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Ramos-Fresnedo A, Domingo RA, Sanchez-Garavito JE, Perez-Vega C, Akinduro OO, Jentoft ME, Vora SA, Brown PD, Porter AB, Bendok BR, Link MJ, Middlebrooks EH, Trifiletti DM, Chaichana KL, Quiñones-Hinojosa A, Sherman WJ. The impact of multiple lesions on progression-free survival of meningiomas: a 10-year multicenter experience. J Neurosurg 2022; 137:9-17. [PMID: 34798603 DOI: 10.3171/2021.8.jns211252] [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: 05/18/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple meningiomas (MMs) occur in as many as 18% of patients with meningioma, and data on progression-free survival (PFS) are scarce. The objective of this study was to explore the influence of the number of lesions and clinical characteristics on PFS in patients with WHO grade I meningiomas. METHODS The authors retrospectively reviewed the records of all adults diagnosed with a meningioma at their three main sites from January 2009 to May 2020. Progression was considered the time from diagnosis until radiographic growth of the originally resected meningioma. A secondary analysis was performed to evaluate the time of diagnosis until the time to second intervention (TTSI). Univariable and multivariable analyses were conducted to assess whether the number of lesions or any associated variables (age, sex, race, radiation treatment, tumor location, and extent of resection) had a significant impact on PFS and TTSI. RESULTS Eight hundred thirty-eight patients were included. Use of a log-rank test to evaluate PFS and TTSI between a single and multiple lesions showed a significantly shorter progression for MM (p < 0.001 and p < 0.001, respectively). Multivariable Cox regression analysis showed significantly inferior PFS on MM compared to a single lesion (hazard ratio [HR] 2.262, 95% confidence interval [CI] 1.392-3.677, p = 0.001) and a significantly inferior TTSI for patients with MM when compared to patients with a single meningioma (HR 2.377, 95% CI 1.617-3.494, p = 0.001). By testing the number of meningiomas as a continuous variable, PFS was significantly inferior for each additional meningioma (HR 1.350, 95% CI 1.074-1.698, p = 0.010) and TTSI was significantly inferior as well (HR 1.428, 95% CI 1.189-1.716, p < 0.001). African American patients had an inferior PFS when compared to non-Hispanic White patients (HR 3.472, 95% CI 1.083-11.129, p = 0.036). CONCLUSIONS The PFS of meningiomas appears to be influenced by the number of lesions present. Patients with MM also appear to be more prone to undergoing a second intervention for progressive disease. Hence, a closer follow-up may be warranted in patients who present with multiple lesions. These results show a decreased PFS for each additional lesion present, as well as a shorter PFS for MM compared to a single lesion. When assessing associated risk factors, African American patients showed an inferior PFS, whereas older age and adjuvant therapy with radiation showed an improved PFS.
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Affiliation(s)
| | | | - Jesus E Sanchez-Garavito
- Departments of1Neurosurgery
- 2Facultad de Ciencias de la Salud, Universidad Anahuac Mexico, Mexico City, Mexico
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Sharma S, Sharma P, Kumar A. Diffuse Meningiomatosis without Neurofibromatosis: A Rare Diagnosis with Atypical Presentation. Indian J Radiol Imaging 2021; 31:768-771. [PMID: 34790335 PMCID: PMC8590543 DOI: 10.1055/s-0041-1736394] [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] [Indexed: 10/25/2022] Open
Abstract
Meningiomas are amongst the most common neoplasms of the central nervous system; however, "multiple meningiomas" or "meningiomatosis" account for < 10% of cases. The association with neurofibromatosis 2 is seen in ∼50% of cases. We report a case of 35-year-old female patient who presented with left eye proptosis, left forehead swelling, and multiple cranial nerve palsies predominantly on the left side. Imaging evaluation revealed innumerable en plaque meningiomas forming a sheet-like nodular thickening along the dura, causing marked hyperostosis and extending into the orbits, cavernous sinuses, sellar-suprasellar regions, various skull foramina, basal cisterns and into the cervical spinal canal causing mass effect on vital structures of the brain and cervical spinal cord. Similar lesions were found scattered in rest of the spine. We intend to highlight the role of imaging in accurately establishing the diagnosis and evaluating the extent and burden of disease in such rare cases.
