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Peeters JB, Dessesard Olijnyk L, Janelle F, Shedid D, Bojanowski MW, Labidi M. Surgical management of tumors of the cervical spine and craniovertebral junction involving the vertebral artery: A narrative review. Neurochirurgie 2024; 70:101550. [PMID: 38552591 DOI: 10.1016/j.neuchi.2024.101550] [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: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The vertebral artery (VA) is in close proximity to bony structures, nerves and nerve sheaths of the cervical spine and craniovertebral junction (CVJ). These structures can be sources of tumors that are responsible for displacement, encasement and sometimes invasion of the VA. Removing these tumors while minimizing the risk of vascular injury requires thorough knowledge of the vascular anatomy, risk factors of vascular injury, the relationships of each tumor type with the VA, and the different surgical approaches and techniques that result in the best outcomes in terms of vascular control, tumoral exposure and resection. OBJECTIVE To present an overview of preoperative and anatomical considerations, differential diagnoses and various approaches to consider in cases of tumors in close relationship with the VA. METHOD A review of recent literature was conducted to examine the anatomy of the VA, the tumors most frequently affecting it, surgical approaches, and the necessary pre-operative preparations for ensuring safe and maximal tumor resection. This review aims to underscore the principles of treatment. CONCLUSION Tumors located at the CVJ and the cervical spine intimately involved with the VA, pose a surgical challenge and increase the risk of incomplete removal of the lesion. Detailed knowledge of the patient-specific anatomy and a targeted pre-operative work-up enable optimal planning of surgical approach and management of the VA, thereby reducing surgical risks and improving extent of resection.
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Affiliation(s)
- Jean-Baptiste Peeters
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Leonardo Dessesard Olijnyk
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Felix Janelle
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada.
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2
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Liu C, Liu X, Wei Z, Chang Z, Bai Y, Zeng P, Cao Q, Tie C, Lei Z, Sun P, Liang H, Sun Q, Zhang X. Amorphous Albumin Gadolinium-Based Nanoparticles for Ultrahigh-Resolution Magnetic Resonance Angiography. ACS APPLIED MATERIALS & INTERFACES 2024; 16:9702-9712. [PMID: 38363797 PMCID: PMC10911108 DOI: 10.1021/acsami.3c16391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
Magnetic resonance angiography (MRA) contrast agents are extensively utilized in clinical practice due to their capability of improving the image resolution and sensitivity. However, the clinically approved MRA contrast agents have the disadvantages of a limited acquisition time window and high dose administration for effective imaging. Herein, albumin-coated gadolinium-based nanoparticles (BSA-Gd) were meticulously developed for in vivo ultrahigh-resolution MRA. Compared to Gd-DTPA, BSA-Gd exhibits a significantly higher longitudinal relaxivity (r1 = 76.7 mM-1 s-1), nearly 16-fold greater than that of Gd-DTPA, and an extended blood circulation time (t1/2 = 40 min), enabling a dramatically enhanced high-resolution imaging of microvessels (sub-200 μm) and low dose imaging (about 1/16 that of Gd-DTPA). Furthermore, the clinically significant fine vessels were successfully mapped in large mammals, including a circle of Willis, kidney and liver vascular branches, tumor vessels, and differentiated arteries from veins using dynamic contrast-enhanced MRA BSA-Gd, and have superior imaging capability and biocompatibility, and their clinical applications hold substantial promise.
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Affiliation(s)
- Chenchen Liu
- Department
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Guangdong
Provincial Key Laboratory of Biomedical Optical Imaging Technology
& Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese
Academy of Science, Shenzhen 518055, China
| | - Xiaoming Liu
- Department
of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei
Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Zhihao Wei
- Department
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zong Chang
- Guangdong
Provincial Key Laboratory of Biomedical Optical Imaging Technology
& Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese
Academy of Science, Shenzhen 518055, China
| | - Yaowei Bai
- Department
of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei
Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Pei Zeng
- Department
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qi Cao
- Department
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Changjun Tie
- Paul
C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Ziqiao Lei
- Department
of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei
Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Peng Sun
- Clinical
& Technical Support, Philips Healthcare, Beijing 100600, China
| | - Huageng Liang
- Department
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qinchao Sun
- Guangdong
Provincial Key Laboratory of Biomedical Optical Imaging Technology
& Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese
Academy of Science, Shenzhen 518055, China
| | - Xiaoping Zhang
- Department
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute
of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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3
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Ahmed AK, Wilhelmy B, Oliver J, Serra R, Chen C, Gandhi D, Eisenberg HM, Labib MA, Woodworth GF. Variability in the Arterial Supply of Intracranial Meningiomas: An Anatomic Study. Neurosurgery 2023; 93:1346-1352. [PMID: 37530524 DOI: 10.1227/neu.0000000000002608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/14/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intracranial meningiomas are a diverse group of tumors, which vary by grade, genetic composition, location, and vasculature. Expanding the understanding of the supply of skull base (SBMs) and non-skull base meningiomas (NSBMs) will serve to further inform resection strategies. We sought to delineate the vascular supply of a series of intracranial meningiomas by tumor location. METHODS A retrospective study of intracranial meningiomas that were studied using preoperative digital subtraction angiograms before surgical resection at a tertiary referral center was performed. Patient, tumor, radiologic, and treatment data were collected, and regression models were developed. RESULTS One hundred sixty-five patients met inclusion criteria. The mean age was 57.1 years (SD: 12.6). The mean tumor diameter was 4.9 cm (SD: 1.5). One hundred twenty-six were World Health Organization Grade I, 37 Grade II, and 2 Grade III. Arterial feeders were tabulated by Al-Mefty's anatomic designations. SBMs were more likely to derive arterial supply from the anterior circulation, whereas NSBMs were supplied by external carotid branches. NSBMs were larger (5.61 cm vs 4.45 cm, P = <.001), were more often presented with seizure (20% vs 8%, P = .03), were higher grade ( P = <.001) had more frequent peritumoral brain edema (84.6% vs 66%, P = .04), and had more bilateral feeders (47.7% vs 28%, P = .01) compared with SBMs. More arterial feeders were significantly associated with lower tumor grade ( P = .023, OR = 0.59). Higher tumor grade (Grade II/III) was associated with fewer arterial feeders ( P = .017, RR = 0.74). CONCLUSION Meningioma location is associated with specific vascular supply patterns, grade, and patient outcomes. This information suggests that grade I tumors, especially larger tumors, are more likely to have diverse vascular supply patterns, including internal carotid branches. This study may inform preoperative embolization and surgical considerations, particularly for large skull base tumors.
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Affiliation(s)
- Abdul-Kareem Ahmed
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Bradley Wilhelmy
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Jeffrey Oliver
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Riccardo Serra
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Chixiang Chen
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Dheeraj Gandhi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore , Maryland , USA
- Department of Neurology, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Howard M Eisenberg
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Mohamed A Labib
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Graeme F Woodworth
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore , Maryland , USA
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Choi JW, Ho R, Zhang YJ, Sae-Ow W, Hui FK, Brown SC, Tsappidi S. A rare case of solitary, isolated dural metastasis from hepatocellular carcinoma mimicking a meningioma. Surg Neurol Int 2023; 14:398. [PMID: 38053699 PMCID: PMC10695471 DOI: 10.25259/sni_733_2023] [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: 09/03/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023] Open
Abstract
Background Distinguishing an isolated metastatic dural tumor from a meningioma on imaging is challenging and may lead to a delay in treatment. Here, we present the first known case of isolated, solitary dural metastasis from hepatocellular carcinoma (HCC) mimicking a meningioma. Case Description A 64-year-old male with a history of liver cirrhosis presented with a 5.8 cm enhancing left parafalcine hemorrhagic dural-based mass extending across the midline. Cerebral angiography revealed a distal left anterior pseudoaneurysm, and tumor contrast blush with feeders from the left ophthalmic and right middle meningeal artery. The pseudoaneurysm was successfully embolized to stop the bleeding, followed by an uneventful bi-coronal frontal craniotomy for falcine tumor resection to relieve brain compression. Histopathological analysis of the dural-based tumor showed poorly differentiated carcinoma with positive albumin in situ hybridization and cytokeratin tumor markers, consistent with dural metastases from HCC. Conclusion When encountering a solitary, highly vascular mass bearing resemblance to a meningioma, it may be prudent to consider the possibility of a dural-based metastatic carcinoma.
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Affiliation(s)
- Joo Won Choi
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Richard Ho
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Yi Jonathan Zhang
- Department of Neurosurgery, The Queen’s Medical Center, Honolulu, Hawaii, United States
| | - Wichit Sae-Ow
- Department of Pathology, The Queen’s Medical Center, Honolulu, Hawaii, United States
| | - Ferdinand K. Hui
- Department of Neurointerventional Surgery, The Queen’s Medical Center, Honolulu, Hawaii, United States
| | - Stacy C. Brown
- Department of Neuroscience Institute, The Queen’s Medical Center, Honolulu, Hawaii, United States
| | - Samuel Tsappidi
- Department of Neurointerventional Surgery, The Queen’s Medical Center, Honolulu, Hawaii, United States
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5
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Mancuso-Marcello M, Qureshi AI, Nikola C, Stoian I, Jia Y, Saeed D, Bhogal P. Intra-arterial lidocaine therapy via the middle meningeal artery for migraine headache: Theory, current practice and future directions. Interv Neuroradiol 2023:15910199231195470. [PMID: 37574789 DOI: 10.1177/15910199231195470] [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: 08/15/2023] Open
Abstract
Recent developments in neurointerventional research have seen the emergence of the middle meningeal artery (MMA) as an effective conduit for intra-arterial (IA) therapy for a number of pathologies. Here, we review the anatomical, pathophysiological and experimental basis for utilisation of the MMA for IA treatment of migraine headache. We explore the in-human case literature for the treatment of headaches with IA lidocaine and discuss considerations and challenges for future research.
