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Zheng K, Murphy MC, Camerucci E, Plitt AR, Shan X, Sui Y, Manduca A, Van Gompel JJ, Ehman RL, Huston J, Yin Z. Improved quantification of tumor adhesion in meningiomas using MR elastography-based slip interface imaging. PLoS One 2024; 19:e0305247. [PMID: 38917107 PMCID: PMC11198761 DOI: 10.1371/journal.pone.0305247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Meningiomas, the most prevalent primary benign intracranial tumors, often exhibit complicated levels of adhesion to adjacent normal tissues, significantly influencing resection and causing postoperative complications. Surgery remains the primary therapeutic approach, and when combined with adjuvant radiotherapy, it effectively controls residual tumors and reduces tumor recurrence when complete removal may cause a neurologic deficit. Previous studies have indicated that slip interface imaging (SII) techniques based on MR elastography (MRE) have promise as a method for sensitively determining the presence of tumor-brain adhesion. In this study, we developed and tested an improved algorithm for assessing tumor-brain adhesion, based on recognition of patterns in MRE-derived normalized octahedral shear strain (NOSS) images. The primary goal was to quantify the tumor interfaces at higher risk for adhesion, offering a precise and objective method to assess meningioma adhesions in 52 meningioma patients. We also investigated the predictive value of MRE-assessed tumor adhesion in meningioma recurrence. Our findings highlight the effectiveness of the improved SII technique in distinguishing the adhesion degrees, particularly complete adhesion. Statistical analysis revealed significant differences in adhesion percentages between complete and partial adherent tumors (p = 0.005), and complete and non-adherent tumors (p<0.001). The improved technique demonstrated superior discriminatory ability in identifying tumor adhesion patterns compared to the previously described algorithm, with an AUC of 0.86 vs. 0.72 for distinguishing complete adhesion from others (p = 0.037), and an AUC of 0.72 vs. 0.67 for non-adherent and others. Aggressive tumors exhibiting atypical features showed significantly higher adhesion percentages in recurrence group compared to non-recurrence group (p = 0.042). This study validates the efficacy of the improved SII technique in quantifying meningioma adhesions and demonstrates its potential to affect clinical decision-making. The reliability of the technique, coupled with potential to help predict meningioma recurrence, particularly in aggressive tumor subsets, highlights its promise in guiding treatment strategies.
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Affiliation(s)
- Keni Zheng
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | | | | | - Aaron R. Plitt
- Neurosurgery, Mayo Clinic, Rochester, MN, United States of America
| | - Xiang Shan
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Yi Sui
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Armando Manduca
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America
| | - Jamie J. Van Gompel
- Neurosurgery, Mayo Clinic, Rochester, MN, United States of America
- Otolaryngology, Mayo Clinic, Rochester, MN, United States of America
| | | | - John Huston
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Ziying Yin
- Radiology, Mayo Clinic, Rochester, MN, United States of America
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Shi X, Liu Y, Zhang Z, Tao B, Zhang D, Jiang Q, Chen G, Ma H, Feng Y, Xie J, Zheng X, Zhang J. The value of radiographic features in predicting postoperative facial nerve function in vestibular schwannoma patients: A retrospective study and nomogram analysis. CNS Neurosci Ther 2024; 30:e14526. [PMID: 37990346 PMCID: PMC11017437 DOI: 10.1111/cns.14526] [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: 08/20/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE The purpose of this study was to identify significant prognostic factors associated with facial paralysis after vestibular schwannoma (VS) surgery and develop a novel nomogram for predicting facial nerve (FN) outcomes. METHODS Retrospective data were retrieved from 355 patients who underwent microsurgery via the retrosigmoid approach for VS between December 2017 and December 2022. Univariate and multivariate logistic regression analysis were used to construct a radiographic features-based nomogram to predict the risk of facial paralysis after surgery. RESULTS Following a thorough screening process, a total of 185 participants were included. The univariate and multivariate logistic regression analysis revealed that tumor size (p = 0.005), fundal fluid cap (FFC) sign (p = 0.014), cerebrospinal fluid cleft (CSFC) sign (p < 0.001), and expansion of affected side of internal auditory canal (IAC) (p = 0.033) were independent factors. A nomogram model was constructed based on these indicators. When applied to the validation cohort, the nomogram demonstrated good discrimination and favorable calibration. Then we generated a web-based calculator to facilitate clinical application. CONCLUSION Tumor size, FFC and CSFC sign, and the expansion of the IAC, serve as good predictors of postoperative FN outcomes. Based on these factors, the nomogram model demonstrates good predictive performance.
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Affiliation(s)
- Xudong Shi
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yuyang Liu
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Zehan Zhang
- Department of Neurosurgerythe Air Force Hospital of Southern Theater CommandGuangzhouChina
| | - Bingyan Tao
- Department of Neurosurgery961th Hospital of Joint Logistics Support ForceQiqiharChina
| | - Ding Zhang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Qingyu Jiang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Guilin Chen
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Hengchao Ma
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yaping Feng
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Jiaxin Xie
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Xuan Zheng
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Jun Zhang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
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Maiuri F, Corvino S. Meningiomas of the rolandic region: risk factors for motor deficit and role of intra-operative monitoring. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05630-6. [PMID: 37277557 DOI: 10.1007/s00701-023-05630-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Meningiomas of the rolandic region are associated to high risk of postoperative motor deficits. This study discusses the factors affecting motor outcome and recurrences from the analysis of a monoinstitutional case series and eight studies from a literature review. METHODS Data of 75 patients who underwent surgery for meningioma of the rolandic region were retrospectively reviewed. The analyzed factors included tumor location and size, clinical presentation, magnetic resonance imaging (MRI) and surgical findings, brain-tumor interface, extent of resection, postoperative outcome and recurrence. Eight studies from literature on rolandic meningiomas treated with or without intraoperative monitoring (IOM) were reviewed with the aim to define the impact of IOM on the extent of resection and motor outcome. RESULTS Among the 75 patients of the personal series, the meningioma was on the brain convexity in 34 (46%), at the parasagittal region in 28 (37%) and at the falx in 13 (17%). The brain-tumor interface was preserved in 53 cases (71%) at MRI and in 56 (75%) at surgical exploration. Simpson grade I resection was obtained in 43% of patients, grade II in 33%, grade III in 15% and grade IV in 9%. The motor function worsened postoperatively in 9 among 32 cases with preoperative deficit (28%) and in 5 among 43 with no preoperative deficit (11.5%); definitive motor deficit was evidenced in overall series at follow-up in 7 (9.3%). Patients with meningioma with lost arachnoid interface had significant higher rates of worsened postoperative motor deficit (p = 0.01) and seizures (p = 0.033). Recurrence occurred in 8 patients (11%). The analysis of the 8 reviewed studies (4 with and 4 without IOM) shows in the group without IOM higher rates of Simpson grades I and II resection (p = 0.02) and lower rates of grades IV resection (p = 0.002); no significant differences in postoperative immediate and long-term motor deficits were evidenced between the two groups. CONCLUSIONS Data from literature review show that the use of IOM does not affect the postoperative motor deficit Therefore, its role in rolandic meningiomas resection remains to be determined and will be defined in further studies.
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Affiliation(s)
- Francesco Maiuri
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", School of Medicine, Via Pansini, 5, 80131, Naples, Italy.
| | - Sergio Corvino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", School of Medicine, Via Pansini, 5, 80131, Naples, Italy
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Liu X, Wang Y, Han T, Liu H, Zhou J. Preoperative surgical risk assessment of meningiomas: a narrative review based on MRI radiomics. Neurosurg Rev 2022; 46:29. [PMID: 36576657 DOI: 10.1007/s10143-022-01937-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/08/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
Meningiomas are one of the most common intracranial primary central nervous system tumors. Regardless of the pathological grading and histological subtypes, maximum safe resection is the recommended treatment option for meningiomas. However, considering tumor heterogeneity, surgical treatment options and prognosis often vary greatly among meningiomas. Therefore, an accurate preoperative surgical risk assessment of meningiomas is of great clinical importance as it helps develop surgical treatment strategies and improve patient prognosis. In recent years, an increasing number of studies have proved that magnetic resonance imaging (MRI) radiomics has wide application values in the diagnostic, identification, and prognostic evaluations of brain tumors. The vital importance of MRI radiomics in the surgical risk assessment of meningiomas must be apprehended and emphasized in clinical practice. This narrative review summarizes the current research status of MRI radiomics in the preoperative surgical risk assessment of meningiomas, focusing on the applications of MRI radiomics in preoperative pathological grading, assessment of surrounding tissue invasion, and evaluation of tumor consistency. We further analyze the prospects of MRI radiomics in the preoperative assessment of meningiomas angiogenesis and adhesion with surrounding tissues, while pointing out the current challenges of MRI radiomics research.
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Affiliation(s)
- Xianwang Liu
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, People's Republic of China
- Second Clinical School, Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, People's Republic of China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, People's Republic of China
| | - Yuzhu Wang
- Second Clinical School, Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, People's Republic of China
| | - Tao Han
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, People's Republic of China
- Second Clinical School, Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, People's Republic of China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, People's Republic of China
| | - Hong Liu
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, People's Republic of China
- Second Clinical School, Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, People's Republic of China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, People's Republic of China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, People's Republic of China.
- Second Clinical School, Lanzhou University, Lanzhou, People's Republic of China.
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, People's Republic of China.
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, People's Republic of China.
