitness-for-duty cases are often challenging and even more so when neurocognition is called into question. Symptoms may be subtle and gradual in onset, making recognition and diagnosis difficult. Dementia, alcohol or substance misuse/abuse, and psychiatric diagnoses are often the first conditions considered when evaluating new cognitive impairment in a pilot. This case highlights the importance of keeping a broad differential, including intracranial masses, conducting a thorough neurological examination, and the judicious use of brain imaging.Hong M, Kreykes AJ. Cognitive changes in a commercial pilot secondary to an olfactory meningioma. Aerosp Med Hum Perform. 2020; 91(12):966969.

Long Non-Coding RNAs As Epigenetic Regulators in Cancer

Long noncoding RNAs (lncRNAs) constitute large portions of the mammalian transcriptome which appeared as a fundamental player, regulating various cellular mechanisms. LncRNAs do not encode proteins, have mRNA-like transcripts and frequently processed similar to the mRNAs. Many investigations have determined that lncRNAs interact with DNA, RNA molecules or proteins and play a significant regulatory function in several biological processes, such as genomic imprinting, epigenetic regulation, cell cycle regulation, apoptosis, and differentiation. LncRNAs can modulate gene expression on three levels: chromatin remodeling, transcription, and post-transcriptional processing. The majority of the identified lncRNAs seem to be transcribed by the RNA polymerase II. Recent evidence has illustrated that dysregulation of lncRNAs can lead to many human diseases, in particular, cancer. The aberrant expression of lncRNAs in malignancies contributes to the dysregulation of proliferation and differentiation process. Consequently, lncRNAs can be useful to the diagnosis, treatment, and prognosis, and have been characterized as potential cancer markers as well. In this review, we highlighted the role and molecular mechanisms of lncRNAs and their correlation with some of the cancers.

miRNA Regulation of Glutathione Homeostasis in Cancer Initiation, Progression and Therapy Resistance

Glutathione (GSH) is the most abundant antioxidant that contributes to regulating the cellular production of Reactive Oxygen Species (ROS) which, maintained at physiological levels, can exert a function of second messengers in living organisms. In fact, it has been demonstrated that moderate amounts of ROS can activate the signaling pathways involved in cell growth and proliferation, while high levels of ROS induce DNA damage leading to cancer development. Therefore, GSH is a crucial player in the maintenance of redox homeostasis and its metabolism has a role in tumor initiation, progression, and therapy resistance. Our recent studies demonstrated that neuroblastoma cells resistant to etoposide, a common chemotherapeutic drug, show a partial monoallelic deletion of the locus coding for miRNA 15a and 16-1 leading to a loss of these miRNAs and the activation of GSH-dependent responses. Therefore, the aim of this review is to highlight the role of specific miRNAs in the modulation of intracellular GSH levels in order to take into consideration the use of modulators of miRNA expression as a useful strategy to better sensitize tumors to current therapies.

Longitudinal association of carotid endothelial shear stress with renal function decline in aging adults with normal renal function: A population-based cohort study

The aim of this study was to investigate the associations between carotid wall shear stress (WSS) and renal function impairment (RFI) and albuminuria in aging adults. A total of 1,447 subjects aged 60 years and older with normal estimated glomerular filtration rate (eGFR ≥ 60 mL·min-1·1.72 m-2) and albumin/creatinine ratio (ACR < 30 mg·g-1) were enrolled between April 2007 and October 2009 in the Shandong area, China. Carotid WSS was assessed at baseline, and eGFR, which is based on serum creatinine and cystatin C, and ACR were assessed at baseline and at the annual follow-up visits. After an average of 62.9 months of follow-up, the reduction in eGFR and the increase in ACR were significantly higher in the Q1+2+3 group than the Q4 group, as classified by either the interquartile of the mean WSS or the interquartile of the peak WSS after adjustment for multi-variabilities, including the average blood pressures at every annual visit and baseline eGFR and ACR. For groups classified by mean WSS, the hazard ratios (95% confidence intervals) were 3.45 (1.36-8.75, p = 0.008) in the incident RFI and 3.24 3.22 (1.37-7.57, p = 0.009) in the incident albuminuria for the Q1+2+3 group compared with the Q4 group. Similar results were observed among groups classified by peak WSS. The Q1+2+3 group was associated with endothelial dysfunction and inflammation with respect to the Q4 group as classified by mean or peak WSS. The results indicate that carotid WSS plays an important role in RFI and albuminuria progression in aging adults. Lower WSS was associated with a higher risk of RFI and albuminuria compared with higher WSS.