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Affiliation(s)
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | | | | | - YiFan Jia
- Imperial College School of Medicine, Imperial College London, London, UK
| | | | - Pervinder Bhogal
- Interventional Neuroradiology, Barts Health NHS Trust, London, UK
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6
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Ghodrati F, Mekonnen M, Mahgerefteh N, Zhang AB, Pradhan A, Mozaffari K, Duong C, Yang I. Preoperative meningioma vascularity index is associated with significantly increased intraoperative blood loss and greater risk of subtotal resection. J Neurooncol 2023; 161:583-591. [PMID: 36786952 DOI: 10.1007/s11060-023-04259-w] [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: 01/11/2023] [Accepted: 02/04/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Surgical recovery of meningiomas relies on a variety of factors, including tumor volume, vascularity, embolization status, and blood loss during excision. Although hypervascular meningiomas can potentially be amendable to embolization, methods for determining optimal vascularity for this procedure are currently lacking. Our group previously established the meningioma vascularity index (MVI) as a marker of tumor vascularity. In this study, we aim to build on our previous work and further examine the relationship between MVI and intraoperative estimated blood loss (EBL). METHODS A retrospective data extraction was conducted between August 2010 and October 2019 from patients undergoing craniotomy for meningioma. Of the 85 intracranial meningiomas included, 39 were embolized. Demographic data, extent of resection, embolization status, and EBL were among the extracted variables. Flow void volumes were measured on T2-weighted MRI images using a segmentation software with a voxel-based segmentation method. RESULTS MVI was a predictor of EBL within the entire cohort, when controlling for tumor volume (R2 adjusted = 0.26; P = 0.027). A high MVI (> 2.01 cm3) was associated with higher likelihood of receiving subtotal resection (STR) (OR 4.07, 95% CI 1.17-14.15; P = 0.035). Although the mean MVI and tumor volume were higher in the embolized cohort (P = 0.009 and P = 0.005), there were no significant differences in EBL, or blood transfusion rates regardless of embolization status. CONCLUSIONS MVI may be used as a non-invasive radiological marker to gauge meningioma vascularity, predict EBL, and guide the decision-making process when it comes to embolization and surgical planning.
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Affiliation(s)
- Farinaz Ghodrati
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mahlet Mekonnen
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA
| | | | - Ashley B Zhang
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anjali Pradhan
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | | | - Courtney Duong
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Isaac Yang
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA. .,Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, USA. .,Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, USA. .,Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, USA. .,Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, USA. .,Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, USA. .,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA. .,Department of Neurosurgery, University of California, 300 Stein Plaza, Suite 562, Los Angeles, CA, 90095-1761, USA.
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Al-Mufti F, Gandhi CD, Couldwell WT, Rybkin I, Abou-Al-Shaar H, Dodson V, Amin AG, Wainwright JV, Cohen E, Schmidt MH, Cole C, Bowers CA. Preoperative meningioma embolization reduces perioperative blood loss: a multi-center retrospective matched case-control study. Br J Neurosurg 2023; 37:67-70. [PMID: 34569389 DOI: 10.1080/02688697.2021.1979191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE The utility of preoperative embolization remains controversial within the literature. Here, we evaluate whether preoperative meningioma embolization is effective in reducing intraoperative blood loss, safe to perform, and cost-effective when compared with surgical resection without preoperative embolization. METHODS Twenty-nine patients with meningiomas were matched by tumor size and location to 29 control patients with meningiomas at another institution where preoperative embolization was not practiced. The variables evaluated were pre- and post-operative hemoglobin and hematocrit levels as a measure of operative blood loss and postoperative morbidity. The additional cost of undergoing angiography and embolization was calculated from hospital charges obtained from the billing department. RESULTS The mean decrease in perioperative hemoglobin and hematocrit was 0.9 and 2.7, respectively, in the embolization group and 2.8 and 10.0, respectively, in the control group for a significant decrease in operative blood loss as measured by change in hematocrit and hemoglobin levels after surgery. There was no significant difference in operative blood loss when subdividing patients based on tumor location. There were no angiogram-related complications. Twenty-two of 29 patients (76%) underwent embolization of a feeding artery, whereas 7 patients underwent only a diagnostic angiogram. The mean additional charge per patient in the embolization group was $88,767. CONCLUSIONS Preoperative embolization was safe and effective in reducing the overall perioperative blood loss in patients undergoing meningioma resection, as measured by the change in postoperative hemoglobin and hematocrit levels. However, the cost of embolization was significant.
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Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.,Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.,Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | | | - Ilya Rybkin
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vincent Dodson
- Department of Neurosurgery, Rutgers University, New Jersey Medical School, 90 Bergen Street, Newark, NJ, USA
| | - Anubhav G Amin
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.,Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - John V Wainwright
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.,Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA
| | - Eric Cohen
- Department of Neurosurgery, Rutgers University, New Jersey Medical School, 90 Bergen Street, Newark, NJ, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, USA
| | - Chad Cole
- Department of Neurosurgery, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, USA
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Outcome of medical treatment of otogenic brain abcess without therapeutic drainage: A case of central vertigo. Radiol Case Rep 2022; 17:3559-3563. [PMID: 35923347 PMCID: PMC9340120 DOI: 10.1016/j.radcr.2022.06.102] [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: 04/08/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Otogenic brain abscess is a severe infection that must be treated as early as possible. Rare cases with a high mortality rate can be reduced by recognizing the red flags of a brain abscess, such as headaches, mental status changes, fever, and focal neurological deficits. Those could be supported by modern diagnostic management and adequate antibiotic therapy that was able to penetrate the central nervous system and abscesses. We report a case of a cerebellar abscess of the 49-year-old man with the chief complaint of vertigo. It was accompanied by chronic progressive headache, fever, bidirectional nystagmus, abnormal Romberg test, and abnormal cerebellar signs. Magnetic resonance imaging (MRI) of the head with contrast showed a right cerebellar abscess with an infectious source of otitis media and mastoiditis. The MRI evaluation showed improvement after admistered metronidazole 500 mg every 6 hours (week 22) and cefixime 200 mg every 12 hours (week 13). Long-term antibiotic treatment can be an alternative if surgery cannot be performed. However, surgery is still considered if there is no good clinical response during medical therapy.
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9
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E Anirudh E, Harrichandparsad R, Lazarus L. Anatomical basis of intracranial meningiomas referred for preoperative embolisation: A retrospective chart review. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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10
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van der Zijden T, Mondelaers A, Franck C, Voormolen M, Menovsky T. Selective Angiographic Flat Detector Computer Tomography Blood Volume Imaging in Pre-Operative Vascular Mapping and Embolization of Hypervascular Intracranial Tumors-Preliminary Clinical Experience. Diagnostics (Basel) 2022; 12:1185. [PMID: 35626340 PMCID: PMC9139786 DOI: 10.3390/diagnostics12051185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
Pre-operative embolization of hypervascular intracranial tumors can be performed to reduce bleeding complications during resection. Accurate vascular mapping of the tumor is necessary for both the correct indication setting for embolization and for the evaluation of the performed embolization. We prospectively examined the role of whole brain and selective parenchymal blood volume (PBV) flat detector computer tomography perfusion (FD CTP) imaging in pre-operative angiographic mapping and embolization of patients with hypervascular intracranial tumors. Whole brain FD CTP imaging with a contrast injection from the aortic root and selective contrast injection in the dural feeding arteries was performed in five patients referred for tumor resection. Regional relative PBV values were obtained pre- and post-embolization. Total tumor volumes with selective external carotid artery (ECA) supply volumes and post-embolization devascularized tumor volumes were determined as well. In all patients, including four females and one male, with a mean age of 54.2 years (range 44-64 years), the PBV scans were performed without adverse events. The average ECA supply was 54% (range 31.5-91%). The mean embolized tumor volume was 56.5% (range 25-94%). Relative PBV values decreased from 5.75 ± 1.55 before embolization to 2.43 ± 1.70 post-embolization. In one patient, embolization was not performed because of being considered not beneficial for the resection. Angiographic FD CTP imaging of the brain tumor allows 3D identification and quantification of individual tumor feeder arteries. Furthermore, the technique enables monitoring of the efficacy of pre-operative endovascular tumor embolization.
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Affiliation(s)
- Thijs van der Zijden
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; (C.F.); (M.V.)
- Department of Medical Imaging, AZ Klina, 2930 Brasschaat, Belgium
| | - Annelies Mondelaers
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; (C.F.); (M.V.)
- Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium
| | - Caro Franck
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; (C.F.); (M.V.)
- Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium
| | - Maurits Voormolen
- Department of Radiology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium; (C.F.); (M.V.)