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Yin Z, Lu X, Cohen Cohen S, Sui Y, Manduca A, Van Gompel JJ, Ehman RL, Huston J. A new method for quantification and 3D visualization of brain tumor adhesion using slip interface imaging in patients with meningiomas. Eur Radiol 2021; 31:5554-5564. [PMID: 33852045 DOI: 10.1007/s00330-021-07918-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To develop an objective quantitative method to characterize and visualize meningioma-brain adhesion using MR elastography (MRE)-based slip interface imaging (SII). METHODS This retrospective study included 47 meningiomas (training dataset: n = 35; testing dataset: n = 12) with MRE/SII examinations. Normalized octahedral shear strain (NOSS) values were calculated from the acquired MRE displacement data. The change in NOSS at the tumor boundary (ΔNOSSbdy) was computed, from which a 3D ΔNOSSbdy map of the tumor surface was created and the probability distribution of ΔNOSSbdy over the entire tumor surface was calculated. Statistical features were calculated from the probability histogram. After eliminating highly correlated features, the capability of the remaining feature for tumor adhesion classification was assessed using a one-way ANOVA and ROC analysis. RESULTS The magnitude and location of the tumor adhesion can be visualized by the reconstructed 3D ΔNOSSbdy surface map. The entropy of the ΔNOSSbdy histogram was significantly different between adherent tumors and partially/completely non-adherent tumors in both the training (AUC: 0.971) and testing datasets (AUC: 0.900). Based on the cutoff values obtained from the training set, the ΔNOSSbdy entropy in the testing dataset yielded an accuracy of 0.83 for distinguishing adherent versus partially/non-adherent tumors, and 0.67 for distinguishing non-adherent versus completely/partially adherent tumors. CONCLUSIONS SII-derived ΔNOSSbdy values are useful for quantification and classification of meningioma-brain adhesion. The reconstructed 3D ΔNOSSbdy surface map presents the state and location of tumor adhesion in a "clinician-friendly" manner, and can identify meningiomas with a high risk of adhesion to adjacent brain parenchyma. KEY POINTS • MR elastography (MRE)-based slip interface imaging shows promise as an objective tool to preoperatively discriminate meningiomas with a high risk of intraoperative adhesion. • Measurement of the change of shear strain at meningioma boundaries can provide quantitative metrics depicting the state of adhesion at the tumor-brain interface. • The surface map of tumor adhesion shows promise in assisting precise adhesion localization, using a comprehensible, "clinician-friendly" 3D visualization.
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Affiliation(s)
- Ziying Yin
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA.
| | - Xin Lu
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | | | - Yi Sui
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
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Saito A, Inoue T, Suzuki S, Ezura M, Uenohara H, Tominaga T. Relationship between Pathological Characteristics and Radiological Findings on Perfusion MR Imaging of Meningioma. Neurol Med Chir (Tokyo) 2021; 61:228-235. [PMID: 33504729 PMCID: PMC7966207 DOI: 10.2176/nmc.oa.2020-0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Few studies have reviewed the roles of perfusion magnetic resonance (MR) imaging in the histopathological examination of meningiomas. We analyzed the relationships between radiological findings on perfusion MR imaging and pathological characteristics such as origin of the tumor, mitotic activity, pathological subtype, and perifocal edema formation. The subjects were 21 surgical cases of meningioma preoperatively evaluated by perfusion MR imaging. A region of interest (ROI) was set inside of the tumor, and perifocal edema of the same size, cerebral blood volume (CBV), and cerebral blood flow (CBF) on perfusion MR and diffusion-weighted (DW) imaging were analyzed. These radiological data were evaluated in comparison with histopathological characteristics. On perfusion MR imaging, the average ratio of CBV against the contralateral side was 6.43 (1.13–20.0) and that of CBF was 7.73 (1.34–11.3). There was no significant relationship with perfusion MR imaging data, tumor volume, or perifocal edema volume. However, the large peritumoral edema group often had a higher CBV and CBF than the non-large peritumoral edema group. The skull base group had a significantly higher CBV and lower signal intensity on DW images than the non-skull base group. Signal intensity on DW images was higher in grade II or III than in grade I. Perfusion MR imaging data revealed that the higher ratio of peritumoral edema against tumor size was associated with higher blood flow and blood volume under intratumoral circulatory conditions, and that skull base meningioma had a higher blood volume than non-skull base meningioma.
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Affiliation(s)
- Atsushi Saito
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Takashi Inoue
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Shinsuke Suzuki
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Hiroshi Uenohara
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Zhu Z, Wang C, Xu J, Wang C, Xia L, Li Q, Lu J, Cai L, Zheng W, Su Z. A Quantified Risk-Scoring System for the Recurrence of Meningiomas: Results From a Retrospective Study of 392 Patients. Front Oncol 2020; 10:585313. [PMID: 33123487 PMCID: PMC7570434 DOI: 10.3389/fonc.2020.585313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: This study aimed to identify the independent risk factors of recurrence in patients undergoing primary resection of meningioma and construct a scoring system for the prediction of the risk of postoperative recurrence. Materials and Methods: The clinical data of 591 patients who underwent primary surgical resection for meningioma at the First Affiliated Hospital of Wenzhou Medical University between November 2010 and December 2016 were retrospectively reviewed. The clinical, radiological, and pathological characteristics were evaluated, and the independent risk factors for recurrence were identified via receiver operating characteristic (ROC) curve and logistic analyses. A scoring system that included these independent risk factors was used to construct a risk-predicting model that was evaluated via a ROC curve analysis. The recurrences of different subgroups were observed by Kaplan-Meier's curves. Results: The clinical data of 392 patients with meningioma were used to construct the scoring system. The logistic analysis showed that sex (OR = 2.793, 95% CI = 1.076-7.249, P = 0.035), heterogeneous tumor enhancement (OR = 4.452, 95% CI = 1.714-11.559, P = 0.002), brain invasion (OR = 2.650, 95% CI = 1.043-6.733, P = 0.041), Simpson's removal grade (OR = 5.139, 95% CI = 1.355-19.489, P = 0.016), and pathological grade (OR = 3.282, 95% CI = 1.123-9.595, P = 0.030) were independent risk factors for recurrence. A scoring system was developed and used to divide the patients into the following four subgroups: subgroup 1 with scores of 0-75 (n = 249), subgroup 2 with scores of 76-154 (n = 88), subgroup 3 with scores of 155-215 (n = 46), and subgroup 4 with scores of 216-275 (n = 9). The incidences of recurrence in each subgroup were as follows: subgroup 1, 1.2%; subgroup 2, 5.7%; subgroup 3, 26.1%; and subgroup 4, 66.7% (P < 0.001). The scoring system reliably predicted the postoperative recurrence of meningioma with a high area under the ROC curve. Conclusions: Our scoring system is a simple and reliable instrument for identifying meningioma patients at risk of postoperative recurrence and could help in optimizing individualized clinical treatment.
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Affiliation(s)
- Zhangzhang Zhu
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengde Wang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiadong Xu
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chunyong Wang
- Department of General Surgery, Zhuji People's Hospital of Zhejiang Province, Shaoxing, China
| | - Lei Xia
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qun Li
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianglong Lu
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lin Cai
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiming Zheng
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhipeng Su
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Neurosurgery, Wencheng County People's Hospital, Wenzhou, China
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Ong T, Bharatha A, Alsufayan R, Das S, Lin AW. MRI predictors for brain invasion in meningiomas. Neuroradiol J 2020; 34:3-7. [PMID: 32924772 DOI: 10.1177/1971400920953417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE In the 2016 revision of the World Health Organization classification of central nervous system tumours, brain invasion was added as an independent histological criterion for the diagnosis of a World Health Organization grade II atypical meningioma. The aim of this study was to assess whether magnetic resonance imaging characteristics can predict brain invasion for meningiomas. MATERIALS AND METHODS We conducted a retrospective review of all meningiomas resected at our institution between 2005 and 2016 which had preoperative magnetic resonance imaging and included brain tissue within the pathology specimen. One hundred meningiomas were included in the study, 60 of which had histopathological brain invasion, 40 of which did not. Magnetic resonance imaging characteristics of tumours were evaluated for potential predictors of brain invasion. Tumour location, size, perilesional oedema, contour, cerebrospinal fluid cleft, peritumoral cyst, dural venous sinus invasion, bone invasion, hyperostosis and the presence of enlarged pial arteries and veins were evaluated. Data were analysed using conventional chi-square, Fisher's exact test and logistic regression. RESULTS The volume of peritumoral oedema was significantly higher in the brain-invasive meningioma group compared to the non-brain-invasive group. The presence of a complete cleft was a rare finding that was only found in non-brain-invasive meningiomas. The presence of enlarged pial feeding arteries was a rare finding that was only found in brain-invasive meningiomas. CONCLUSIONS An increased volume of perilesional oedema is associated with the likelihood of brain invasion for meningiomas.