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Affiliation(s)
- Smily Sharma
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Sharma
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Kumar
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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NAGAO K, SAKATA K, KAWASAKI T, MANAKA H, URAMARU K, YAMAMOTO T, SHIBUYA M. Double Meningioma: A Case of Two Fibrous Meningiomas Coexisting Isolatedly in Meningothelial Meningioma. NMC Case Rep J 2021; 8:215-220. [PMID: 35079466 PMCID: PMC8769410 DOI: 10.2176/nmccrj.cr.2020-0159] [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: 05/14/2020] [Accepted: 09/03/2020] [Indexed: 12/02/2022] Open
Abstract
Meningiomas are the most common intracranial primary neoplasm in adults, and show
various histological subtypes, indicating heterogeneous clinical and molecular
genetic characteristics. Different subtypes of meningioma coexisting
independently within the main tumor of another different subtype is a quite rare
clinical situation. A 69-year-old woman presented with a several- year history
of dizziness as a non-specific complaint. Magnetic resonance imaging (MRI)
revealed an extra-axial mass lesion in the left parieto-occipital region
including two well-demarcated, round mass components. Total resection was
performed via left parieto-occipital craniotomy. Two white masses were
identified within the main tumor, with neither showing dural attachments.
Pathological findings showed the main mass represented meningothelial meningioma
and the demarcated mass lesions were both fibrous meningiomas. No transitional
features existed between these subtypes. No differences in genetic
characteristics were evident between subtypes of meningioma. We have described,
apparently for the first time, a case of two fibrous meningiomas coexisting in
an isolated manner in meningothelial meningioma with the similar molecular
genetic profile.
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Affiliation(s)
- Kagemichi NAGAO
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Katsumi SAKATA
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Takashi KAWASAKI
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Hiroshi MANAKA
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Koichi URAMARU
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tetsuya YAMAMOTO
- Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Makoto SHIBUYA
- Central Laboratory, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
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Sheng HS, Shen F, Zhang N, Yu LS, Lu XQ, Zhang Z, Fang HY, Zhou LL, Lin J. Whole exome sequencing of multiple meningiomas with varying histopathological presentation in one patient revealed distinctive somatic mutation burden and independent clonal origins. Cancer Manag Res 2019; 11:4085-4095. [PMID: 31123420 PMCID: PMC6510395 DOI: 10.2147/cmar.s202394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Although meningiomas are common intracranial tumors, multiple meningiomas (MMs) are rare entities in patients without neurofibromatosis type 2. Previous studies suggest most sporadic MMs are of monoclone in origin. Objective: To elucidate the clonal relationship between two sporadic meningiomas from the same patient by using the next-generation sequencing (NGS) platform. Methods: Two MMs, located frontally and parietally on the right side, were surgically removed from a 52-year-old male. Pathological examinations and whole exome sequencing were performed on tumor samples, followed by Sanger sequencing validation. Results: MMs were diagnosed as secretory and fibrous subtypes, respectively, on histology (WHO grade I) and tumor DNA exhibited distinctive somatic mutation patterns. Specifically, the secretory subtype carried more single nucleotide variant while the fibrous subtype had much higher copy number variation. Besides, the two tumors demonstrated different mutation profiles in predisposing genes and known driver mutations. For example, the secretory subtype had missense mutations in TRAF7 and KLF4, while the fibrous subtype had frameshift deletion of NF2 gene in addition to copy number loss of NF2 and SMARCB1, genetic events that have already been associated with the development of meningiomas. Significantly mutated gene analysis revealed novel mutations of LOC729159 in the secretory subtype and RPGRIP1L and DPP6 in the fibrous subtype. Sanger sequencing validated important point mutations in TRAF7 (c.1678G>A, p.G560S), KLF4 (c.1225A>C, p.K409Q) and CDH11 (c.169T>G, p.W57G). Conclusion: Our data suggest the two meningiomas might develop independently in this patient and molecular subtyping by NGS is a valuable supplement to conventional pathology. Further study is needed to ascertain whether these novel genetic events are tumorigenic or simply passenger mutations, as well as their clinical implications.