- Research Group mVision, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital (UZA), 2650 Edegem, Belgium;
- Research Group Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Antwerp, Belgium
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11
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Yin Y, Li Y, Jiang Z, Zhang C, Ge H, Chen Z, Hu R, Chen Y, Li X, Li F, Feng H. Clinical Outcomes and Complications of Preoperative Embolization for Intracranial Giant Meningioma Tumorectomy: A Retrospective, Observational, Matched Cohort Study. Front Oncol 2022; 12:852327. [PMID: 35350565 PMCID: PMC8957910 DOI: 10.3389/fonc.2022.852327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The potential benefits of preoperative embolization for intracranial meningiomas are still under debate. We aimed to investigate whether preoperative embolization can improve surgical and functional outcomes, based on controlling patient- and tumor-related confounding factors. Methods We reviewed all meningioma cases in our department from January 2016 to May 2021. Cases in the nonembolization cohort were matched to the embolization cohort by 1:1 ratio propensity score matching, through controlling patient- and tumor-related confounds. Surgical outcomes, complications, and functional outcomes were retrospectively compared between these two groups. Results Sixty-six cases in each group were included in our study after being matched. We did not find any significant differences of estimated blood loss (600.00 (400) vs. 500.00 (500.00) ml, p = 0.31), decrease of HGB level (30.81 ± 15.82 vs. 26.59 ± 12.90 g/L, p = 0.09), gross total resection rate (74.24% vs. 77.27%, p = 0.68), surgical time (302.50 (136) vs. 300.00 (72) min, p = 0.48), blood transfusion rates (53.03% vs. 42.42%, p = 0.35), blood transfusion volume [650.00 (657.50) vs. 535.00 (875.00) ml, p = 0.63] between the embolization group and nonembolization group. The number of patients who experience postsurgery complications were significantly higher in the nonembolization group (39.39% vs. 21.21%, p = 0.02). Patients in the nonembolization group were more likely to have a higher rate of mRS decline postsurgery (31.82% vs. 15.15%, p = 0.04). Conclusion Our study showed significant lower rates of surgical complications and long-term disabilities of meningioma patients treated with preoperative embolization. There were no significant differences in estimated blood loss, surgical time, and blood transfusion volume between embolization and nonembolization groups.
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Affiliation(s)
- Yi Yin
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuhong Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhouyang Jiang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chao Zhang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hongfei Ge
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Rong Hu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xuegang Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fei Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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12
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Kimura Y, Ghosn M, Cheema W, Adusumilli PS, Solomon SB, Srimathveeralli G. Expanding the role of interventional oncology for advancing precision immunotherapy of solid tumors. Mol Ther Oncolytics 2022; 24:194-204. [PMID: 35036524 PMCID: PMC8752905 DOI: 10.1016/j.omto.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Adoptive cell therapy with chimeric antigen receptors (CAR) T cells has proven effective for hematologic malignancies, but success in solid tumors has been impeded by poor intratumoral infiltration, exhaustion of effector cells from antigen burden, and an immunosuppressive tumor microenvironment. Results from recent clinical trials and preclinical studies lend promising evidence of locoregional approaches for CAR T cell delivery, priming the tumor microenvironment, and performing adjuvant therapies that sustain T cell activity. Interventional oncology is a subspeciality of interventional radiology where imaging guidance is used to perform percutaneous and catheter-directed procedures for localized, non-surgical therapy or interrogation of solid tumors. Interventional oncology provides unique synergies with immunotherapy, which has been well-studied to improve treatment efficacy while reducing toxicities associated with systemic treatment. Besides aiding in CAR T cell delivery, priming, or the stimulation of the tumor microenvironment to promote effector survival and function, interventional oncology can also aid in the monitoring of treatment response through selective, multiplex tumor sampling and catheter-based venous sampling. This review presents an overview of interventional oncology, its various procedures, and its potential for advancing CAR T cell immunotherapy of solid tumors.
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Affiliation(s)
- Yasushi Kimura
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, USA
| | - Mario Ghosn
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Waseem Cheema
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B. Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Govindarajan Srimathveeralli
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, USA
- Department of Biomedical Engineering, University of Massachusetts at Amherst, Amherst, MA, USA
- Institute for Applied Life Sciences, University of Massachusetts at Amherst, Amherst, MA, USA
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13
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Salgado-Lopez L, Oemke H, Feng R, Matsoukas S, Mocco J, Shrivastava R, Bederson J. Intraoperative use of heads-up display in skull base surgery. NEUROSURGICAL FOCUS: VIDEO 2022; 6:V2. [PMID: 36284591 PMCID: PMC9557332 DOI: 10.3171/2021.10.focvid21177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022]
Abstract
In this video, the authors highlight the applications of virtual reality and heads-up display in skull base surgery by presenting the case of a 45-year-old woman with an incidental large clinoid meningioma extending into the posterior fossa. The patient underwent preoperative endovascular tumor embolization to facilitate tumor resection and reduce blood loss, followed by a right pterional craniotomy. The use of intraoperative Doppler, intraoperative neurophysiological monitoring, and endoscope-assisted microsurgery is also featured. A subtotal resection was planned given tumor encasement of the posterior communicating and anterior choroidal arteries. No new neurological deficits were noted after the surgical procedure. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21177
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Affiliation(s)
| | - Holly Oemke
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
| | - Rui Feng
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
| | - Stavros Matsoukas
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
| | - Raj Shrivastava
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
| | - Joshua Bederson
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
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14
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Yamada H, Tanikawa M, Sakata T, Aihara N, Mase M. Usefulness of T2 Relaxation Time for Quantitative Prediction of Meningioma Consistency. World Neurosurg 2021; 157:e484-e491. [PMID: 34695610 DOI: 10.1016/j.wneu.2021.10.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Meningioma consistency is one of the most critical factors affecting the difficulty of surgery. Although many studies have attempted to predict meningioma consistency via magnetic resonance imaging findings, no definitive method has been established, because most have been based on qualitative evaluations. Therefore, the present study examined the potential of the T2 relaxation time (T2 value), a tissue-specific quantitative parameter, for assessment of meningioma consistency. METHODS Eighteen surgically treated meningiomas in 16 patients were included in the present study. Preoperatively, the T2 values of all meningiomas were calculated pixel by pixel, and a T2 value distribution map was generated. A total of 27 tumor specimens (multiple specimens were procured if heterogeneous) were taken from these meningiomas, with each localization identified intraoperatively using image guidance. The consistency of the specimens was measured with a durometer, originally a device for measuring the hardness of material such as elastic rubber, and their water content was subsequently measured using wet and dry measurements. RESULTS A significant correlation was found between the T2 values of the matched locations identified by image guidance intraoperatively and the consistency measured using the durometer (r = -0.722; P < 0.01) and the water content (r = 0.621; P = 0.01). In addition, the water content correlated significantly with the durometer consistency (r = -0.677; P < 0.01). CONCLUSIONS The T2 values could be a reliable quantitative predictor of meningioma consistency, and the T2 value distribution map, which elucidated the internal structure of the tumor in detail, could provide helpful information for surgical resection.
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Affiliation(s)
- Hiroshi Yamada
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Motoki Tanikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
| | - Tomohiro Sakata
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Noritaka Aihara
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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15
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Perng PS, Lee PH, Hsu HH, Huang CC, Huang CY, Lee JS. Technical Case Report of a Cranioplasty With ex vivo Frozen Ostoblastic Bone Graft From Large Skull Metastasis. Front Surg 2021; 8:746034. [PMID: 34621783 PMCID: PMC8490705 DOI: 10.3389/fsurg.2021.746034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Liquid nitrogen cryotherapy has shown efficacy in the treatment of bone tumors of the extremities with good oncologic and functional outcomes. However, its application in metastatic skull tumors has been rarely reported and whether the adjuvant radiotherapy affects the future bone healing is not yet explored. We report an immediate cranioplasty with the resected osteoblastic bone, which underwent ex vivo cryotherapy, and discuss the surgical techniques and postoperative images. Methods: A 58-year-old man with esophageal adenocarcinoma, undergoing chemoradiotherapy, presented with a rapidly enlarging scalp mass for 5 months. Imaging revealed an enhancing mass, centered in the frontal skull bone with extracranial and intracranial invasion, suggestive of osteoblastic metastasis. After preoperative transarterial embolization, the tumor was excised en bloc. Immediate cranioplasty was performed with the osteoblastic bone graft after ex vivo cryotherapy. It was soaked in liquid nitrogen for 20 min, thawed at room temperature for 15 min, and soaked in povidone-iodine solution for 10 min. Then, the bone graft was fixed to its original place. Pathologic examination revealed metastasis originating from the esophagus. He underwent adjuvant radiotherapy for local tumor control. Results: He had an uneventful clinical course without any neurologic deficit. Brain imaging during the six-month follow-up showed no tumor recurrence and partial bony union. Conclusions: Cranioplasty using an autologous bone graft with ex vivo cryotherapy was helpful in the reconstruction of osteoblastic metastatic skull tumor treatment. It was a simple and cost-effective procedure that achieved satisfactory cosmetic results without negatively impacting bone healing, even after adjuvant radiotherapy.