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Affiliation(s)
- Thomas Ong
- Division of Neuroradiology, St Michael's Hospital, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Canada.,Department of Radiology, Jewish General Hospital, Montreal, Canada
| | - Aditya Bharatha
- Division of Neuroradiology, St Michael's Hospital, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Canada.,Division of Neurosurgery, St Michael's Hospital, Toronto, Canada
| | - Reema Alsufayan
- Division of Neuroradiology, St Michael's Hospital, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Canada.,Johns Hopkins Aramco Healthcare, Saudi Arabia
| | - Sunit Das
- Division of Neurosurgery, St Michael's Hospital, Toronto, Canada
| | - Amy Wei Lin
- Division of Neuroradiology, St Michael's Hospital, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Canada
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Raffa G, Picht T, Scibilia A, Rösler J, Rein J, Conti A, Ricciardo G, Cardali SM, Vajkoczy P, Germanò A. Surgical treatment of meningiomas located in the rolandic area: the role of navigated transcranial magnetic stimulation for preoperative planning, surgical strategy, and prediction of arachnoidal cleavage and motor outcome. J Neurosurg 2020; 133:107-118. [PMID: 31200378 DOI: 10.3171/2019.3.jns183411] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/15/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Surgical treatment of convexity meningiomas is usually considered a low-risk procedure. Nevertheless, the risk of postoperative motor deficits is higher (7.1%-24.7% of all cases) for lesions located in the rolandic region, especially when an arachnoidal cleavage plane with the motor pathway is not identifiable. The authors analyzed the possible role of navigated transcranial magnetic stimulation (nTMS) for planning resection of rolandic meningiomas and predicting the presence or lack of an intraoperative arachnoidal cleavage plane as well as the postoperative motor outcome. METHODS Clinical data were retrospectively collected from surgical cases involving patients affected by convexity, parasagittal, or falx meningiomas involving the rolandic region, who received preoperative nTMS mapping of the motor cortex (M1) and nTMS-based diffusion tensor imaging (DTI) fiber tracking of the corticospinal tract before surgery at 2 different neurosurgical centers. Surgeons' self-reported evaluation of the impact of nTMS-based mapping on surgical strategy was analyzed. Moreover, the nTMS mapping accuracy was evaluated in comparison with intraoperative neurophysiological mapping (IONM). Lastly, we assessed the role of nTMS as well as other pre- and intraoperative parameters for predicting the patients' motor outcome and the presence or absence of an intraoperative arachnoidal cleavage plane. RESULTS Forty-seven patients were included in this study. The nTMS-based planning was considered useful in 89.3% of cases, and a change of the surgical strategy was observed in 42.5% of cases. The agreement of nTMS-based planning and IONM-based strategy in 35 patients was 94.2%. A new permanent motor deficit occurred in 8.5% of cases (4 of 47). A higher resting motor threshold (RMT) and the lack of an intraoperative arachnoidal cleavage plane were the only independent predictors of a poor motor outcome (p = 0.04 and p = 0.02, respectively). Moreover, a higher RMT and perilesional edema also predicted the lack of an arachnoidal cleavage plane (p = 0.01 and p = 0.03, respectively). Preoperative motor status, T2 cleft sign, contrast-enhancement pattern, and tumor volume had no predictive value. CONCLUSIONS nTMS-based motor mapping is a useful tool for presurgical assessment of rolandic meningiomas, especially when a clear cleavage plane with M1 is not present. Moreover, the RMT can indicate the presence or absence of an intraoperative cleavage plane and predict the motor outcome, thereby helping to identify high-risk patients before surgery.
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Affiliation(s)
- Giovanni Raffa
- 1Division of Neurosurgery, University of Messina, Italy; and
| | - Thomas Picht
- 2Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
| | | | - Judith Rösler
- 2Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
| | - Johannes Rein
- 2Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
| | - Alfredo Conti
- 1Division of Neurosurgery, University of Messina, Italy; and
- 2Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
| | | | | | - Peter Vajkoczy
- 2Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
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Karthigeyan M, Dhandapani S, Salunke P, Singh P, Radotra BD, Gupta SK. The Predictive Value of Conventional Magnetic Resonance Imaging Sequences on Operative Findings and Histopathology of Intracranial Meningiomas: A Prospective Study. Neurol India 2020; 67:1439-1445. [PMID: 31857531 DOI: 10.4103/0028-3886.273632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Previous studies have tried to relate magnetic resonance (MR) characteristics of meningiomas with its intraoperative features and histopathology with varying results. This is a prospective study to assess the independent predictive value of conventional MR signals [T1, T2, and fluid attenuated inversion recovery (FLAIR)] in relation to consistency, vascularity, operative plane, Simpson excision, and histopathology of intracranial meningiomas in a multivariate model. Materials and Methods Seventy patients underwent T1, T2, FLAIR, postcontrast sequences followed by excision of their meningiomas. Tumor signal intensity in various sequences was studied in relation to the above-mentioned variables. Multivariate analysis to find their independent association was performed. Results T1 images showed no correlation with any of the variables. FLAIR hypointensity and inhomogeneous enhancement had significant association with tumor hardness. FLAIR hypointense tumors were associated with low vascularity. FLAIR hypointensity, skull base location, and recurrence were significantly related to the subpial or mixed operative plane. The meningioma-brain interface on T2 sequence was significantly related to the operative plane. Only skull base location had significant impact on the extent of excision. T2 and FLAIR hypointensity had significant association with fibroblastic or psammomatous meningiomas. On multivariate analysis, FLAIR hypointensity and skull base location had a significant independent relationship with suboptimal operative plane, while skull base location had association with the extent of excision. Among MRI sequences, FLAIR hypointensity showed high specificity (94%) in predicting the suboptimal operative plane. Conclusions FLAIR hypointensity of meningiomas appears to have a significant independent association with the suboptimal operative plane with high specificity.
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Affiliation(s)
- Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan D Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kwon SM, Kim JH, Yoo HJ, Kim YH, Hong SH, Cho YH, Kim CJ, Nam SJ. Predictive factors for high-grade transformation in benign meningiomas. Clin Neurol Neurosurg 2020; 195:105897. [PMID: 32505062 DOI: 10.1016/j.clineuro.2020.105897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/11/2020] [Accepted: 05/03/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Although they are generally slow-growing benign tumors, meningiomas may recur after surgery with transformation into atypical meningiomas. The purpose of this study was to investigate the radiological and histopathological factors that predict the risk of tumor progression from a benign to an atypical meningioma. PATIENTS AND METHODS All patients treated for recurrent meningiomas in whom the tumor showed histopathologically confirmed high-grade transformation (HGT) from a benign to an atypical meningioma between 2001 and 2017 were included. To evaluate the predictors of transformation, patient medical records documenting the diagnosis of a benign meningioma at the first surgery prior to second surgery with HGT were reviewed. Each patient was matched with four age- and sex-matched controls who were treated for a benign meningioma. The control group comprised all patients without any recurrence for at least 60 months. RESULTS Fourteen patients with benign meningioma underwent HGT and were included. The median time interval of transformation was 63 months (range, 19-132 months). Multivariate analysis indicated that an increased mitotic index (odds ratio [OR], 10.409; 95 % confidence interval [CI], 1.297-83.549; P = 0.027) was a significant predictor of transformation. Prominent peritumoral edema (OR, 33.822; 95 % CI, 0.935-223.688; P = 0.054) did not reach the statistical significance. CONCLUSION An increased mitotic index may be used as the predictor for HGT of benign meningiomas. Although these tumors with a high risk for transformation do not meet the diagnostic criteria for atypical meningiomas, they may require more attentive observation and management than other benign meningiomas.
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Affiliation(s)
- Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Hee Jun Yoo
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang Jin Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soo Jeong Nam
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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12
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Yao A, Rutland JW, Verma G, Banihashemi A, Padormo F, Tsankova NM, Delman BN, Shrivastava RK, Balchandani P. Pituitary adenoma consistency: Direct correlation of ultrahigh field 7T MRI with histopathological analysis. Eur J Radiol 2020; 126:108931. [PMID: 32146344 DOI: 10.1016/j.ejrad.2020.108931] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/17/2020] [Accepted: 02/29/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Tumor consistency is a critical factor in surgical planning that influences ease of resection and risk of operative morbidity. The ability of MRI to predict tumor consistency tumor consistency has been shown to increase with higher field strength. The present study examined the utility of 7 T (7 T) MRI in predicting the tumor consistency of pituitary adenomas. METHOD Fifteen patients with pituitary adenomas were preoperatively scanned at 7 T MRI. Regions of interest were drawn around lesions for voxel-based signal intensity (SI) analysis. The percentage of tumor voxels with intensity higher than local gray matter was calculated on T2-weighted imaging. A single neurosurgeon rated tumor firmness for all patients. Histopathological analysis was performed. Radiological tumor features were correlated with intraoperative tumor consistency measurements and histopathology. RESULTS Tumors rated as 'soft' intraoperatively were hyperintense to local gray matter on T2-weighted imaging. 'Firm' tumors were hypointense to local gray matter. There was no significant difference in SI ratio between soft and firm tumors (p = 0.098). Soft tumors had a significantly higher percentage of tumor voxels greater than local gray matter compared to firm tumors (p = 0.035, Cohen's D-effect size = 1.208). Soft tumors had higher vascularity than firm tumors, p = 0.015. CONCLUSIONS The signal and contrast advantage conferred by 7 T MRI may provide valuable preoperative information regarding pituitary tumor consistency and physiology. The use of granular, voxel-based analysis maximizes the potential afforded by the high resolution of 7 T imaging, and may be a valuable method of predicting consistency of pituitary adenoma.
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Affiliation(s)
- Amy Yao
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Gaurav Verma
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Amir Banihashemi
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Francesco Padormo
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nadejda M Tsankova
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bradley N Delman
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Priti Balchandani
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Sapkota MR, Yang Z, Zhu D, Zhang Y, Yuan T, Gao J, Si T, Wang J. Evaluation of Epidemiologic Factors, Radiographic Features, and Pathologic Findings for Predicting Peritumoral Brain Edema in Meningiomas. J Magn Reson Imaging 2020; 52:174-182. [PMID: 31922353 DOI: 10.1002/jmri.27046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite several treatment options that are available for meningiomas, surgery is the only method currently practiced. Peritumoral brain edema (PTBE) in meningiomas causes difficulty marginalizing the dissection in an intraoperative setting. PURPOSE To evaluate whether the epidemiological variables, imaging characteristics, and pathologic parameters are correlated with the presence of PTBE in meningiomas. STUDY TYPE Retrospective study from 2015 to 2018. SUBJECTS In all, 550 patients with histopathologically confirmed meningioma were included. After exclusion of patients with extradural, spinal, and intraventricular meningiomas and those with image artifacts, a total of 441 patients were included in the final analysis. FIELD STRENGTH/SEQUENCE Images were performed with 3T MR scanners and axial/sagittal T1 WI, axial/coronal T2 WI and axial/sagittal/coronal contrast-enhanced T1 WI after administration of 0.1 mmol/kg of body weight of Gd-DTPA. ASSESSMENT Fourteen variables were patients' age, sex, skull changes, calcification, density, location, margin, volume, cerebrospinal fluid (CSF) cleft, signal intensity (SI) on T2 WI, degree and pattern of contrast enhancement, WHO histological classification, and Ki-67 labeling index. STATISTICAL TESTS The relationship between each factor and the formation of PTBE was examined by multivariate logistic regression analysis. RESULTS After multivariate logistic regression, the absence of CSF cleft (odds ratio [OR]: 63.43, 95% confidence interval [CI]: 27.24-121.42, P = 1.2 × 10-8 ), non-skull base location (OR: 15.32, 95% CI: 5.81-28.23, P = 0.0008), high SI on T2 WI (OR: 5.05, 95% CI: 2.27-14.88, P = 0.01), and G I uncommon subtypes (OR: 4.75, 95% CI: 1.42-15.94, P = 0.01) were found to be significant independent factors associated with the occurrence of PTBE in meningiomas. In patients with PTBE-positive meningiomas, there was no significant correlation between the volume of PTBE and the volume of the tumor (r = 0.17, P = 0.60). DATA CONCLUSION These factors may be suggestive of anticipating the formation of PTBE. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;52:174-182.
