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Torres-Ríos JA, Rodríguez-Camacho A, Basilio-Tomé E, Meraz-Soto JM, Camacho-Ordonez A, Romero-Luna G, Gutierrez-Aceves GA, Olhovich IG, Celis-López MA, Hernández-Sánchez LC, Moreno-Jiménez S. Radiation therapy for optic nerve sheath meningiomas: Local control and treatment related visual changes. World Neurosurg X 2024; 23:100291. [PMID: 38523881 PMCID: PMC10958468 DOI: 10.1016/j.wnsx.2024.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Objective Our primary objective is to evaluate the local control of optic nerve sheath meningiomas (ONSMs) treated with ionizing radiation and related visual changes after treatment. Our secondary objective is to describe the clinical characteristics and perform an analysis of the treatment impact on the functional status of this group of patients. Methods We present our series of 19 patients treated with ionizing radiation therapy at our radio-neurosurgery unit between 2016 and 2022. The setting, ophthalmological follow-up, morbidity, and survival are analyzed and discussed. Results Patients were followed up, and the impact of treatment on local disease control, visual alterations of the affected eye, and functional status of the patient were analyzed. The progression-free survival (PFS) median was 60 months (95% CI 50.3-69.6 months). The estimated PFS rates at 48 and 66 months were 100% and 66%, respectively. At diagnosis, nine (47.3%) eyes were in amaurosis and ten (52.6%) with vision. Of the ten patients without amaurosis at the time of diagnosis, three (30%) maintained unchanged visual acuity, and seven (70%) had decreased visual acuity; three of them developed amaurosis during the first year after treatment (p = 0.018). Conclusions Using ionizing radiation therapy is a successful treatment for the local control of ONSMs. This therapeutic modality can compromise the visual acuity of the affected eye and improve dyschromatopsia and campimetry defects. The life prognosis is good for these patients, with a zero mortality rate, but their vision prognosis is poor.
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Affiliation(s)
- Jorge Alejandro Torres-Ríos
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Alejandro Rodríguez-Camacho
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Radiotherapy Department of Oncology Hospital, XXI Century Mexican Institute of Social Security, Mexico City, Mexico
| | - Estefania Basilio-Tomé
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Juan Marcos Meraz-Soto
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Azyadeh Camacho-Ordonez
- Neuro-Ophthalmology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Gerardo Romero-Luna
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Guillermo Axayacatl Gutierrez-Aceves
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Irene González Olhovich
- Neuro-Ophthalmology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Miguel Angel Celis-López
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | | | - Sergio Moreno-Jiménez
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- American British Cowdray Medical Center, Cancer Center, Mexico City, 01120, Mexico
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Villanueva-Castro E, Meraz-Soto JM, Hernández-Dehesa IA, Tena-Suck ML, Hernández-Reséndiz R, Mateo-Nouel EDJ, Ponce-Gómez JA, Arriada-Mendicoa JN. Spinal Ependymomas: An Updated WHO Classification and a Narrative Review. Cureus 2023; 15:e49086. [PMID: 38125233 PMCID: PMC10731541 DOI: 10.7759/cureus.49086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Ependymomas are neuroepithelial tumors that develop from ependymal cells found in the brain parenchyma and can spread to any part of the spinal cord. Three to six percent of all malignancies affecting the central nervous system (CNS) are ependymomas. Even the most talented surgeons are challenged by spinal cord ependymomas; as a result, research into this clinical phenomenon should continue. Since 1979, the World Health Organization (WHO) has published a classification and grading system for CNS malignancies to ensure consistent diagnostic standards worldwide. The WHO prepared an update on these tumors, paying particular attention to molecular techniques to categorize the therapeutic management of each patient with greater accuracy and clarity. We thoroughly reviewed the literature on the epidemiology, etiology, diagnosis, and treatment of spinal ependymomas since there has not been a recent review of these tumors. This included modifications to the 2021 WHO Classification of Tumors of the Central Nervous System.
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Affiliation(s)
- Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Marcos Meraz-Soto
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Martha Lilia Tena-Suck
- Department of Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Edgardo de Jesus Mateo-Nouel
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Monjarás-Romo G, Zavala-Romero L, Tejada-Pineda MF, Meraz-Soto JM, Ballesteros-Herrera D, Cienfuegos-Meza J, Alcaráz-Félix RJ, Moreno-Jiménez S. Lhermitte-Duclos Disease: A Case Series. Cureus 2023; 15:e44326. [PMID: 37779805 PMCID: PMC10536449 DOI: 10.7759/cureus.44326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Lhermitte-Duclos disease (LDD), or dysplastic cerebellar gangliocytoma, is a rare benign tumor characterized by unilateral hemispheric cerebellar expansion. It is linked to mutations in the phosphatase and tensin homolog (PTEN) gene, which inhibit the phosphatidylinositol-3'-kinase pathway, leading to increased cell division and defective neuronal migration. This study aims to compare the clinical, radiological, histopathological, surgical resolution, and follow-up characteristics of reported cases of this rare condition. An in-depth search of LDD patients' clinical records at our institute between 2003 and 2023 was conducted, in addition to a systematic literature review on PubMed. Three patients with a diagnosis of LDD were found. Cerebellar abnormalities, varying headaches, and visual impairment were all present clinically. On T2 in the posterior fossa, all three MRI scans displayed the typical hyperintense parallel streak appearance. The histopathological report showed that large ganglion cells had replaced the granular layer, Purkinje cells had degenerated, the molecular layer had become hyper-myelinated, and synaptophysin and chromogranin were positive. Partial tumor resection and avoiding intracranial hypertension were the main goals of treatment. Genetic follow-up was conducted for all three patients. Neurosurgeons must be aware of LDD to provide close genetic monitoring despite the benign nature of the tumor because of its link to Cowden syndrome and elevated risk of cancer in other organs.
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Affiliation(s)
- Gonzalo Monjarás-Romo
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Lilian Zavala-Romero
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | | | - Juan Marcos Meraz-Soto
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Daniel Ballesteros-Herrera
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | - Jesús Cienfuegos-Meza
- Pathology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
| | | | - Sergio Moreno-Jiménez
- Radiosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico, MEX
- Neurosurgery-Radiosurgery Department, American British Cowdray Medical Center, Mexico, MEX
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