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Affiliation(s)
- Pang-Shuo Perng
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Hsuan Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Hsiang Hsu
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chen Huang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Yuan Huang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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16
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Luther E, Kaur G, Komotar R, Ivan ME. Commentary: Concomitant Embolization and Microsurgical Resection of a Giant, Hypervascular Skull Base Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E99-E100. [PMID: 34015826 DOI: 10.1093/ons/opab164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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17
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Radiation-induced brain injury in patients with meningioma treated with proton or photon therapy. J Neurooncol 2021; 153:169-180. [PMID: 33886111 DOI: 10.1007/s11060-021-03758-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Radiation therapy is often used to treat meningioma with adverse features or when unresectable. Proton therapy has advantages over photon therapy in reducing integral dose to the brain. This study compared the incidence of radiological and clinical adverse events after photon versus proton therapy in the treatment of meningioma. METHODS A retrospective review was conducted on patients with meningioma treated with proton or photon therapy at two high-volume tertiary cancer centers. Patients with a history of prior radiation therapy (RT) or less than 3 months of follow-up were excluded. Post-RT imaging changes were categorized into abnormal T2 signal intensities (T2 changes) or abnormal T1 post-contrast and T2 signal intensities (T1c+T2 changes) on magnetic resonance imaging (MRI). Clinical outcomes of adverse events and survival were compared between the proton and photon therapies. RESULTS Among the total of 77 patients, 38 patients received proton therapy and 39 patients received photon therapy. The median age at diagnosis was 55 years and median follow-up was 2.2 years. No significant differences in symptomatic adverse events were observed between the two groups: grade ≥ 2 adverse events were seen in 4 (10.5%) patients in the proton group and 3 (7.7%) patients in the photon group (p = 0.67). The 2-year cumulative incidences of T2 changes were 38.3% after proton therapy and 47.7% after photon therapy (p = 0.53) and the 2-year cumulative incidences of T1c+T2 changes were 26.8% after proton therapy and 5.3% after photon therapy (p = 0.02). One patient experienced grade ≥ 4 adverse event in each group (p = 0.99). Estimated 2-year progression-free survival was 79.5% (proton therapy 76.0% vs. photon therapy 81.3%, p = 0.66) and 2-year overall survival was 89.7% (proton therapy 86.6% vs. photon therapy 89.3%, p = 0.65). CONCLUSIONS Following RT, high rates of T2 changes were seen in meningioma patients regardless of treatment modality. Proton therapy was associated with significantly higher rates of T1c+T2 changes compared with photon therapy, but severe adverse events were uncommon in both groups and survival outcomes were comparable between the two groups. Future studies will aim at correlating the MRI changes with models that can be incorporated into RT planning to avoid toxicity.
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Fujimori T, Okauchi M, Toyota Y, Ogawa D, Okada M, Hatakeyama T, Shindo A, Kawanishi M, Miyake K, Tamiya T. Clinicopathologic Factors Associated with Tumor Necrosis after Preoperative Embolization of Meningiomas. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:517-524. [PMID: 37502761 PMCID: PMC10370582 DOI: 10.5797/jnet.oa.2020-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/04/2020] [Indexed: 07/29/2023]
Abstract
Objective Preoperative embolization of meningiomas induces necrosis prior to surgery and facilitates resection. Lack of contrast enhancement on postembolization MRI correlates with pathological findings of necrosis and can be used to assess embolization efficacy. This study aimed to examine clinicopathologic factors associated with tumor necrosis after embolization. Methods A total of 119 patients with intracranial meningioma who underwent 145 surgical resections between 2010 and 2019 at our institute were reviewed. Inclusion criteria for the study were preoperative embolization with trisacryl gelatin microspheres (Embosphere) or absorbable gelatine sponge (Gelfoam). Postembolization Gd-enhanced T1-weighted and angiographic imaging, and histopathologic examination results were reviewed to evaluate the effectiveness of embolization. Results In all, 66 patients satisfied the inclusion criteria. In total, 36 patients were embolized with Embosphere and 30 patients were embolized with Gelfoam. Patients embolized with Embosphere had a significantly higher necrosis rate (NR) than patients with Gelfoam (21% vs. 7.1%, P <0.01). The 36 Embosphere patients were analyzed regarding clinicopathologic factors associated with NR. Tumors in 12 patients were located in the parasagittal/falx region; these patients had a significantly lower NR compared with tumors in other locations (10.6% vs. 26.2%, P = 0.016). In all, 13 patients had feeders arising from only the middle meningeal artery (MMA), which was associated with a significantly higher NR (29.3% vs. 14.4%, P = 0.015). In total, 11 patients had meningeal feeders arising from internal carotid artery (ICA), which was associated with a significantly lower NR (9.0% vs. 26.3%, P <0.01). Conclusion This study showed embolization agent, tumor location, and blood supply were important factors predicting necrosis after preoperative embolization.
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Affiliation(s)
- Takeshi Fujimori
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Masanobu Okauchi
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Yoshinori Toyota
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Daisuke Ogawa
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Masaki Okada
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Tetsuhiro Hatakeyama
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Atsushi Shindo
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Masahiko Kawanishi
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Keisuke Miyake
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Takashi Tamiya
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
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Wilson TA, Huang L, Ramanathan D, Lopez-Gonzalez M, Pillai P, De Los Reyes K, Kumal M, Boling W. Review of Atypical and Anaplastic Meningiomas: Classification, Molecular Biology, and Management. Front Oncol 2020; 10:565582. [PMID: 33330036 PMCID: PMC7714950 DOI: 10.3389/fonc.2020.565582] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Although the majority of meningiomas are slow-growing and benign, atypical and anaplastic meningiomas behave aggressively with a penchant for recurrence. Standard of care includes surgical resection followed by adjuvant radiation in anaplastic and partially resected atypical meningiomas; however, the role of adjuvant radiation for incompletely resected atypical meningiomas remains debated. Despite maximum treatment, atypical, and anaplastic meningiomas have a strong proclivity for recurrence. Accumulating mutations over time, recurrent tumors behave more aggressively and often become refractory or no longer amenable to further surgical resection or radiation. Chemotherapy and other medical therapies are available as salvage treatment once standard options are exhausted; however, efficacy of these agents remains limited. This review discusses the risk factors, classification, and molecular biology of meningiomas as well as the current management strategies, novel therapeutic approaches, and future directions for managing atypical and anaplastic meningiomas.
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Affiliation(s)
| | - Lei Huang
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Promod Pillai
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Warren Boling
- Loma Linda University, Loma Linda, CA, United States
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20
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Bonasia S, Smajda S, Ciccio G, Robert T. Middle Meningeal Artery: Anatomy and Variations. AJNR Am J Neuroradiol 2020; 41:1777-1785. [PMID: 32883667 DOI: 10.3174/ajnr.a6739] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022]
Abstract
The middle meningeal artery is the major human dural artery. Its origin and course can vary a great deal in relation, not only with the embryologic development of the hyostapedial system, but also because of the relationship of this system with the ICA, ophthalmic artery, trigeminal artery, and inferolateral trunk. After summarizing these systems in the first part our review, our purpose is to describe, in this second part, the anatomy, the possible origins, and courses of the middle meningeal artery. This review is enriched by the correlation of each variant to the related embryologic explanation as well as by some clinical cases shown in the figures. We discuss, in conclusion, some clinical conditions that require detailed knowledge of possible variants of the middle meningeal artery.
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Affiliation(s)
- S Bonasia
- From the Department of Neurosurgery (S.B., T.R.), Neurocenter of the Southern Switzerland, Lugano, Switzerland
| | - S Smajda
- Department of Interventional Neuroradiology (S.S., G.C.), Rothschild Foundation Hospital, Paris, France
| | - G Ciccio
- Department of Interventional Neuroradiology (S.S., G.C.), Rothschild Foundation Hospital, Paris, France
| | - T Robert
- From the Department of Neurosurgery (S.B., T.R.), Neurocenter of the Southern Switzerland, Lugano, Switzerland .,University of Southern Switzerland (T.R.), Lugano, Switzerland
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21
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Pre-surgical embolization of intracranial meningioma with Onyx: A safety and efficacy study. J Neuroradiol 2020; 47:353-357. [DOI: 10.1016/j.neurad.2019.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/17/2022]
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Abstract
Interventional neuroradiology (INR) has evolved from a hybrid mixture of daring radiologists and iconoclastic neurosurgeons into a multidisciplinary specialty, which has become indispensable for cerebrovascular and neurological centers worldwide. This manuscript traces the origins of INR and describes its evolution to the present day. The focus will be on cerebrovascular disorders including aneurysms, stroke, brain arteriovenous malformations, dural arteriovenous fistulae, and atherosclerotic disease, both intra- and extracranial. Also discussed are cerebral vasospasm, venolymphatic malformations of the head and neck, tumor embolization, idiopathic intracranial hypertension, inferior petrosal venous sinus sampling for Cushing's disease, and spinal interventions. Pediatric INR has not been included and deserves a separate, dedicated review.
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Dabus G, Linfante I, McDermott MW. Angiography and embolization of meningiomas. HANDBOOK OF CLINICAL NEUROLOGY 2020; 169:193-202. [PMID: 32553290 DOI: 10.1016/b978-0-12-804280-9.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
The preoperative embolization of meningiomas has been part of the surgical treatment of large meningiomas for over 45 years. During that time there have been huge advances in the field of endovascular surgery with respect to techniques and instrumentation. Angiography and embolization are usually reserved for the largest tumors where there are concerns over potential blood loss with surgical excision. In this chapter, we discuss the technical aspects of angiography and embolization as well as results and complications.