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Affiliation(s)
- Mani R Sapkota
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Zonghe Yang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Dan Zhu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Tengfei Yuan
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Junfeng Gao
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Tongguo Si
- Interventional Treatment Department, Tianjin Medical University Cancer Hospital, Tianjin, China
| | - Junping Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
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14
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Moussa WM. Predictive value of brain edema in preoperative computerized tomography scanning on the recurrence of meningioma. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2012.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Wael M. Moussa
- Department of Neurosurgery, Faculty of Medicine , Alexandria University , Egypt
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15
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Rezaei S, Faeghi F, Samadian M, Shekarchi B. Preoperative Evaluation of Tumor Adhesion to Adjacent Brain Tissue in Patients with Meningioma with BSMI Method and Its Comparison with the Width of Edema Around Tumor. Asian Pac J Cancer Prev 2018; 19:2007-2012. [PMID: 30051700 PMCID: PMC6165639 DOI: 10.22034/apjcp.2018.19.7.2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background This study aims to investigate the ability of BSMI, to preoperative evaluation of tumor adhesion to adjacent brain tissue in patients with meningioma and comparing this method to the width of edema around tumor, using surgery findings as the reference standard. Methods Thirty patients with meningioma brain tumor who underwent surgery at Loghman hospital were selected for the study between November 2016 and January 2018. The level of edema according to the classification of Ide et al., (u1995) was compared with the surgical findings with blinded results, and neurosurgeons made a qualitative assessment of tumor adhesion at the time of resection. The ability of BSMI and level of edema to predict the surgical assessment of adhesion was tested using the Fisher Exact Test. Results BSMI method was conducted on patients with meningioma brain tumor, which judged 22 (73.3%) patients as adhesion (+) and 8 (26.66%) patients as adhesion (-). In this case, there was a significant relationship between BSMI judgment and surgical findings (p-value<0.0001). The sensitivity, specificity, precision and accuracy was high, at 91.30%, 85.71%, 95.45% and 90%, respectively. Using T2-Weighted SPACE sequence, of the 30 patients, 13 (43.3%) were judged as adhesion (+) and 17 (56.7%) as adhesion (-) from edema, whereas surgical findings evaluated 23 (76.7%) as adhesion (+) and 7 (23.3%) as adhesion (-).The sensitivity was moderate but the specificity was high, at 52.17% and 85.71%, respectively. Other criteria such as precision and accuracy were 62.31% and 60%, respectively. Conclusions BSMI evaluated adhesion of the tumor to the adjacent brain tissue with high-accuracy prior to surgery. This method was more effective than Edema method in evaluating adhesion between meningioma and the brain.
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Affiliation(s)
- Sonia Rezaei
- Department of Radiology, School of Allied Medical Science, Shahid Beheshti University of Medical Science,Tehran, Iran.
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16
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Yao A, Pain M, Balchandani P, Shrivastava RK. Can MRI predict meningioma consistency?: a correlation with tumor pathology and systematic review. Neurosurg Rev 2018; 41:745-753. [PMID: 27873040 PMCID: PMC5438899 DOI: 10.1007/s10143-016-0801-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/19/2016] [Accepted: 11/06/2016] [Indexed: 11/25/2022]
Abstract
Tumor consistency is a critical factor that influences operative strategy and patient counseling. Magnetic resonance imaging (MRI) describes the concentration of water within living tissues and as such, is hypothesized to predict aspects of their biomechanical behavior. In meningiomas, MRI signal intensity has been used to predict the consistency of the tumor and its histopathological subtype, though its predictive capacity is debated in the literature. We performed a systematic review of the PubMed database since 1990 concerning MRI appearance and tumor consistency to assess whether or not MRI can be used reliably to predict tumor firmness. The inclusion criteria were case series and clinical studies that described attempts to correlate preoperative MRI findings with tumor consistency. The relationship between the pre-operative imaging characteristics, intraoperative findings, and World Health Organization (WHO) histopathological subtype is described. While T2 signal intensity and MR elastography provide a useful predictive measure of tumor consistency, other techniques have not been validated. T1-weighted imaging was not found to offer any diagnostic or predictive value. A quantitative assessment of T2 signal intensity more reliably predicts consistency than inherently variable qualitative analyses. Preoperative knowledge of tumor firmness affords the neurosurgeon substantial benefit when planning surgical techniques. Based upon our review of the literature, we currently recommend the use of T2-weighted MRI for predicting consistency, which has been shown to correlate well with analysis of tumor histological subtype. Development of standard measures of tumor consistency, standard MRI quantification metrics, and further exploration of MRI technique may improve the predictive ability of neuroimaging for meningiomas.
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Affiliation(s)
- Amy Yao
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Annenberg 8, One Gustave L Levy Pl, New York, NY, 10029, USA.
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Annenberg 8, One Gustave L Levy Pl, New York, NY, 10029, USA
| | - Priti Balchandani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Annenberg 8, One Gustave L Levy Pl, New York, NY, 10029, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Annenberg 8, One Gustave L Levy Pl, New York, NY, 10029, USA
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17
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Preoperative MRI evaluation of meningioma consistency: A focus on detailed architectures. Clin Neurol Neurosurg 2018; 169:178-184. [DOI: 10.1016/j.clineuro.2018.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/11/2018] [Accepted: 04/22/2018] [Indexed: 11/24/2022]
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18
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Hale AT, Wang L, Strother MK, Chambless LB. Differentiating meningioma grade by imaging features on magnetic resonance imaging. J Clin Neurosci 2017; 48:71-75. [PMID: 29174756 DOI: 10.1016/j.jocn.2017.11.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/22/2017] [Accepted: 11/15/2017] [Indexed: 11/30/2022]
Abstract
Atypical meningioma has an aggressive clinical course. Distinguishing atypical from benign meningioma preoperatively could affect surgical planning and improve treatment outcomes. In this study, we examined whether pre-operative magnetic resonance imaging (MRI) features could distinguish between benign and atypical meningioma. Imaging factors analyzed included peritumoral edema, the presence of a draining vein, tumor necrosis, tumor location and tumor volume. Using univariate analysis, the most striking predictor of grade was tumor volume (p < .001). When adjusting for the degree of peritumoral edema, volume remained a positive predictor of higher histological grade meningioma (p = .042) and was the strongest single predictor of higher-grade meningioma in this study. Additional imaging features associated with increased risk for atypical pathology in univariate analysis included the presence of tumor necrosis (p = .012), peritumoral edema (p = .022) and location along the falx and convexity (p = .026). Despite statistically significant associations using univariate analysis, in multivariate analysis, we found that only presence of peritumoral edema was predictive of a higher-grade meningioma. Further multivariate analyses suggests that edema, draining vein and necrosis are all positive predictors of tumor volume (p < .0001). Overall, these data suggest that radiographic features including presence of tumor necrosis, and tumor location along the falx or convexity may be predictive of higher-grade meningioma when considered alone. However, most strikingly, our data point to tumor volume as the most robust pre-operative indicator of higher-grade meningioma.
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Affiliation(s)
- Andrew T Hale
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA; Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Li Wang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Megan K Strother
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Hayashi Y, Kita D, Fukui I, Sasagawa Y, Oishi M, Tachibana O, Ueda F, Nakada M. Preoperative Evaluation of the Interface Between Tuberculum Sellae Meningioma and the Optic Nerves on Fast Imaging with Steady-State Acquisition for Extended Endoscopic Endonasal Transsphenoidal Surgery. World Neurosurg 2017; 103:153-160. [DOI: 10.1016/j.wneu.2017.03.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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Rai SKR, Mancarella C, Goel AH. Brain Tumor Interface Dissection Technique with Surgical Blade from Laboratory to Neurosurgical Operating Room. World Neurosurg 2017; 100:601-606. [DOI: 10.1016/j.wneu.2017.01.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
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21
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Yin Z, Hughes JD, Trzasko JD, Glaser KJ, Manduca A, Van Gompel J, Link MJ, Romano A, Ehman RL, Huston J. Slip interface imaging based on MR-elastography preoperatively predicts meningioma-brain adhesion. J Magn Reson Imaging 2017; 46:1007-1016. [PMID: 28194925 PMCID: PMC5600107 DOI: 10.1002/jmri.25623] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 01/26/2023] Open
Abstract
Purpose To investigate the ability of slip interface imaging (SII), a recently developed magnetic resonance elastography (MRE)‐based technique, to predict the degree of meningioma–brain adhesion, using findings at surgery as the reference standard. Materials and Methods With Institutional Review Board approval and written informed consent, 25 patients with meningiomas >2.5 cm in maximal diameter underwent preoperative SII assessment. Intracranial shear motions were introduced using a soft, pillow‐like head driver and the resulting displacement field was acquired with an MRE pulse sequence on 3T MR scanners. The displacement data were analyzed to determine tumor–brain adhesion by assessing intensities on shear line images and raw as well as normalized octahedral shear strain (OSS) values along the interface. The SII findings of shear line images, OSS, and normalized OSS were independently and blindly correlated with surgical findings of tumor adhesion by using the Cohen's κ coefficient and chi‐squared test. Results Neurosurgeons categorized the surgical plane as extrapial (no adhesion) in 15 patients, mixed in four, and subpial (adhesion) in six. Both shear line images and OSS agreed with the surgical findings in 18 (72%) cases (fair agreement, κ = 0.37, 95% confidence interval [CI]: 0.05–0.69), while normalized OSS was concordant with the surgical findings in 23 (92%) cases (good agreement, κ = 0.86, 95% CI: 0.67–1). The correlation between SII predictions (shear line images, OSS, and normalized OSS) and the surgical findings were statistically significant (chi‐squared test, P = 0.02, P = 0.02, and P < 0.0001, respectively). Conclusion SII preoperatively evaluates the degree of meningioma–brain adhesion noninvasively, allowing for improved prediction of surgical risk and tumor resectability. Level of Evidence: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1007–1016.