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Affiliation(s)
- Han-Song Sheng
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Fang Shen
- Department of Orthopedic Surgery's Spine Division, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, People's Republic of China
| | - Nu Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Li-Sheng Yu
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiang-Qi Lu
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Zhe Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the 2nd Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Huang-Yi Fang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the 2nd Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ling-Li Zhou
- Department of Pathology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jian Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Araújo Pereira BJ, Nogueira de Almeida A, Pires de Aguiar PH, Paiva WS, Teixeira MJ, Nagahashi Marie SK. Multiple Intracranial Meningiomas: A Case Series and Review of the Literature. World Neurosurg 2018; 122:e1536-e1541. [PMID: 30471445 DOI: 10.1016/j.wneu.2018.11.097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the published data to create a more comprehensive natural history of multiple meningiomas (MM). METHODS A review of MM published until now was carried out through a Medline search up to August 2018. The use of the "multiple meningiomas" keyword returned 278 articles, and the characteristics analyzed in our present cohort were searched on those publications. Articles without detailed description of clinical findings, neuroimaging confirmation of tumor multiplicity, follow-up at least of 5 years, and clear description of clinical findings were excluded. We added series to this review. RESULTS 293 patients with MM were analyzed: 220 women and 73 men, with a total of 932 tumors (3.1 tumors per patient). The majority of tumors were located in the convexity (653% to 74.5%). The total number of tumors treated was 429 (43.9%): 338 (78.8%) by surgical resection and 91 (21.2%) by radiotherapy. Histopathologic description was available in 303 of 429 cases, being grade I in 272 (90.3%) cases, with a predominance of the meningothelial subtype (30.7%). Tumor recurrence was described in 32 (8.07%) among 397 and only 10 deaths (3.4%) of 281 reported cases, where this characteristic was evaluated. CONCLUSIONS World Health Organization grade I predominance was observed among multiple meningiomas in similarity to single meningiomas. Only a fraction of MM patients (43.89%) needed treatment. A benign tumor behavior was corroborated by the observed low frequency of recurrence and mortality.
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Affiliation(s)
| | - Antônio Nogueira de Almeida
- Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil; Divisão de Neurocirurgia Funcional IPQ, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil
| | | | - Wellingson Silva Paiva
- Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil
| | - Manoel Jacobsen Teixeira
- Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil
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Tsermoulas G, Turel MK, Wilcox JT, Shultz D, Farb R, Zadeh G, Bernstein M. Management of multiple meningiomas. J Neurosurg 2017; 128:1403-1409. [PMID: 28731398 DOI: 10.3171/2017.2.jns162608] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple meningiomas account for 1%-10% of meningiomas. This study describes epidemiological aspects of the disease and its management, which is more challenging than for single tumors. METHODS A consecutive series of adult patients with ≥ 2 spatially separated meningiomas was reviewed. Patients with neurofibromatosis Type 2 were excluded. The authors collected clinical, imaging, histological, and treatment data to obtain information on epidemiology, management options, and outcomes of active treatment and surveillance. RESULTS A total of 133 consecutive patients were included over 25 years, with a total of 395 synchronous and 53 metachronous meningiomas, and a median of 2 tumors per patient. One hundred six patients had sporadic disease, 26 had radiation-induced disease, and 1 had familial meningiomatosis. At presentation, half of the patients were asymptomatic. In terms of their maximum cross-sectional diameter, the tumors were small (≤ 2 cm) in 67% and large (> 4 cm) in 11% of the meningiomas. Fifty-four patients had upfront treatment, and 31 had delayed treatment after an observation period (mean 4 years). One in 4 patients had ≥ 2 meningiomas treated. Overall, 64% of patients had treatment for 142 tumors-67 with surgery and 18 with radiotherapy alone. The mean follow-up was 7 years, with 13% of treated patients receiving salvage therapy. Approximately 1 in 4 patients who underwent surgery had ≥ 1 WHO Grade II or III meningioma. Meningiomas of different histological subtypes and grades in the same patient were not uncommon. CONCLUSIONS Multiple meningiomas are often asymptomatic, probably because the majority are small and a significant proportion are induced by radiation. Approximately two-thirds of patients with multiple meningiomas require therapy, but only one-third of all meningiomas need active treatment. The authors recommend surveillance for stable and asymptomatic meningiomas and therapy for those that are symptomatic or growing.