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Affiliation(s)
- Guilherme Dabus
- Miami Neuroscience Institute, Baptist Health of South Florida, Miami, FL, United States; Miami Cardiac & Vascular Institute, Baptist Health of South Florida, Miami, FL, United States.
| | - Italo Linfante
- Miami Neuroscience Institute, Baptist Health of South Florida, Miami, FL, United States; Miami Cardiac & Vascular Institute, Baptist Health of South Florida, Miami, FL, United States
| | - Michael W McDermott
- Miami Neuroscience Institute, Baptist Health of South Florida, Miami, FL, United States; Division of Neuroscience, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
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Ansari SF, Shah KJ, Hassaneen W, Cohen-Gadol AA. Vascularity of meningiomas. HANDBOOK OF CLINICAL NEUROLOGY 2020; 169:153-165. [PMID: 32553286 DOI: 10.1016/b978-0-12-804280-9.00010-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Information on the vascular supply to meningiomas is critical to the neurosurgeon. Most meningiomas are supplied by the external carotid artery, though many get pial contribution as well. Angiogenesis is critical for these neoplasms to grow. Vascular endothelial growth factor (VEGF) has been a popular target of research to decrease angiogenesis. Peritumoral brain edema (PTBE) is occasionally seen in meningiomas, which makes surgical resection more challenging. The exact cause of PTBE remains unclear, but a number of factors have been postulated to contribute. Assessment of the vascularity of meningiomas is best carried out with angiography, but noninvasive techniques are improving, diminishing the need for more invasive imaging. Embolization of tumors can be performed to minimize perioperative blood loss and potentially lower surgical morbidity. However, it has not been shown to improve outcomes, and procedural risks exist. Higher grade tumors commonly have higher vascularity. Higher vascular meningiomas are more likely to recur and have higher levels of VEGF. The vascularity of meningiomas remains a topic of interest and is the focus of many research projects.
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Affiliation(s)
- Shaheryar F Ansari
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States
| | - Kushal J Shah
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States; Department of Neurosurgery, University of Kansas, Kansas City, MO, United States
| | - Wael Hassaneen
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States; Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, IL, United States; Department of Neurosurgery, Carle Illinois College of Medicine, Champaign, IL, United States
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States.
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Bonasia S, Bojanowski M, Robert T. Embryology and anatomical variations of the ophthalmic artery. Neuroradiology 2019; 62:139-152. [PMID: 31863143 DOI: 10.1007/s00234-019-02336-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/04/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The ophthalmic artery (OA) has one of the most complex anatomy and the most fascinating embryological development. METHODS The complexity of the embryologic development of the OA resides in the implication of three different embryological systems: the carotid system, the stapedial system, and the ventral pharyngeal system. RESULTS This explains very well the numerous variations in origin of the OA and the importance of vascular anastomoses developed with branches of the external carotid artery and with the middle meningeal artery. CONCLUSION In this review, authors propose a comprehensive description of different hypotheses on the embryologic development of the OA and, in a second part, explain all anatomical variations and clinical implications of this artery.
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Affiliation(s)
- Sara Bonasia
- Department of Neurosurgery, Regional Hospital of Lugano, Neurocenter of the Southern Switzerland, Via Tesserete 46, CH-6903, Lugano, Switzerland
| | - Michel Bojanowski
- Department of Neurosurgery, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - Thomas Robert
- Department of Neurosurgery, Regional Hospital of Lugano, Neurocenter of the Southern Switzerland, Via Tesserete 46, CH-6903, Lugano, Switzerland.
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Kang Y, Wei KC, Toh CH. Can we predict intraoperative blood loss in meningioma patients? Application of dynamic susceptibility contrast-enhanced magnetic resonance imaging. J Neuroradiol 2019; 48:254-258. [PMID: 31722226 DOI: 10.1016/j.neurad.2019.10.003] [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: 06/07/2019] [Revised: 10/02/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the potential of quantitative dynamic susceptibility contrast (DSC) perfusion MR imaging parameters as imaging biomarkers for predicting intraoperative blood loss in meningioma. METHODS Fifty-one non-embolized meningioma patients who had undergone preoperative DSC perfusion MR imaging were retrospectively included. The corrected relative cerebral blood volume (rCBV) and leakage coefficient (K2) of the entire enhanced tumor were obtained using leakage correction. Tumor volume, location, grade, and other clinical variables, were also analyzed. To investigate the vascularity and vascular permeability of meningiomas, and their correlation with predicting estimated blood loss (EBL) using preoperative DSC perfusion MR imaging, the authors proposed an index reflecting the inherent tendency of meningiomas to bleed after controlling volume (i.e., EBL/cm3). Simple regression was performed to identify predictors of EBL/cm3; subsequently, the relevant variables included in the stepwise multiple linear regression. RESULTS On univariate analysis, EBL/cm3 was correlated with rCBV (r=0.677; P<0.001), K2 (r=0.294; P=0.036), and tumor volume (r=-0.312, P=0.026). EBL/cm3 was not correlated with age (P=0.873), sex (P=0.404), tumor location (P=0.327), or histological grade (P=0.230). On multiple linear regression, rCBV (β=0.663 [0.463-0.864], B=1.293 [0.903-1.684; P<0.001) and K2 (β=0.260 [0.060-0.460], B=2.277 [0.523-4.031], P=0.012), were the only independent predictors of EBL/cm3. CONCLUSION The rCBV and K2 derived from DSC perfusion MR imaging in meningiomas may serve as feasible tools for clinicians to predict intraoperative blood loss and facilitate surgical planning.
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Affiliation(s)
- Yeonah Kang
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Cheng Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
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Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply. J Neurointerv Surg 2019; 12:204-208. [DOI: 10.1136/neurintsurg-2019-015129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022]
Abstract
IntroductionEndovascular embolization of intracranial meningiomas is commonly used as an adjunct to surgical resection. We sought to describe the anatomic locations and vascular supplies of meningiomas to identify characteristics predictive of successful preoperative endovascular embolization.MethodsWe conducted a retrospective review of 139 meningioma cases receiving cerebral angiograms for possible preoperative endovascular embolization at our institution between December 2000 and March 2017. The extent of embolization, arterial supply, anatomic location, and procedural complications were recorded for each case. Univariate and multivariate analyses were performed to identify tumor characteristics that predicted successful embolization.ResultsOf the total meningioma patients undergoing preoperative angiography, 78% (108/139) were successfully embolized, with a 2.8% periprocedural complication rate (3/108). Within the subset of patients with successful embolization, 31% (33/108) achieved complete angiographic embolization. Significant multivariate predictors of embolization (either partial or complete) were convexity/parasagittal locations (OR 5.15, 95% CI 0.93 to 28.54, p=0.060), meningohypophyseal trunk (MHT, OR 4.65, 95% CI 1.63 to 13.23, p=0.004), middle meningeal artery (MMA, OR 10.89, 95% CI 3.43 to 34.64, p<0.001), and ascending pharyngeal artery supply (APA, OR 9.96, 95% CI 1.88 to 52.73, p=0.007). Significant predictors for complete embolization were convexity/parasagittal locations (OR 4.79, 95% CI 1.66 to 13.84, p=0.004) and embolized APA supply (OR 6.94, 95% CI 1.90 to 25.39, p=0.003). Multiple arterial supply was a negative predictor of complete embolization (OR 0.38, 95% CI 0.15 to 0.98, p=0.05).ConclusionsTumor characteristics can be used to predict the likelihood of preoperative meningioma embolization. Parasagittal and convexity meningiomas, and those with APA supply, are most likely to achieve complete angiographic embolization.
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Walker M. Lipstick meningioma: artifactual findings during diagnostic cerebral angiogram. Postgrad Med J 2019; 95:404. [PMID: 31123176 DOI: 10.1136/postgradmedj-2019-136511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/30/2019] [Accepted: 05/04/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Melanie Walker
- Neurological Surgery, University of Washington, Seattle, Washington, USA
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30
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Friconnet G, Espíndola Ala VH, Janot K, Brinjikji W, Bogey C, Lemnos L, Salle H, Saleme S, Mounayer C, Rouchaud A. MRI predictive score of pial vascularization of supratentorial intracranial meningioma. Eur Radiol 2019; 29:3516-3522. [DOI: 10.1007/s00330-019-06197-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
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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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Wirsching HG, Richter JK, Sahm F, Morel C, Krayenbuehl N, Rushing EJ, von Deimling A, Valavanis A, Weller M. Post-operative cardiovascular complications and time to recurrence in meningioma patients treated with versus without pre-operative embolization: a retrospective cohort study of 741 patients. J Neurooncol 2018; 140:659-667. [PMID: 30196368 DOI: 10.1007/s11060-018-2996-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Preoperative embolization of radiographically suspected meningiomas is often performed to facilitate tumor resection. Its effects on the subsequent disease course of meningioma patients have not been studied in detail and randomized trials are lacking. The purpose of this study was to explore associations of preoperative meningioma embolization with postoperative outcome. PATIENTS AND METHODS Patients undergoing resection of an intracranial meningioma at the University Hospital Zurich 2000-2013 (N = 741) were reviewed for the inclusion of pre-operative embolization in the management strategy. Annotations included demographics, radiographic, surgical, histological and hematological parameters, cardiovascular risk factors, pre- and postoperative neurological function and gene methylation-based classification. Binary regression and Cox proportional hazards models were applied to determine factors associated with outcome. RESULTS Pre-operative embolization was performed in 337 patients (42%). Cardiovascular events after surgery comprised mostly deep vein thrombosis (N = 39) and pulmonary embolisms (N = 64). On multivariate analyses of post-operative cardiovascular adverse events controlling for established risk factors, there were associations with embolization (OR 2.38, 95% CI 1.37-4.00), and with female gender (OR 2.18, 95% CI 1.17-4.08). Recurrence-free survival (RFS) of embolized patients was less favorable among patients with WHO grade II or grade III meningiomas (median RFS: 4.3 vs. 7.0 years, P = 0.029) or in patients with intermediate or malignant gene methylation subtype meningiomas (median RFS: 2.0 vs. 8.2 years, P = 0.005). CONCLUSION Pre-operative meningioma embolization may cause adverse outcomes. Randomized trials to determine benefit-risk ratios are warranted to clarify the role of pre-operative embolization for the treatment of meningioma patients.
