Relationships Between Neurofibromatosis-2, Progesterone Receptor Expression, the Use of Exogenous Progesterone, and Risk of Orbitocranial Meningioma in Females

Correspondence of Meningioma Orbital Grading and Clinicopathological Features among Indonesian Patients

BACKGROUND: Orbital meningiomas can cause visual disturbances, protrusion of the eyes, double vision, and optic nerve abnormalities that significantly decrease vision and eventually lead to blindness. To the best of our knowledge, data on the incidence and pathogenesis of orbital meningioma in Indonesia are non-existent. AIM: This study aimed to analyze the clinicopathological relationship with orbital meningioma grading. METHODS: It is a cross-sectional observational analysis on 44 orbital meningioma patients in Dr. Hasan Sadikin General Hospital and the National Eye Center, Cicendo Eye Hospital in 2017–2020. Chi-square analysis and logistic regression with statistical significance (p < 0.05) were engaged in the method. RESULTS: Orbital meningioma mostly occurred in women aged 30–44 years. Meningioma Grade I was dominated by meningothelial meningioma found in 14 (31.8%) patients, Grade II was atypical meningioma in 9 (20.9%) patients, and Grade III was anaplastic meningioma in 3 patients (6.8%). Clinical symptoms in the form of papillary atrophy (p = 0.046), visual acuity (p = 0.026), proptosis (p = 0.029), and hyperostosis (p = 0.024) were statistically significant and there was a significant difference between Grade I, Grade II, and Grade III using the Chi-square test. Logistic regression results showed that hyperostosis is significantly related to grading the orbital meningioma (p = 0.044) with an odds ratio of 0.206 (IK95% 0.04–0.955). CONCLUSION: Hyperostosis increases the grading of the orbital meningioma because it is related to the invasion of the tumor into the orbital bone and is a neoplastic process. The presence of hyperostosis which is more common in Grade III meningiomas can be used as one of the most important predictors of meningioma recurrence postoperatively. Nonetheless, our data add to the existing literature the potential points of anti-invasive adjuvant therapy attacks.

EANO guideline on the diagnosis and management of meningiomas

Meningiomas are the most common intracranial tumors. Yet, only few controlled clinical trials have been conducted to guide clinical decision making, resulting in variations of management approaches across countries and centers. However, recent advances in molecular genetics and clinical trial results help to refine the diagnostic and therapeutic approach to meningioma. Accordingly, the European Association of Neuro-Oncology (EANO) updated its recommendations for the diagnosis and treatment of meningiomas. A provisional diagnosis of meningioma is typically made by neuroimaging, mostly magnetic resonance imaging. Such provisional diagnoses may be made incidentally. Accordingly, a significant proportion of meningiomas, notably in patients that are asymptomatic or elderly or both, may be managed by a watch-and-scan strategy. A surgical intervention with tissue, commonly with the goal of gross total resection, is required for the definitive diagnosis according to the WHO classification. A role for molecular profiling including gene panel sequencing and genomic methylation profiling is emerging. A gross total surgical resection including the involved dura is often curative. Inoperable or recurrent tumors requiring treatment can be treated with radiosurgery, if the size or the vicinity of critical structures allows that, or with fractionated radiotherapy (RT). Treatment concepts combining surgery and radiosurgery or fractionated RT are increasingly used, although there remain controversies regard timing, type, and dosing of the various RT approaches. Radionuclide therapy targeting somatostatin receptors is an experimental approach, as are all approaches of systemic pharmacotherapy. The best albeit modest results with pharmacotherapy have been obtained with bevacizumab or multikinase inhibitors targeting vascular endothelial growth factor receptor, but no standard of care systemic treatment has been yet defined.