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Affiliation(s)
- Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joshua D Hughes
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joshua D Trzasko
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jamie Van Gompel
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Anthony Romano
- Naval Research Laboratory, Code 7160, Washington, DC, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John Huston
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Thenier-Villa JL, Alejandro Galárraga Campoverde R, Ramón DE LA Lama Zaragoza A, Conde Alonso C. Predictors of Morbidity and Cleavage Plane in Surgical Resection of Pure Convexity Meningiomas Using Cerebrospinal Fluid Sensitive Image Subtraction Magnetic Resonance Imaging. Neurol Med Chir (Tokyo) 2016; 57:35-43. [PMID: 27580930 PMCID: PMC5243163 DOI: 10.2176/nmc.oa.2016-0169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Meningiomas are the most common primary intracranial tumors. Since the adhesions in the plane of dissection are of interest in surgical planning, we suggest that digital image subtraction of FLAIR data from the T2 sequence of MRI may represent better the CSF spaces in the brain–tumor interface and may be a predictor of the intraoperative cleavage plane. From 2006 to 2016, 83 convexity meningiomas were resected in the Department of Neurosurgery of the University Hospital Complex of Vigo, an analysis of preoperative MRI was performed to assess peritumoral edema (PTE), tumor volume, among others; a digital subtraction of T2-FLAIR sequences was performed and analyzed in relationship to the cleavage plane described in the intraoperative report and postoperative neurological deficits. Simpson grade 1 resection was achieved in 85.54%, the overall 5-year PFS was 93.75%. Our rate of permanent new neurological deficit was 4.82% and the overall complication rate of 14.46%. The grade of PTE was proportional to tumor volume, 20 ± 2.8, 30 ± 5.3, and 34 ± 4.3 cm3 for grades 1, 2, and 3, respectively, positive cleft sign on image subtraction was predictive of good intraoperative cleavage plane and low grade cleavage plane (P = 0.04), and was a protective factor for postoperative neurological deficit (P = 0.02). Positive cleft sign in T2-FLAIR digital subtraction image is an independent predictor of good intraoperative cleavage plane, PTE is an independent predictor of the bad cleavage plane. Negative cleft sign in the image subtraction and a bad intraoperative cleavage plane are predictors of postoperative neurological deficit.
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Mohme M, Emami P, Matschke J, Regelsberger J, Westphal M, Eicker SO. Secretory Meningiomas. Neurosurg Clin N Am 2016; 27:181-7. [DOI: 10.1016/j.nec.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Intracranial meningiomas are tumors arising from the covering cells of the arachnoid layer of the dura mater or from the intraventricular choroid plexus. While mostly benign tumors, they still represent a major challenge to neurosurgeons and other medical disciplines involved in their diagnostic and therapeutic management. Although this review intends to give some state-of-the-art information from the literature, it is mainly based on personal experiences since more than 30 years caring for more than 1500 meningioma patients and point to a few new strategies to further improve on patient outcome.Diagnostics are based on magnetic resonance imaging which shows the relationship between tumor and surrounding intracranial structures, particularly the brain but also the vasculature and to some extent the cranial nerves. Furthermore, it may suggest the grading of the tumor and is very helpful in the postoperative diagnosis of complications and later follow-up course.Surgery still is the main treatment with the aim to completely remove the tumor; also in cases of recurrence, other additional options include radiotherapy and radiosurgery for incompletely removed or recurrent meningiomas. Postoperative chemotherapy has not been shown to provide substantial benefit to the patient especially in highly malignant meningiomas.All therapy options should be intended to provide the patient with the best possible functional outcome. Patients' perspective is not always equivalent to surgeons' perspectives. Neuropsychological evaluation and additional guidance of patients harboring meningiomas have proven to be important in modern neurosurgical intracranial tumor treatment. Their help beyond neurosurgical care facilitates the patients to lead an independent postoperative life.
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Affiliation(s)
- H Maximilian Mehdorn
- Department of Neurosurgery, University Clinics of Schleswig-Holstein Campus Kiel, Arnold Heller Str 3 Hs 41, 24105, Kiel, Germany.
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Rapid and Accurate MRI Segmentation of Peritumoral Brain Edema in Meningiomas. Clin Neuroradiol 2015; 27:145-152. [PMID: 26603998 DOI: 10.1007/s00062-015-0481-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The extent of peritumoral brain edema (PTBE) in meningiomas commonly affects the clinical outcome. Despite its importance, edema volume is usually highly inaccurately approximated to a spheroid shape. We tested the accuracy and the reproducibility of semiautomatic lesion management software for the analysis of PTBE in a homogeneous case series of surgically confirmed intracranial meningiomas. METHODS PTBE volume was calculated on magnetic resonance images in 50 patients with intracranial meningiomas using commercial lesion management software (Vue PACS Livewire, Carestream, Rochester, NY, USA). Inter and intraobserver agreement evaluation and a comparison between manual volume calculation, the semiautomatic software and spheroid approximation were performed in 22 randomly selected patients. RESULTS The calculation of edema volume was possible in all cases irrespective of the extent of the signal changes. The median time for each calculation was 3 min. Interobserver and intraobserver agreement confirmed the reproducibility of the method. Comparison with standard (fully manual) calculation confirmed the accuracy of this software. CONCLUSIONS Our study showed a high level of reproducibility of this semiautomatic computational method for peritumoral brain edema. It is rapid and easy to use after relatively short training and is suitable for implementation in clinical practice.
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Yin Z, Glaser KJ, Manduca A, Van Gompel JJ, Link MJ, Hughes JD, Romano A, Ehman RL, Huston J. Slip Interface Imaging Predicts Tumor-Brain Adhesion in Vestibular Schwannomas. Radiology 2015; 277:507-17. [PMID: 26247776 DOI: 10.1148/radiol.2015151075] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To test the clinical feasibility and usefulness of slip interface imaging (SII) to identify and quantify the degree of tumor-brain adhesion in patients with vestibular schwannomas. MATERIALS AND METHOD S With institutional review board approval and after obtaining written informed consent, SII examinations were performed in nine patients with vestibular schwannomas. During the SII acquisition, a low-amplitude mechanical vibration is applied to the head with a pillow-like device placed in the head coil and the resulting shear waves are imaged by using a phase-contrast pulse sequence with motion-encoding gradients synchronized with the applied vibration. Imaging was performed with a 3-T magnetic resonance (MR) system in less than 7 minutes. The acquired shear motion data were processed with two different algorithms (shear line analysis and calculation of octahedral shear strain [OSS]) to identify the degree of tumor-brain adhesion. Blinded to the SII results, neurosurgeons qualitatively assessed tumor adhesion at the time of tumor resection. Standard T2-weighted, fast imaging employing steady-state acquisition (FIESTA), and T2-weighted fluid-attenuated inversion recovery (FLAIR) imaging were reviewed to identify the presence of cerebral spinal fluid (CSF) clefts around the tumors. The performance of the use of the CSF cleft and SII to predict the degree of tumor adhesion was evaluated by using the κ coefficient and McNemar test. RESULTS Among the nine patients, SII agreed with the intraoperative assessment of the degree of tumor adhesion in eight patients (88.9%; 95% confidence interval [CI]: 57%, 98%), with four of four, three of three, and one of two cases correctly predicted as no adhesion, partial adhesion, and complete adhesion, respectively. However, the T2-weighted, FIESTA, and T2-weighted FLAIR images that used the CSF cleft sign to predict adhesion agreed with surgical findings in only four cases (44.4% [four of nine]; 95% CI: 19%, 73%). The κ coefficients indicate good agreement (0.82 [95% CI: 0.5, 1]) for the SII prediction versus surgical findings, but only fair agreement (0.21 [95% CI: -0.21, 0.63]) between the CSF cleft prediction and surgical findings. However, the difference between the SII prediction and the CSF cleft prediction was not significant (P = .103; McNemar test), likely because of the small sample size in this study. CONCLUSION SII can be used to predict the degree of tumor-brain adhesion of vestibular schwannomas and may provide a method to improve preoperative planning and determination of surgical risk in these patients.
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Affiliation(s)
- Ziying Yin
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
| | - Kevin J Glaser
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
| | - Armando Manduca
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
| | - Jamie J Van Gompel
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
| | - Michael J Link
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
| | - Joshua D Hughes
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
| | - Anthony Romano
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
| | - Richard L Ehman
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
| | - John Huston
- From the Departments of Radiology (Z.Y., K.J.G., R.L.E., J.H.), Physiology and Biomedical Engineering (A.M.), and Neurosurgery (J.J.V.G., M.J.L., J.D.H.), Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; and Naval Research Laboratory, Washington, DC (A.R.)