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Affiliation(s)
- Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | - Johannes Konstantin Richter
- Department of Neuroradiology, University Hospital and University of Zurich, Zurich, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital and University of Bern, Bern, Switzerland
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Corinne Morel
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Niklaus Krayenbuehl
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Elisabeth Jane Rushing
- Department of Neuropathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antonios Valavanis
- Department of Neuroradiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
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Primary Intracranial Rhabdomyosarcoma in the Cerebellopontine Angle Resected After Preoperative Embolization. World Neurosurg 2018; 116:110-115. [DOI: 10.1016/j.wneu.2018.05.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 11/22/2022]
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Ehresman JS, Mampre D, Rogers D, Olivi A, Quinones-Hinojosa A, Chaichana KL. Volumetric tumor growth rates of meningiomas involving the intracranial venous sinuses. Acta Neurochir (Wien) 2018; 160:1531-1538. [PMID: 29869111 DOI: 10.1007/s00701-018-3571-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/22/2018] [Indexed: 12/23/2022]
Abstract
OBJECT There is currently no consensus as to whether meningiomas located inside the venous sinuses should be aggressively or conservatively treated. The goals of this study were to identify how sinus-invading meningiomas grow, report and compare growth rates of tumor components inside and outside the different venous sinuses, identify risk factors associated with increased tumor growth, and determine the effects of the extent of tumor resection on recurrence for meningiomas that invade the dural venous sinuses. METHODS Adult patients who underwent primary, non-biopsy resection of a WHO grade 1 meningioma invading the dural venous sinuses at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Rates of tumor growth were fit to several growth models to evaluate the most accurate model. Cohen's d analysis was used to identify associations with increased growth of tumor in the venous sinuses. Logistic regression was used to compare extent of resection with recurrence. RESULTS Of the 68 patients included in the study, 34 patients had postoperative residual tumors in the venous sinuses that were measured over time. The growth model that best fit the growth of intrasinus meningiomas was the Gompertzian growth model (r2 = 0.93). The annual growth rate of meningiomas inside the sinuses was 7.3%, compared to extrasinus tumors with 13.6% growth per year. The only factor significantly associated with increased tumor growth in sinuses was preoperative embolization (effect sizes (ES) [95% CI], 1.874 [7.633-46.735], p = 0.008). CONCLUSIONS This study shows that meningiomas involving the venous sinuses have a Gompertzian-type growth with early exponential growth followed by a slower growth rate that plateaus when they reach a certain size. Overall, the growth rate of the intrasinus portion is low (7.3%), which is half of the reported growth rates for other studies involving primarily extrasinus tumors.
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Affiliation(s)
- Jeffrey S Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Mampre
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Davis Rogers
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Kaisorn L Chaichana
- Department of Neurosurgery, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Yoon N, Shah A, Couldwell WT, Kalani MYS, Park MS. Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance. Neurosurg Focus 2018; 44:E5. [DOI: 10.3171/2018.1.focus17686] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Skull base meningiomas are technically challenging tumors to treat because of their deep vascular supply that can preclude early devascularization during resection. Preoperative embolization of these arterial feeders is thought to decrease blood loss and facilitate resection; however, given the complex and varied anatomy of these skull base lesions, preoperative embolization is not without risk. It is essential for both endovascular and skull base neurosurgeons to understand these risks in light of the potential benefits. The authors review the vascular anatomy of skull base meningiomas, indications for preoperative devascularization, endovascular techniques, and published results regarding embolization of these lesions.
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Affiliation(s)
- Nam Yoon
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - Aatman Shah
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - William T. Couldwell
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - M. Yashar S. Kalani
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
- 2Departments of Neurosurgery and Neurology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Min S. Park
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
- 2Departments of Neurosurgery and Neurology, University of Virginia School of Medicine, Charlottesville, Virginia
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Zabalo G, de Frutos D, García JC, Ortega R, Guelbenzu JJ, Zazpe I. Dumbbell malignant dorsal schwannoma embolized and operated by single posterior approach. Neurocirugia (Astur) 2018; 30:28-32. [PMID: 29472158 DOI: 10.1016/j.neucir.2018.01.004] [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: 09/28/2017] [Revised: 12/03/2017] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
Abstract
We report a case of a 41 years old patient complaining of chronic dorsalgia. MRI showed a well defined intradural extramedular dumbbell-shaped lesion, associated to a left paravertebral tumor at D5-D6 level. The tumor was embolizated prior to surgery. Following she underwent a D4-D6 laminotomy, left D5-D6 costotransversectomy and resection of the intracanal extradural part of the lesion with section of the left D5 nerve. Posteriorly, complete resection of the extracanal portion of the tumor was performed by a postero-lateral approach. The anatomopathologic diagnosis was a malignant schwannoma. After the surgery, the patient required adyuvant radiotherapic treatment. Malignant schwannoma is a very uncommon tumor which belongs to the malignant peripheral nerve sheath tumors (MPNST). It develops from Schwann cells. It is frequently associated with type 1 neurofibromatosis. MPNST usually present local recurrence and can metastatize.
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Affiliation(s)
- Gorka Zabalo
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España.
| | - Daniel de Frutos
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Juan Carlos García
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Rodrigo Ortega
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Juan José Guelbenzu
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Idoya Zazpe
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
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Nakashima T, Hatano N, Kanamori F, Muraoka S, Kawabata T, Takasu S, Watanabe T, Kojima T, Nagatani T, Seki Y. Tumor Volume Decrease via Feeder Occlusion for Treating a Large, Firm Trigone Meningioma. NMC Case Rep J 2017; 5:9-14. [PMID: 29354332 PMCID: PMC5767480 DOI: 10.2176/nmccrj.cr.2017-0014] [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: 01/18/2017] [Accepted: 05/28/2017] [Indexed: 12/18/2022] Open
Abstract
Trigone meningiomas are considered a surgical challenge, as they tend to be considerably large and hypervascularized at the time of presentation. We experienced a case of a large and very hard trigone meningioma that was effectively treated using initial microsurgical feeder occlusion followed by surgery in stages. A 19-year-old woman who presented with loss of consciousness was referred to our hospital for surgical treatment of a brain tumor. Radiological findings were compatible with a left ventricular trigone meningioma extending laterally in proximity to the Sylvian fissure. At initial surgery using the transsylvian approach, main feeders originating from the anterior and lateral posterior choroidal arteries were occluded at the inferior horn; however, only a small section of the tumor could initially be removed because of its firmness. Over time, feeder occlusion resulted in tumor necrosis and a 20% decrease in its diameter; the mass effect was alleviated within 1 year. The residual meningioma was then totally excised in staged surgical procedures after resection became more feasible owing to ischemia-induced partial softening of the tumor. When a trigone meningioma is large and very hard, initial microsurgical feeder occlusion in the inferior horn can be a safe and effective option, and can lead to necrosis, volume decrease, and partial softening of the residual tumor to allow for its staged surgical excision.
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Affiliation(s)
- Takuma Nakashima
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Norikazu Hatano
- Department of Stroke Medicine, Kawashima Hospital, Nagoya, Aichi, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Shinsuke Muraoka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Teppei Kawabata
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Syuntaro Takasu
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Tadashi Watanabe
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Takao Kojima
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Nagatani
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yukio Seki
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
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Talacchi A, Biroli A, Medaglia S, Locatelli F, Meglio M. Surgical Management of Anterolateral and Posteromedial Incisural Tentorial Meningioma. Oper Neurosurg (Hagerstown) 2017; 15:120-130. [DOI: 10.1093/ons/opx228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/27/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Tentorial meningiomas are a broad and consistent category of tumors but their definition is still unclear and their classification uncertain.
OBJECTIVE
To report the clinical and surgical characteristics of tentorial hiatus meningiomas based on a revised classification of tentorial meningiomas.
METHODS
We reviewed the records of 14 patients who had undergone microsurgical removal of incisural tentorial meningioma. Two tumor subgroups, anterolateral (AL) and posteromedial (PM), were distinguished according to their site of attachment: the middle third and the posterior third of the tentorial free margin, respectively. Clinical presentation, radiological findings, surgical approaches, extent of resection, and outcome were compared.
RESULTS
The 2 subgroups differed by tumor size (larger in PM), incidence of the direction of growth (infratentorial in PM), and hydrocephalus (only in PM), as well as by some clinical aspects. Surgical approach depended on tumor location: lateral (pterional, subtemporal, and retromastoid) for AL lesions; medial (occipital or supracerebellar infratentorial) for PM lesions. Total removal (Simpson grade I-II) was performed in 64% of cases and complications occurred in 14%. Stereotactic radiosurgery was performed in cases of incomplete resection. At a mean follow-up of 104.5 mo, clinical improvement with low recurrence (9%) was achieved.
CONCLUSION
Reallocation of tentorial edge meningiomas is the premise to compare treatment and further improve the approach case-by-case. In spite of their deep site, good outcomes can be achieved in both AL and PM tentorial meningiomas. Also of note is the indolent behavior of residual tumor.