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Affiliation(s)
| | | | | | - David Shultz
- 2Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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7
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Méningiomes multiples. Neurochirurgie 2016; 62:128-35. [DOI: 10.1016/j.neuchi.2015.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 11/20/2022]
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Huang H, Buhl R, Hugo HH, Mehdorn HM. Clinical and Histological Features of Multiple Meningiomas Compared with Solitary Meningiomas. Neurol Res 2013; 27:324-32. [PMID: 15845217 DOI: 10.1179/016164105x39932] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Between 1991 and 2002, 456 patients with an intracranial meningioma were treated. Thirty-nine of these had more than one meningioma (8.6%). The mean age was 58 years (27-85 years). Sex distribution was 8.8:1 (35 female, four male). There was no associated spinal meningioma. No patient had neurofibromatosis. In 19 patients all meningiomas were removed. Twelve showed the same histology, seven had different histological features. In the remaining 20 patients only the symptomatic meningioma was removed. Recurrences occurred in 11 patients (28.2%). Six patients died during follow-up. Multiple meningiomas have their own clinical features. Besides a high female preponderance, PR expression was stronger in multiple meningiomas than in solitary meningiomas while p53 status and MIB-1 LI were similar between the two groups. Progesterone receptor, p53 status and MIB-1 LI were valuable markers for predicting a patient's outcome in multiple meningiomas. The number of meningiomas is growing in patients with recurrent meningiomas.
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Affiliation(s)
- Hongguang Huang
- Department of Neurosurgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China
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Koh YC, Yoo H, Whang GC, Kwon OK, Park HI. Multiple meningiomas of different pathological features: case report. J Clin Neurosci 2001; 8 Suppl 1:40-3. [PMID: 11386824 DOI: 10.1054/jocn.2001.0875] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Meningioma is a common intracranial tumour and it may occur not infrequently as one of the multiple tumours, especially in patients with neurofibromatosis. The incidence of multiple meningiomas (MMs) without the stigmata of neurofibromatosis is rare, ranging from 1 to 9% of all meningiomas in the literature. Multiple meningiomas with different pathologic features are even rarer, and most of them are benign histologies. The authors report an extremely rare case of MMs which were presented with malignant and benign histological features simultaneously. The underlying mechanism of MM formation is still unclear, however, subarachnoid spread was thought to be the most likely mechanism. The findings of most of MMs showed identical histopathological features and several molecular biologic studies provided evidence for the monoclonal origin of MMs to back up the above hypothesis. However, different histological features among the reported multiple meningioma cases including our particular one, suggests their origin from multicentric neoplastic foci activated by a supposed tumour-producing factor. However, we cannot completely exclude the possibility of independent progression from monoclonal origin.
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Affiliation(s)
- Y C Koh
- Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Korea.