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Preoperative radiologic classification of convexity meningioma to predict the survival and aggressive meningioma behavior. PLoS One 2015; 10:e0118908. [PMID: 25786236 PMCID: PMC4364713 DOI: 10.1371/journal.pone.0118908] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022] Open
Abstract
Background A subgroup of meningioma demonstrates clinical aggressive behavior. We set out to determine if the radiological parameters can predict histopathological aggressive meningioma, and propose a classification to predict survival and aggressive meningioma behavior. Methods A retrospective review of medical records was conducted for patients who underwent surgical resection of their convexity meningioma. WHO-2007 grading was used for histopathological diagnosis. Preoperative radiologic parameters were analyzed, each parameter was scored 0 or 1. Signal intensity on diffusion weighted MRI (DWI) (hyperintensity=1), heterogeneity on T1-weighted gadolinium enhanced MRI (heterogeneity=1), disruption of arachnoid at brain-tumor interface=1and peritumoral edema (PTE) on T2-weighted MRI (presence of PTE=1) and tumor shape (irregular shape=1). Multivariate logistic regression analyses were conducted to determine association of radiological parameters to histopathological grading. Kaplan-Meier and Cox regression models were used to determine the association of scoring system to overall survival and progression free survival (PFS). Reliability of the classification was tested using Kappa co-efficient analysis. Results Hyperintensity on DWI, disruption of arachnoid at brain-tumor interface, PTE, heterogenicitiy on T1-weighted enhanced MRI and irregular tumor shape were independent predictors of non-grade I meningioma. Mean follow-up period was 94.6 months (range, 12-117 months). Median survival and PFS in groups-I, II and III was 114.1±1.2 and 115.7± 0.8, 88± 3.3 and 58.5±3.9, 43.2± 5.1 and 18.2±1.7 months respectively. In cox regression analysis model, age (P<0.0001, OR–1.039, CI-1.017-0.062), WHO non-grade-I meningioma (P=0.017, OR–3.014, CI-1.217-7.465), radiological classification groups II (P=0.002, OR–6.194, CI–1.956-19.610) and III (P<0.0001, OR–21.658, CI–5.701-82.273) were independent predictors of unfavorable survival outcomes. Conclusions Preoperative radiological classification can be used as a supplement to the histopathological grading. Group-I meningiomas demonstrate benign radiological, histopathological and clinical features; group-III demonstrates aggressive features. Group-II meningiomas demonstrate intermediate features; the need for more aggressive follow-up and/or treatment should be further investigated.
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Valdes PA, Bekelis K, Harris BT, Wilson BC, Leblond F, Kim A, Simmons NE, Erkmen K, Paulsen KD, Roberts DW. 5-Aminolevulinic acid-induced protoporphyrin IX fluorescence in meningioma: qualitative and quantitative measurements in vivo. Neurosurgery 2014; 10 Suppl 1:74-82; discussion 82-3. [PMID: 23887194 DOI: 10.1227/neu.0000000000000117] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence has shown promise as a surgical adjunct for maximizing the extent of surgical resection in gliomas. To date, the clinical utility of 5-ALA in meningiomas is not fully understood, with most descriptive studies using qualitative approaches to 5-ALA-PpIX. OBJECTIVE To assess the diagnostic performance of 5-ALA-PpIX fluorescence during surgical resection of meningioma. METHODS ALA was administered to 15 patients with meningioma undergoing PpIX fluorescence-guided surgery at our institution. At various points during the procedure, the surgeon performed qualitative, visual assessments of fluorescence by using the surgical microscope, followed by a quantitative fluorescence measurement by using an intraoperative probe. Specimens were collected at each point for subsequent neuropathological analysis. Clustered data analysis of variance was used to ascertain a difference between groups, and receiver operating characteristic analyses were performed to assess diagnostic capabilities. RESULTS Red-pink fluorescence was observed in 80% (12/15) of patients, with visible fluorescence generally demonstrating a strong, homogenous character. Quantitative fluorescence measured diagnostically significant PpIX concentrations (cPpIx) in both visibly and nonvisibly fluorescent tissues, with significantly higher cPpIx in both visibly fluorescent (P < .001) and tumor tissue (P = .002). Receiver operating characteristic analyses also showed diagnostic accuracies up to 90% for differentiating tumor from normal dura. CONCLUSION ALA-induced PpIX fluorescence guidance is a potential and promising adjunct in accurately detecting neoplastic tissue during meningioma resective surgery. These results suggest a broader reach for PpIX as a biomarker for meningiomas than was previously noted in the literature.
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Affiliation(s)
- Pablo A Valdes
- *Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ‡Thayer School of Engineering, Hanover, New Hampshire; §Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ‖Departments of Pathology and Neurology, Georgetown University Medical Center, Washington, DC; ¶Ontario Cancer Institute, University of Toronto, Toronto, Ontario, Canada; #Engineering Physics Department, École Polytechnique de Montréal, Montreal, Quebec, Canada; **Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Hou J, Kshettry VR, Selman WR, Bambakidis NC. Peritumoral brain edema in intracranial meningiomas: the emergence of vascular endothelial growth factor-directed therapy. Neurosurg Focus 2014; 35:E2. [PMID: 24289127 DOI: 10.3171/2013.8.focus13301] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Meningioma is the second most common type of adult intracranial neoplasm. A substantial subset of patients present with peritumoral brain edema (PTBE), which can cause significant morbidity via mass effect, complicate surgical management, and impact the safety of stereotactic radiosurgery. Recent studies suggest a close relationship between vascular endothelial growth factor-A (VEGF-A) expression and PTBE development in meningiomas. The authors performed a systematic review of the literature on the pathogenesis of PTBE in meningiomas, the effectiveness of steroid therapy, the role played by VEGF-A, and the current clinical evidence for antiangiogenic therapy to treat peritumoral brain edema. Mounting evidence suggests VEGF-A is secreted directly by meningioma cells to induce angiogenesis and edemagenesis of tumoral as well as peritumoral brain tissue. The VEGF-A cascade results in recruitment of cerebral-pial vessels and disruption of the tumor-brain barrier, which appear to be requisite for VEGF-A to have an edemagenic effect. Results of preliminary clinical studies suggest VEGF-directed therapy has modest activity against recurrent and progressive meningioma growth but can alleviate PTBE in some patients. A comprehensive understanding of the VEGF-A pathway and its modulators may hold the key to an effective therapeutic approach to treating PTBE associated with meningiomas. Further clinical trials with larger patient cohorts and longer follow-up periods are warranted to confirm the efficacy of VEGF-directed therapy.
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Affiliation(s)
- Jack Hou
- Department of Neurological Surgery, University Hospitals Case Medical Center; and
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ENOKIZONO M, MORIKAWA M, MATSUO T, HAYASHI T, HORIE N, HONDA S, IDEGUCHI R, NAGATA I, UETANI M. The Rim Pattern of Meningioma on 3D FLAIR Imaging: Correlation with Tumor-brain Adhesion and Histological Grading. Magn Reson Med Sci 2014; 13:251-60. [DOI: 10.2463/mrms.2013-0132] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mikako ENOKIZONO
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru MORIKAWA
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences
| | - Takayuki MATSUO
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Tomayoshi HAYASHI
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences
| | - Nobutaka HORIE
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Sumihisa HONDA
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences
| | - Reiko IDEGUCHI
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences
| | - Izumi NAGATA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Masataka UETANI
- Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences
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Jensen R, Lee J. Predicting outcomes of patients with intracranial meningiomas using molecular markers of hypoxia, vascularity, and proliferation. Neurosurgery 2012; 71:146-56. [PMID: 22472549 DOI: 10.1227/neu.0b013e3182567886] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The natural history of surgically treated intracranial meningiomas can be quite variable. Recurrence and patient outcome cannot currently be predicted with accuracy. OBJECTIVE To explore the potential roles of tumor hypoxia-regulated biological markers, preoperative imaging, measures of proliferation, and angiogenesis in predicting patient outcome. METHODS Tissue from 263 patients (average follow-up, 75 months) was examined for molecular markers hypoxia-inducible factor-1α (HIF-1α), carbonic anhydrase-IX (CA-IX), and glucose transporter-1 (Glut-1); vascular endothelial growth factor (VEGF); proliferation (MIB-1); and microvascular density (MVD) (Factor VIII). Preoperative magnetic resonance images were also examined for tumor size and peritumoral brain edema (PTBE). RESULTS VEGF, HIF-1α, CA-IX, and Glut-1 are positively correlated (P < .001-.005). PTBE was associated with higher grade (P = .03), larger tumors (P = .02), and log of MVD (P = .004). Progression-free survival (PFS) was associated with higher grade (P < .001), subtotal resection (P = .004), VEGF expression (P = .004), and log of MIB-labeling index (P < .001) on pairwise comparisons. Using multivariate analysis, PFS was associated with subtotal resection (HR 2.71, P = .027), higher grade (HR 6.29, P < .001), higher VEGF expression (HR 1.52, P = .038), and log of MIB-labeling index (HR 1.68, P = .005). Shorter overall survival was associated with subtotal resection (HR 3.23, P = .002), higher grade (HR 4.47, P < .001), higher expression of HIF-1α (HR 1.56, P < .001) and Glut-1 (HR 1.39, P = .02), and log of MIB-labeling index (HR 1.87, P < .001) when controlled for age. CONCLUSION HIF, VEGF, and MIB-1 are significantly correlated with tumor recurrence. With further study, these molecular markers may be used to predict outcome for patients with intracranial meningiomas.
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Affiliation(s)
- Randy Jensen
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Osawa T, Tosaka M, Nagaishi M, Yoshimoto Y. Factors affecting peritumoral brain edema in meningioma: special histological subtypes with prominently extensive edema. J Neurooncol 2012; 111:49-57. [PMID: 23104516 DOI: 10.1007/s11060-012-0989-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 10/10/2012] [Indexed: 11/30/2022]
Abstract
Various degrees of peritumoral brain edema (PTBE) are observed in patients with intracranial meningiomas. Factors affecting the occurrence of PTBE in intracranial meningioma were investigated. PTBE was investigated retrospectively for 110 patients with primary intracranial meningiomas. Predictive factors related to PTBE were analyzed, for example patient age, sex, magnetic resonance imaging features (contrast enhancement, tumor shape, tumor location, tumor volume), angiographical features (tumor stain, pial-cortical arterial supply, venous obstruction), and histopathological features (histological subtypes, mindbomb homolog 1 labeling index (MIB1-LI)). Histological subtypes were classified into World Health Organization (WHO) grade I common type (meningothelial, transitional, fibrous), grade I uncommon type, and grade II and III types. The extent of PTBE was assessed by calculation of the edema index (EI). PTBE was present in 53 cases (48 %). Male sex, heterogeneous enhancement, superficial location, tumor volume (≥10 cm(3)), remarkable tumor stain, pial supply, venous obstruction, malignant pathology, and MIB1-LI ≥4 % were correlated with PTBE in univariate analysis. Pial supply and remarkable tumor stain were correlated with PTBE in multivariate analysis. WHO grade I uncommon type had obviously higher EI than WHO grade I common type, and WHO grade II and III types (P < 0.001). Seven cases with prominently high EI (EI ≥10) were all WHO grade I uncommon type, including angiomatous, microcystic, secretory, and lymphoplasmacyte-rich meningioma. Prominently extensive PTBE might indicate the presence of WHO grade I uncommon type meningioma.