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Affiliation(s)
- Andrea Talacchi
- Department of Neurosciences, Biomedi-cine and Movement Sciences, Section of Neurosurgery, University of Verona, Italy
| | - Antonio Biroli
- Department of Neurosciences, Biomedi-cine and Movement Sciences, Section of Neurosurgery, University of Verona, Italy
- Department of Neurosurgery, Hospital Eugenio Espejo, Quito, Ecuador
| | - Stefano Medaglia
- Department of Neurosciences, Biomedi-cine and Movement Sciences, Section of Neurosurgery, University of Verona, Italy
| | - Francesca Locatelli
- Department of Neurosciences, Biomedi-cine and Movement Sciences, Section of Neurosurgery, University of Verona, Italy
- Department of Public Health and Community Medicine, Section of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Mario Meglio
- Department of Neurosciences, Biomedi-cine and Movement Sciences, Section of Neurosurgery, University of Verona, Italy
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Shivapathasundram G, Wickremesekera AC, Tan ST, Itinteang T. Tumour stem cells in meningioma: A review. J Clin Neurosci 2017; 47:66-71. [PMID: 29113852 DOI: 10.1016/j.jocn.2017.10.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/22/2017] [Indexed: 12/11/2022]
Abstract
Meningioma is a common intracranial and intraspinal neoplasm accounting for 25-30% of all primary neurological tumours. It is associated with high rates of recurrence especially in higher-grade tumours and lesions located at the skull base. Cancer stem cells are increasingly recognised as the origin of cancer and are attributed to loco-regional recurrence, metastasis and treatment resistance. This review presents the accumulating evidence of the presence of tumour stem cells within meningioma and the stem cell markers being used to characterise this putative primitive population within this common tumour.
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Affiliation(s)
- Ganeshwaran Shivapathasundram
- Gillies McIndoe Research Institute, Newtown, Wellington, New Zealand; Department of Neurosurgery, Wellington Regional Hospital, Wellington, New Zealand
| | - Agadha C Wickremesekera
- Gillies McIndoe Research Institute, Newtown, Wellington, New Zealand; Department of Neurosurgery, Wellington Regional Hospital, Wellington, New Zealand
| | - Swee T Tan
- Gillies McIndoe Research Institute, Newtown, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand.
| | - Tinte Itinteang
- Gillies McIndoe Research Institute, Newtown, Wellington, New Zealand
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Nguyen HS, Janich K, Doan N, Patel M, Li L, Mueller W. Extent of T1+C Intensity Is a Predictor of Blood Loss in Resection of Meningioma. World Neurosurg 2017; 101:69-75. [PMID: 28179171 DOI: 10.1016/j.wneu.2017.01.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/21/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Surgery for meningioma is associated with significant blood loss. Preoperative embolization has been associated with reduction of blood loss and has been noted to decrease intensity on T1 + contrast sequences. We investigate potential relationships between blood loss and the extent of T1 + contrast intensity. METHODS Forty-two patients who underwent surgical resection of intracranial meningioma were retrospectively reviewed from August 2009 to May 2016. Clinical data were extracted (age, gender, location of meningioma, grade of meningioma, need for blood transfusion during surgery, preoperative and postoperative hematocrit level, estimated blood loss [EBL], and duration of surgery). Using OsiriX MD, the tumor volume, sinus involvement, peritumoral edema, extent of resection, and T1 index (average T1+C intensity across the tumor normalized to value at basilar artery) were assessed. RESULTS With EBL, univariate analysis for gender, tumor volume, and T1 index showed correlations with P value <0.1. A logistic regression to predict EBL <300 mL and ≥300 mL using the 3 variables yielded T1 index (odds ratio [OR], 31.22; 95% confidence interval [CI], 1.14-855.65), gender (OR, 0.17; 95% CI, 0.03-0.96), and tumor volume (OR, 1.05; 95% CI, 1.00-1.10) as significant predictors (all P < 0.05). With duration for surgery, gender, tumor volume, need for blood transfusion, and preoperative hematocrit exhibited P value <0.05; multivariate analysis did not show a significant model. CONCLUSIONS Along with gender and tumor volume, extent of T1+C intensity is also an independent predictor of EBL. This finding may be helpful for surgical management of meningioma.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Karl Janich
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohit Patel
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Luyuan Li
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Kostić A, Ristić S, Nikolov V, Stefanović I, Dželebdžić Z, Berilažić L. Endovascular prelude for delicate meningeoma operation: A case report. SANAMED 2017. [DOI: 10.24125/sanamed.v1i1.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Embolization prior to surgery can make tumor resection less complicated by reducing blood loss during surgery and shortening the time of the operation. Case report: In this paper, we presented a case of a sixty-three-year-old woman who was admitted to the Clinic of Neurosurgery, Clinical Center Niš, Serbia, at November 2016, after she underwent a CT brain scan that showed a large tumor of the left cerebellopontile angle. Digital subtraction angiography presented a large, highly vascularized tumor lesion that compressed the brain stem. The patient underwent endovascular procedure, and complete embolization of the tumor vessels was established. The radiologist delivered embolization material via the left ascending pharyngeal artery. In the next 24 hours, an operation was performed i.e. radical extirpation surgery (Simpson grade I). Postoperatively, the patient's GCS was 15, with no new neurological deficit. Postoperative brain CT scan showed neither rest tumor nor blood clot inside the tumor bed. Pathohistological finding revealed atypical meningioma grade II. Conclusion: Despite some clinicians' dilemma considering the utility of preoperative embolization of meningioma vessels, we believe that a team of educated and dedicated radiologist and neurosurgeon could achieve great results in resection of large and inaccessible cranial tumors.
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Laviv Y, Thomas A, Kasper EM. Hypervascular Lesions of the Cerebellopontine Angle: The Relevance of Angiography as a Diagnostic and Therapeutic Tool and the Role of Stereotactic Radiosurgery in Management. A Comprehensive Review. World Neurosurg 2016; 100:100-117. [PMID: 28049034 DOI: 10.1016/j.wneu.2016.12.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The cerebellopontine angle (CPA) is a narrowed skull base area containing important cranial nerves and vessels and bordering with eloquent areas of the posterior fossa. Tumors of the CPA are a heterogeneous group and can have extradural, intradural/extra-axial, or intra-axial origins. Their vascular supply changes depending on their anatomic origin. Symptomatic, large CPA tumors require surgical resection in order to prevent irreversible, severe neurological damages. However, its tight and strategical location make surgery in the CPA very challenging and require appropriate pre-surgical planning. Pre-surgical diagnosis is of great importance as it allows us to choose the optimal management for the particular patient. This is of further significance when encountering high-risk lesions such as hypervascular tumors. Neurosurgeons should utilize every available pre-surgical diagnostic modalities as well as neo-adjuvant treatments in order to reduce such risks. METHODS We review all reported cases of hypervascular lesions of the CPA and discuss the roles of angiography and stereotactic radiosurgery in their management. RESULTS Three lesions of the CPA can be considered as truly hypervascular: hemangioblastomas, hemangiopericytomas and paragangliomas. All lesions share many radiological features. However, each lesion has a different anatomical origin and hence, has a characteristic vascular supply. Pre-surgical angiography can be utilized as a diagnostic tool to narrow down the differential diagnosis of a vascular CPA lesion, based on the predominant supplying vessel. In addition, pre-surgical embolization at time of angiography will narrow the associated surgical risks. CONCLUSIONS Angiography is a crucial diagnostic and therapeutic tool, helping both in narrowing the presurgical differential diagnosis and in controlling intraoperative bleeding. Because of the high surgical risks associated with resection of vascular tumors in the CPA, noninvasive treatments, such as stereotactic radiosurgery, also may have a crucial role.
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Affiliation(s)
- Yosef Laviv
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ajith Thomas
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Wen LL, Zhang X, Zhang QR, Wu Q, Chen SJ, Deng JL, Huang K, Wang HD. Flat-detector computed tomography PBV map in the evaluation of presurgical embolization for hypervascular brain tumors. J Neurointerv Surg 2016; 9:1139-1144. [PMID: 27856651 DOI: 10.1136/neurintsurg-2016-012658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/22/2016] [Accepted: 10/27/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Preoperative embolization of hypervascular brain tumors is frequently used to minimize intraoperative bleeding. OBJECTIVE To explore the efficacy of embolization using flat-detector CT (FDCT) parenchymal blood volume (PBV) maps before and after the intervention. MATERIALS AND METHODS Twenty-five patients with hypervascular brain tumors prospectively received pre- and postprocedural FDCT PBV scans using a biplane system under a protocol approved by the institutional research ethics committee. Semiquantitative analysis, based on region of interest measurements of the pre- and post-embolization PBV maps, operating time, and blood loss, was performed to assess the feasibility of PBV maps in detecting the perfusion deficit and to evaluate the efficacy of embolization. RESULTS Preoperative embolization was successful in 18 patients. The relative PBV decreased significantly from 3.98±1.41 before embolization to 2.10±2.00 after embolization. Seventeen patients underwent surgical removal of tumors 24 hours after embolization. The post-embolic tumor perfusion index correlated significantly with blood loss (ρ=0.55) and operating time (ρ=0.60). CONCLUSIONS FDCT PBV mapping is a useful method for evaluating the perfusion of hypervascular brain tumors and the efficacy of embolization. It can be used as a supplement to CT perfusion, MRI, and DSA in the evaluation of tumor embolization.