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Larson JJ, Tew JM, Simon M, Menon AG. Evidence for clonal spread in the development of multiple meningiomas. J Neurosurg 1995; 83:705-9. [PMID: 7674021 DOI: 10.3171/jns.1995.83.4.0705] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Meningiomas are common intracranial tumors that arise from the arachnoid cells of the meninges. Occasionally patients develop multiple meningiomas. Because the underlying mechanism of multiple meningioma formation is unknown, the authors examined the pattern of X chromosome inactivation in multiple meningiomas. Fifteen intracranial meningiomas were resected in four patients with multiple meningiomas to determine whether the tumors in patients with multiple meningiomas originate from a common progenitor cell or arise independently. Specimens were examined using polymerase chain reaction assays to detect the pattern of X chromosome inactivation. In each patient, all tumors showed inactivation of the same X chromosome, suggesting that tumors arose from the same clone of cells (p < 0.0005). The authors conclude that multiple meningiomas arise from the uncontrolled spread of a single progenitor cell.
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Affiliation(s)
- J J Larson
- Department of Molecular Genetics, University of Cincinnati College of Medicine, Ohio, USA
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Abstract
This article reviews the recent literature on the pathogenesis and pathology of meningiomas, contemporary techniques of surgical resection, and new nonsurgical treatments, including radiation and hormone therapy. Factors predisposing to meningioma formation include female sex, previous ionizing radiation, and Type 2 neurofibromatosis. The first factor may act through the expression of sex hormone receptors, especially the progesterone receptor, in these tumors; the other two probably act by causing a deletion on Chromosome 22. The pathological classifications of meningiomas include the traditional division into histological subtypes and the World Health Organization classification that selects characteristics that may lead to recurrence. There is an increasing emphasis on proliferative indices and other characteristics that may predict aggressive behavior in these tumors. On computed tomography, meningiomas are enhancing, well-marginated, dural-based lesions that may have considerable surrounding edema; the cause of the edema is uncertain but may result from secretory products of the tumor. Magnetic resonance imaging with enhancement will demonstrate these lesions accurately and can be used for three-dimensional reconstruction as well. Computed tomography and magnetic resonance imaging have largely replaced angiography in the preoperative diagnosis of meningiomas, but angiographic embolization may be a useful operative adjunct. Although meningioma surgery is sometimes thought of as benign and curative, the reported surgical mortality rate is as high as 14.3% and the reported 10-year survival rate after surgery varies from 43 to 77%. Surgery has advanced most in the management of suprasellar, cavernous sinus, clivus, tentorial, and posterior fossa meningiomas, because new approaches and a better understanding of anatomy have allowed more radical resection. There is still substantial morbidity associated with surgery in these regions, however, and the long-term recurrence rates are still unknown for these new radical techniques. For convexity, parasagittal, lateral sphenoid wing, and olfactory groove meningiomas, complete resection should be the goal and operative morbidity appears to be low. There is a high recurrence rate after surgery. With apparent total removal, the recurrence rate varies from 9 to 20% at 10 years, with subtotal resection varying from 18.4 to 50%. The degree of resection appears to be most important in recurrence, but histopathological features are also important. Recently, radiation therapy has been recognized as a useful adjunct to surgery, and with radiosurgical techniques may become more important in the future. Antiprogesterone therapy appears to have had some success as well, and it or other hormonal therapy may be another future option for residual or recurrent meningiomas.
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Affiliation(s)
- P M Black
- Neurosurgical Service, Brigham and Women's Hospital, Children's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
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Eljamel MS, Foy PM. Multiple meningiomas and their relation to neurofibromatosis. Review of the literature and report of seven cases. SURGICAL NEUROLOGY 1989; 32:131-6. [PMID: 2501882 DOI: 10.1016/0090-3019(89)90201-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A review of 158 cases of multiple meningiomas reported in the literature and 7 additional cases are presented. The average incidence of multiple meningiomas is 2.5% of all meningiomas. In the absence of cutaneous manifestations of von Recklinghausen's disease, it is extremely difficult to distinguish between cases associated with central neurofibromatosis and those representing true multiple meningiomas. There are no specific pathognomonic features that distinguish true multiple meningiomas as a separate disease entity.
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Affiliation(s)
- M S Eljamel
- Mersey Regional Department of Neurosciences, Walton Hospital, Liverpool, England
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