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Affiliation(s)
- Tadashi Osawa
- Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Taoka T, Yamada S, Sakamoto M, Akashi T, Miyasaka T, Ochi T, Wada T, Uchikoshi M, Nakase H, Kichikawa K. Accuracy for predicting adhesion between meningioma and the brain by using brain surface motion imaging: comparison between single and double acquisition methods. Neuroradiology 2012; 54:1313-20. [PMID: 22729701 DOI: 10.1007/s00234-012-1054-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/06/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The presence of adhesions between the brain and the meningioma is an important factor that determines the success of total surgical removal. Brain surface motion imaging enables assessment of the dynamics of brain surface motion. A subtraction image of pulse-gated heavily T2-weighted images in different phases of the cardiac cycle provides a stripe pattern on the surface of the pulsating brain. Thus, the lack of a stripe pattern on the surface of extraaxial tumor indicates the presence of tumor-brain adhesion. The purpose of the present experiment was to evaluate the accuracy of predicting tumor-brain adhesion using the original double acquisition method and the improved single acquisition method. METHODS The subjects were 67 meningioma cases patients who were surgically treated after brain surface motion imaging. Thirty-three cases were evaluated using the double acquisition method and 34 cases were evaluated with the single acquisition method. In the double acquisition method, the two sets of images are acquired as two independent scans, and in the single acquisition method, the images are acquired serially as a single scan. RESULTS The findings for the double acquisition method agreed with the surgical findings in 23 cases (69.7 %), while findings from the single acquisition method agreed with the surgical findings in 26 cases (76.5 %). CONCLUSION Pre-surgical evaluation for tumor-brain adhesion by brain surface motion imaging provides helpful information for meningioma surgery, especially when using the single acquisition method.
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Affiliation(s)
- Toshiaki Taoka
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
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Kawahara Y, Nakada M, Hayashi Y, Kai Y, Hayashi Y, Uchiyama N, Nakamura H, Kuratsu JI, Hamada JI. Prediction of high-grade meningioma by preoperative MRI assessment. J Neurooncol 2012; 108:147-52. [PMID: 22327898 DOI: 10.1007/s11060-012-0809-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 01/27/2012] [Indexed: 10/14/2022]
Abstract
High-grade (World Health Organization grades II and III) meningiomas grow aggressively and recur frequently, resulting in a poor prognosis. Assessment of tumor malignancy before treatment initiation is important. We attempted to determine predictive factors for high-grade meningioma on magnetic resonance (MR) imaging before surgery. We reviewed 65 meningiomas (39 cases, benign; 26 cases, high-grade) and assessed four factors: (1) tumor-brain interface (TBI) on T1-weighted imaging (T1WI), (2) capsular enhancement (CapE), i.e., the layer of the tumor-brain interface on gadolinium-enhanced T1WI (T1Gd), (3) heterogeneity on T1Gd, and (4) tumoral margin on T1Gd. All four factors were useful in distinguishing high-grade from benign meningiomas, according to univariate analysis. On multivariate regression analysis, unclear TBI and heterogeneous enhancement were independent predictive factors for high-grade meningioma. In meningiomas with an unclear TBI and heterogeneous enhancement, the probability of high-grade meningioma was 98%. Our data suggest that this combination of factors obtained from conventional sequences on MR imaging may be useful to predict high-grade meningioma.
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Affiliation(s)
- Yosuke Kawahara
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Fujimoto T, Ishida Y, Uchiyama Y, Nakase H, Sakaki T, Nakamura M, Park YS, Motoyama Y, Nishimura F. Radiological predictive factors for regrowth of residual benign meningiomas. Neurol Med Chir (Tokyo) 2011; 51:415-22. [PMID: 21701104 DOI: 10.2176/nmc.51.415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pre- and postoperative radiological predictive factors for the regrowth of residual benign meningiomas were investigated in 80 of 327 patients who underwent first surgery for intracranial meningioma, who met the following conditions: residual tumor observed on postoperative imaging, follow up for more than 5 years or until regrowth of the residual tumor, histological diagnosis of World Health Organization grade I, and no additional therapy performed within 1 month after surgery. These 80 patients were divided into those with no regrowth during the follow-up period (Group A, n = 54) and those with regrowth (Group B, n = 26), and the clinical characteristics and pre- and postoperative imaging findings were compared. Univariate analysis of factors influencing regrowth showed 6 factors were significant: tumor size ≥4 cm (p = 0.043), tumor volume ≥30 cm(3) (p = 0.026), presence of edema (p = 0.036), unclear brain-tumor interface (p < 0.001), presence of a pial-cortical blood supply (p = 0.031), and residual tumor volume ≥3.0 cm(3) (p < 0.001). Multivariate analysis showed only residual tumor volume ≥3.0 cm(3) was significant (p = 0.001). Generally, the significant imaging findings on univariate analysis suggest malignant meningioma. Similar findings may be observed even in grade I cases, and residual tumors may regrow in such cases. The possibility is particularly high if the residual tumor volume exceeds 3.0 cm(3), so early radiotherapy should be performed to prevent regrowth.
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Celikoglu E, Suslu HT, Hazneci J, Bozbuga M. The relation between surgical cleavage and preoperative neuroradiological findings in intracranial meningiomas. Eur J Radiol 2011; 80:e109-15. [DOI: 10.1016/j.ejrad.2010.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 06/09/2010] [Indexed: 10/18/2022]
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Ildan F, Erman T, Göçer AI, Tuna M, Bağdatoğlu H, Cetinalp E, Burgut R. Predicting the probability of meningioma recurrence in the preoperative and early postoperative period: a multivariate analysis in the midterm follow-up. Skull Base 2011; 17:157-71. [PMID: 17973029 DOI: 10.1055/s-2007-970554] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We reviewed the clinical, radiological, surgical, and histopathological features of patients with meningiomas to identify factors that can predict tumor recurrence after "microscopic total removal," to improve preoperative surgical planning, and to help determine the need for close radiological observation at shorter intervals or the need for radiotherapy as an adjuvant treatment in the early postoperative period. Clinical data, magnetic resonance imaging studies, angiographic data, operative reports, and histopathological findings were examined retrospectively in 137 patients with a meningioma treated microsurgically and with no evidence of residual tumor on postoperative MR images. Based on univariate analysis, tumor size, a mushroom shape, proximity to major sinuses, edema, osteolysis, cortical penetration, signal intensity on T2-weighted MRIs, pial-cortical arterial supply, presence of a brain-tumor interface in surgery, Simpson's criteria, and histopathological classification were significant predictors for recurrence. However, age, gender, location of tumor, dural tail, calcification, signal intensity on T1-weighted images, and histopathologic subtypes in the benign group were not significant predictors. By Cox regression analysis the most important variables related to the time to recurrence were mushroom shape, osteolysis, dural tail, and proximity to major sinuses. Aggressive surgical therapy with wider dural removal should be considered in the presence of the preoperative predictors of a recurrence. Close radiological observation at shorter intervals or radiotherapy should be considered as adjuvant therapy in high-risk patients based on surgical findings predicting recurrence related to the brain-tumor interface, Simpson's criteria, and histopathological findings in the early postoperative period.
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Affiliation(s)
- Faruk Ildan
- Department of Neurosurgery, Cukurova University, School of Medicine, Adana, Turkey
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Toktas ZO, Akgun E, Ozkan A, Bozkurt SU, Bekiroglu N, Seker A, Konya D, Kilic T. Relationship of Angiogenic Potential With Clinical Features in Cranial Meningiomas: A Corneal Angiogenesis Study. Neurosurgery 2010; 67:1724-32; discussion 1732. [DOI: 10.1227/neu.0b013e3181f9f310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rogers L, Gilbert M, Vogelbaum MA. Intracranial meningiomas of atypical (WHO grade II) histology. J Neurooncol 2010; 99:393-405. [PMID: 20740303 DOI: 10.1007/s11060-010-0343-1] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 08/04/2010] [Indexed: 11/27/2022]
Abstract
Atypical (WHO grade II) meningiomas occupy an intermediate risk group between benign (WHO grade I) and anaplastic (WHO grade III) meningiomas. Although grade II meningiomas have traditionally been recognized in only about 5% of cases, after changes in diagnostic criteria with the current 2007 WHO standards, they now comprise approximately 20-35% of all meningiomas. Given the magnitude of this change, much work is now needed to solidify the adoption of these standards, to render inter-observer and inter-institutional comparisons more uniform, and to more carefully define the incidence of grade II histology. However, it is clear that they carry a several-fold increased risk of recurrence, as well as an increased rate of mortality. We will discuss the definition, diagnosis, and treatment of patients with atypical meningioma; review the current phase II cooperative trials; and draw attention to some questions timely for pre-clinical and clinical research.