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Affiliation(s)
- Li-Li Wen
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, PR China
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Qing-Rong Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Qi Wu
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Shu-Juan Chen
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Jin-Long Deng
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | | | - Han-Dong Wang
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, PR China
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Unique Extrancranial-to-Intracranial Neovascularization Found on Diagnostic Angiography Prior to Skull Base Atypical Grade 2 Meningioma Resection: A Case Report and Hypothesis. World Neurosurg 2016; 95:617.e1-617.e6. [DOI: 10.1016/j.wneu.2016.08.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/24/2022]
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Ohnishi H, Miyachi S, Murao K, Hiramatsu R, Takahashi K, Ohnishi H, Kuroiwa T. Infiltrated Embolization of Meningioma with Dilute Cyanoacrylate Glue. Neurol Med Chir (Tokyo) 2016; 57:44-50. [PMID: 27646010 PMCID: PMC5243164 DOI: 10.2176/nmc.tn.2016-0144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe the efficacy and technical aspects of infiltrated preoperative embolization of meningioma by penetration of very dilute glue. In this method, a 13% n-butyl-cyanoacrylate (NBCA)-lipiodol mixture is injected extremely slowly from the middle meningeal artery (MMA) in a similar manner to plug and push injection of ethylene vinyl alcohol copolymer mixed with tantalum and dimethyl sulfoxide (Onyx®) after the tortuous side feeders are proximally embolized. The glue is infiltrated into small tumor arteries and extends to inaccessible feeders from deep meningeal arteries. Since 2011, we have used this technique in the embolization of 32 cases preoperatively diagnosed with meningioma. Intratumoral embolization was possible in 30 cases (94%), and a greater than 50% reduction in contrast area of contrast-enhanced T1-weighted MR imaging (T1-WI) was achieved in 18 cases (56%). Two cases achieved complete devascularization, showing a remarkable shrinkage in tumor size after embolization. If excessive reflux of embolization and the resulting migration of glue into normal arteries is achieved, this method provides extremely effective devascularization on surgical extirpation. It might also be applicable to surgically untreatable meningiomas as a semi-radical treatment option.
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Affiliation(s)
- Hiroyuki Ohnishi
- Department of Neurosurgery Neuroendovascular Surgery, Osaka Medical College
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Nanda A, Bir SC, Maiti TK, Konar SK, Missios S, Guthikonda B. Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma. J Neurosurg 2016; 126:201-211. [PMID: 27058201 DOI: 10.3171/2016.1.jns151842] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The clinical significance of the Simpson system for grading the extent of meningioma resection and its role as a predictor of the recurrence of World Health Organization (WHO) Grade I meningiomas have been questioned in the past, echoing changes in meningioma surgery over the years. The authors reviewed their experience in resecting WHO Grade I meningiomas and assessed the association between extent of resection, as evaluated using the Simpson classification, and recurrence-free survival (RFS) of patients after meningioma surgery. METHODS Clinical and radiological information for patients with WHO Grade I meningiomas who had undergone resective surgery over the past 20 years was retrospectively reviewed. Simpson and Shinshu grading scales were used to evaluate the extent of resection. Statistical analysis was conducted using Kaplan-Meier curves and Cox proportional-hazards regression. RESULTS Four hundred fifty-eight patients were eligible for analysis. Overall tumor recurrence rates for Simpson resection Grades I, II, III, and IV were 5%, 22%, 31%, and 35%, respectively. After Cox regression analysis, Simpson Grade I (extensive resection) was revealed as a significant predictor of RFS (p = 0.003). Patients undergoing Simpson Grade I and II resections showed significant improvement in RFS compared with patients undergoing Grade III and IV resections (p = 0.005). Extent of resection had a significant effect on recurrence rates for both skull base (p = 0.047) and convexity (p = 0.012) meningiomas. Female sex and a Karnofsky Performance Scale score > 70 were also identified as independent predictors of RFS after resection of WHO Grade I meningioma. CONCLUSIONS In this patient cohort, a significant association was noted between extent of resection and rates of tumor recurrence. In the authors' experience the Simpson grading system maintains its relevance and prognostic value and can serve an important role for patient education. Even though complete tumor resection is the goal, surgery should be tailored to each patient according to the risks and surgical morbidity.
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Affiliation(s)
- Anil Nanda
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Shyamal C Bir
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Tanmoy K Maiti
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Subhas K Konar
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Symeon Missios
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
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James RF, Kramer DR, Page PS, Gaughen JR, Martin LB, Mack WJ. Strategic and Technical Considerations for the Endovascular Embolization of Intracranial Meningiomas. Neurosurg Clin N Am 2016; 27:155-66. [PMID: 27012380 DOI: 10.1016/j.nec.2015.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular embolization is a frequently used adjunct to operative resection of meningiomas. Embolization may decrease intraoperative blood loss, operative time, and surgical difficulty associated with resection. The specific clinical applications of this treatment have not been defined clearly. Procedural indications, preferred embolic agent, and latency until tumor resection all differ across operators. It is clear that strategic patient selection, comprehensive anatomic understanding, and sound operative technique are critical to the success of the embolization procedure. This article reviews the management and technical considerations associated with preoperative meningioma embolization.
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Affiliation(s)
- Robert F James
- Department of Neurosurgery, University of Louisville School of Medicine, 550 S. Jackson St., Louisville, KY 40204, USA
| | - Daniel R Kramer
- Department of Neurosurgery, University of Southern California Keck School of Medicine, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90089, USA
| | - Paul S Page
- Department of Neurosurgery, University of Louisville School of Medicine, 550 S. Jackson St., Louisville, KY 40204, USA
| | - John R Gaughen
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA 22908, USA
| | - Lacey B Martin
- Department of Neurosurgery, University of Oklahoma School of Medicine, 660 Parrington Oval, Norman, OK 73019, USA
| | - William J Mack
- Department of Neurosurgery, University of Southern California Keck School of Medicine, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90089, USA.
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Fang QR, He XY, Li XF, Zhang X, Chen M, Li H, Li W, Wang ZQ, Duan CZ. Comparative efficacy of Glubran and polyvinyl-alcohol particles in the embolization of meningiomas. Int J Neurosci 2016; 126:1112-9. [PMID: 26707920 DOI: 10.3109/00207454.2015.1134525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Preoperative embolization of meningiomas decreases intraoperative bleeding and shortens operation time. However, in meningiomas predominantly vascularized by the internal carotid artery (ICA) or vertebral artery (VA) branches, embolization of external carotid artery feeder branches may lead to a hemodynamic increase in blood supply from the ICA or VA, whereas embolization of ICA or VA feeder branches with particle embolic agents may be associated with complications. This study investigated the safety and efficacy of Glubran, a liquid embolic agent, for the embolization of this type of meningioma compared with polyvinyl-alcohol (PVA) particles. MATERIALS AND METHODS From January 2006 to June 2015, 157 consecutive patients (98 females; mean age = 48.3 years) who suffered from meningiomas and were preoperatively referred for embolization were retrospectively analyzed. Glubran (n = 40) and PVA (n = 55) were used to devascularize tumors. Sixty-two patients were not embolized because of dangerous anastomosis or other tumor characteristics. Intraoperative blood loss, intraoperative time, degree of angiographic devascularization and embolization-related complications were analyzed. RESULTS The intraoperative blood loss and operative time were significantly lower in the Glubran-embolized versus non-embolized group. Furthermore, Glubran embolization significantly reduced intraoperative blood loss and operative time for meningiomas that received their primary blood supply from the ICA and/or VA compared with PVA embolization. CONCLUSIONS Preoperative meningioma embolization with Glubran decreases intraoperative blood loss and operative time. Furthermore, embolization with Glubran produces more effective devascularization compared with PVA for meningiomas supplied by the ICA and/or VA. Thus, Glubran may represent a better embolic agent for this meningioma subtype.
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Affiliation(s)
- Qin-Rui Fang
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Xu-Ying He
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Xi-Feng Li
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Xin Zhang
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Min Chen
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Hui Li
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Wei Li
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Ze-Qun Wang
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Chuan-Zhi Duan
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
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Yu J, Guo Y, Xu B, Xu K. Clinical importance of the middle meningeal artery: A review of the literature. Int J Med Sci 2016; 13:790-799. [PMID: 27766029 PMCID: PMC5069415 DOI: 10.7150/ijms.16489] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/22/2016] [Indexed: 12/15/2022] Open
Abstract
The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yunbao Guo
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Hanak BW, Haussen DC, Ambekar S, Ferreira M, Ghodke BV, Peterson EC. Preoperative embolization of intracranial hemangiopericytomas: case series and introduction of the transtumoral embolization technique. J Neurointerv Surg 2015; 8:1084-94. [DOI: 10.1136/neurintsurg-2015-011980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/25/2015] [Indexed: 11/03/2022]
Abstract
Background and purposeHemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx-18 through diminutive external carotid artery (ECA) feeders.MethodsA retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002–November 2014) and Anonymous University #2 (January 2014–November 2014) is presented.ResultsFifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4±10.7%; n=6) than with HPCs supplied via the ICA/VB circulation (57.9±26.9%; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0±34.6%; n=4) versus polyvinyl alcohol particles (33.3±15.3%; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=−0.71; p=0.005). There were no embolization-related complications.ConclusionsThe extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate.
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