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Brain surface motion imaging to predict adhesions between meningiomas and the brain surface. Neuroradiology 2010; 52:1003-10. [PMID: 20333508 DOI: 10.1007/s00234-010-0671-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION "Brain surface motion imaging" (BSMI) is the subtraction of pulse-gated, 3D, heavily T2-weighted image of two different phases of cerebrospinal fluid (CSF) pulsation, which enables the assessment of the dynamics of brain surface pulsatile motion. The purpose of this study was to evaluate the feasibility of this imaging method for providing presurgical information about adhesions between meningiomas and the brain surface. METHODS Eighteen cases with surgically resected meningioma in whom BSMI was presurgically obtained were studied. BSMI consisted of two sets of pulse-gated, 3D, heavily T2-weighted, fast spin echo scans. Images of the systolic phase and the diastolic phase were obtained, and subtraction was performed with 3D motion correction. We analyzed the presence of band-like texture surrounding the tumor and judged the degree of motion discrepancy as "total," "partial," or "none." The correlation between BSMI and surgical findings was evaluated. For cases with partial adhesions, agreements in the locations of the adhesions were also evaluated. RESULTS On presurgical BSMI, no motion discrepancy was seen in eight cases, partial in six cases, and total in four cases. These presurgical predictions about adhesions and surgical findings agreed in 13 cases (72.2%). The locations of adhesions agreed in five of six cases with partial adhesions. CONCLUSION In the current study, BSMI could predict brain and meningioma adhesions correctly in 72.2% of cases, and adhesion location could also be predicted. This imaging method appears to provide presurgical information about brain/meningioma adhesions.
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Chernov MF, Nakaya K, Kasuya H, Kato K, Ono Y, Yoshida S, Nakamura R, Suzuki T, Muragaki Y, Iseki H, Kubo O, Hori T, Takakura K. Metabolic alterations in the peritumoral brain in cases of meningiomas: 1H-MRS study. J Neurol Sci 2009; 284:168-74. [DOI: 10.1016/j.jns.2009.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 05/15/2009] [Accepted: 05/15/2009] [Indexed: 11/25/2022]
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Vignes J, Sesay M, Rezajooi K, Gimbert E, Liguoro D. Peritumoral edema and prognosis in intracranial meningioma surgery. J Clin Neurosci 2008; 15:764-8. [DOI: 10.1016/j.jocn.2007.06.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 05/24/2007] [Accepted: 05/30/2007] [Indexed: 12/01/2022]
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Simis A, Pires de Aguiar PH, Leite CC, Santana PA, Rosemberg S, Teixeira MJ. Peritumoral brain edema in benign meningiomas: correlation with clinical, radiologic, and surgical factors and possible role on recurrence. ACTA ACUST UNITED AC 2008; 70:471-7; discussion 477. [PMID: 18586307 DOI: 10.1016/j.surneu.2008.03.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 03/01/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 60% of meningiomas are associated with peritumoral edema. Various causative factors have been discussed in the literature. The objective of this study was to investigate the correlation of PTBE with clinical, radiologic, and surgical aspects and recurrence of meningiomas. METHODS Sixty-one patients with benign meningiomas were chosen for surgical treatment by the Group of Brain Tumors and Metastasis of the Department of Neurosurgery. All patients underwent complete surgical resection (Simpson grades 1 and 2), and those with atypical and malignant histopathologic grades were excluded. Tumors located in the cavernous sinus, tuberculum sellae, foramen magnum, ventricles, and petroclival region were excluded. RESULTS Edema extension had a positive correlation with the higher recurrence rates (P = .042) and with the presence of irregular margins (P < .011) on bivariate analysis. Meningiomas with larger edema sizes also showed correlation with large meningiomas (P = .035), and the ones with smaller edema sizes correlated with the tentorial location (P = .032). Multivariate analysis showed an association between PTBE and the presence of seizures (odds ratio, 3.469), large meningiomas (odds ratio, 15.977), and for each cubic centimeter added to its size, the risk of edema increased 1.082 times (odds ratio). CONCLUSION Peritumoral brain edema may be related to the invading potential of meningiomas and may play a role in the recurrence potential of the tumor. As a consequence, it is reasonable to consider the presence of edema as an additional factor to be taken into account when mapping out strategies for the treatment of meningiomas.
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Affiliation(s)
- Andre Simis
- Division of Neurosurgery, Hospital das Clínicas-São Paulo Medical School, University of São Paulo, 05403-000 São Paulo, Brazil.
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Preoperative subtyping of meningiomas by perfusion MR imaging. Neuroradiology 2008; 50:835-40. [DOI: 10.1007/s00234-008-0417-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 05/15/2008] [Indexed: 10/22/2022]
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Ketter R, Rahnenführer J, Henn W, Kim YJ, Feiden W, Steudel WI, Zang KD, Urbschat S. Correspondence of tumor localization with tumor recurrence and cytogenetic progression in meningiomas. Neurosurgery 2008; 62:61-9; discussion 69-70. [PMID: 18300892 DOI: 10.1227/01.neu.0000311062.72626.d6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Meningiomas are mostly benign tumors that originate from the coverings of the brain and spinal cord. Cytogenetically, they reveal a normal karyotype or, typically, monosomy of chromosome 22. Progression of meningiomas is associated with a non-random pattern of secondary losses of other autosomes. Deletion of the short arm of one chromosome 1 is a decisive step to anaplastic growth in meningiomas. METHODS Statistical analyses were performed for the karyotypes of 661 meningiomas with respect to localization, progression, and recurrence of the tumor. A mathematical mixture model estimates typical pathogenetic routes in terms of the accumulation of somatic chromosome changes in tumor cells. The model generates a genetic progression score (GPS) that estimates the prognosis as related to the cytogenetic properties of a given tumor. RESULTS In 53 patients, one or several recurrences were documented over the period of observation. This corresponds to a total rate of recurrence of 8.0% after macroscopically complete tumor extirpation. Higher GPS values were shown to be strongly correlated with tumor recurrence (P = 2.9 x 10(-7)). High-risk tumors, both in terms of histology and cytogenetics, are localized much more frequently at the brain surface than at the cranial base (P = 1.2 x 10(-5) for World Health Organization grade and P = 3.3 x 10(-12) for GPS categorization). CONCLUSION The tendency of cranial base meningiomas to recur seems to depend on surgical rather than biological reasons. As a quantitative measure, the GPS allows for a more precise assessment of the prognosis of meningiomas than the established categorical cytogenetic markers.
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Affiliation(s)
- Ralf Ketter
- Department of Neurosurgery, Saarland University, Homburg/Saar, Germany.
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Lee KJ, Joo WI, Rha HK, Park HK, Chough JK, Hong YK, Park CK. Peritumoral brain edema in meningiomas: correlations between magnetic resonance imaging, angiography, and pathology. ACTA ACUST UNITED AC 2008; 69:350-5; discussion 355. [PMID: 18262249 DOI: 10.1016/j.surneu.2007.03.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 03/08/2007] [Indexed: 12/27/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the radiologic characteristics and pathology related to the formation of peritumoral edema in meningiomas. METHODS Seventy-nine patients with meningioma were examined by MRI and cerebral angiography. The predictive factors possibly related to peritumoral edema, such as patient age, sex, tumor location, tumor size, peritumoral rim (CSF cleft), shape of tumor margin, signal intensity of tumor in T2WI, pial blood supply, and pathology, were evaluated. We defined the edema-tumor volume ratio as EI and used this index to evaluate peritumoral edema. RESULTS Male sex (P = .009), tumor size (P = .026), signal intensity of tumor in T2WI (P = .016), atypical and malignant tumor (P = .004), and pial blood supply (P = .001) correlated with peritumoral edema on univariate analyses. However, in multivariate analyses, pial blood supply was statistically significant as a factor for peritumoral edema in meningioma (P = .029). Male sex (P = .067, P < .1) and hyperintensity in T2WI (P = .075, P < .1) might have statistical probability in peritumoral edema. CONCLUSIONS In our results, male sex, hyperintensity on T2WI, and pial blood supply were associated with peritumoral edema in meningioma that influence the clinical prognosis of patients.
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Affiliation(s)
- Kyung-Jin Lee
- Department of Neurosurgery, The Catholic University of Korea, Seoul, 150-713, South Korea
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Abstract
Surgery is the mainstay for many patients with meningiomas, and it remains the standard. In large single-institution series, gross-total resection has been reported to achieve 5-, 10-, and 15-year recurrence-free survival rates of approximately 90, 80, and 70%, respectively. There are a growing number of series of patients with prolonged follow-up in which authors have evaluated fractionated external-beam radiation therapy (EBRT) either as an adjuvant to surgery for subtotally resected, recurrent, or higher-grade meningiomas, or as an alternative to surgery. The primary focus of this review is EBRT, but to lend perspective, a comparative analysis of surgery and radiosurgery is also provided.
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Affiliation(s)
- Leland Rogers
- GammaWest Radiation Therapy, Salt Lake City, Utah 84102, USA.
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Ketter R, Urbschat S, Henn W, Feiden W, Beerenwinkel N, Lengauer T, Steudel WI, Zang KD, Rahnenführer J. Application of oncogenetic trees mixtures as a biostatistical model of the clonal cytogenetic evolution of meningiomas. Int J Cancer 2007; 121:1473-80. [PMID: 17557299 DOI: 10.1002/ijc.22855] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Meningiomas are mostly benign tumors that originate from the coverings of brain and spinal cord. Typically, they reveal a normal karyotype or monosomy for chromosome 22. Rare clinical progression of meningiomas is associated with a nonrandom pattern of secondary losses of other autosomes. Deletion of the short arm of one chromosome 1 appears to be a decisive step for anaplastic growth in meningiomas. We calculated an oncogenetic tree model that estimates the most likely cytogenetic pathways of 661 meningioma patients in terms of accumulation of somatic chromosome changes in tumor cells. The genetic progression score (GPS) estimates the genetic status of a tumor as progression in the corresponding tumor cells along this model. Large GPS values are highly correlated with early recurrence of meningiomas [p < 10(-4)]. This correlation holds even if patients are stratified by WHO grade. We show that tumor location also has an impact on genetic progression. Clinical relevance of the GPS is thus demonstrated with respect to origin, WHO grade and recurrence of the tumor. As a quantitative measure the GPS allows a more precise assessment of the prognosis of meningiomas than categorical cytogenetic markers based on single chromosomal aberrations.
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Affiliation(s)
- Ralf Ketter
- Department of Neurosurgery, Saarland University, Homburg/Saar, Germany.
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