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Marian-Magaña R, Sangrador-Deitos MV, Rodríguez-Hernández L, Lara-Olivas JA, López-Valencia G, Villalobos-Díaz R, Aragón-Arreola JF, Padilla-Leal KE, García-Zazueta JH, Camacho-Castro A, Gómez-Amador JL. Visual outcomes in tuberculum sellae meningiomas comparing transcranial and endoscopic endonasal approaches. World Neurosurg X 2024; 23:100319. [PMID: 38511160 PMCID: PMC10950694 DOI: 10.1016/j.wnsx.2024.100319] [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] [Received: 08/30/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
Background Tuberculum sellae meningiomas (TSM) account for 3-10% of intracranial meningiomas. Visual loss is the presenting symptom in up to 80% of cases. Surgical management poses a great challenge due to tumor proximity to neurovascular structures such as the optic nerve and the internal carotid artery (ICA); hence, there is controversy regarding the optimal approach. The aim of this study is to determine differences in visual outcomes between transcranial (TCA) and endoscopic endonasal (EEA) approaches. Methods A retrospective study including 29 patients with TSM surgically treated by TCA or EEA between 2011 and 2023 in a single referral center was conducted. Pre-and post-operative neuro-ophthalmologic evaluations, focusing on visual acuity and campimetry, were evaluated. Results Sixteen (55.16%) patients were intervened through a TCA and the remaining 13 (44.84%) via an EEA. The lesions in each group were similar in terms of pre- operative volume (15.12 vs 12.9 cm3, p = 0.497) and neurovascular invasion (optic canal invasion 48.26 vs 41.37%, p = 0.664; ICA 44.81 vs 31.03%, p = 0.797). There were no significant differences in visual outcomes between both approaches; TCA presented an improvement of 5.18 points in visual fields (p = 0.140), whereas EEA had an improvement of 17.39 points in visual acuity (p = 0.114). Conclusion EEA seems to offer greater improvement in visual acuity than TCA. However, the ideal approach should be individualized; taking into account the tumor's volume and invasiveness, as well as the patient's visual complaints.
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Affiliation(s)
- Ricardo Marian-Magaña
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
| | - Marcos V Sangrador-Deitos
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
| | - Luis Rodríguez-Hernández
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
| | - Jorge A Lara-Olivas
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
| | - Germán López-Valencia
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
| | - Rodolfo Villalobos-Díaz
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
| | - Jorge F Aragón-Arreola
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
| | - Karen E Padilla-Leal
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
| | - Jesús Humberto García-Zazueta
- Department of Neurosurgery, Culiacan General Hospital Dr Bernard J Gastelum, Av. Juan Aldama s/n Esquina Calle Estado de Nayarit Col. Gral. Antonio Rosales, Culiacán, Mexico
| | - Alfredo Camacho-Castro
- Department of Neurosurgery, Culiacan General Hospital Dr Bernard J Gastelum, Av. Juan Aldama s/n Esquina Calle Estado de Nayarit Col. Gral. Antonio Rosales, Culiacán, Mexico
| | - Juan L Gómez-Amador
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico
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Narotam A, Archary M, Naidoo P, Naidoo Y, Naidu V. Atypical presentation of a posterior fossa tumour: A case report. World J Clin Cases 2024; 12:2281-2285. [DOI: 10.12998/wjcc.v12.i13.2281] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress. This is of interest as the patient had no other symptomatology, especially given the size of the mass, which would typically cause a pressure effect leading to neurological and auditory symptoms.
CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard. He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler. He initially presented to our facility with severe respiratory distress. He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator. He had no constitutional symptoms or impairment of hearing. On clinical examination, the patient’s chest was “silent.” Our initial assessment was status asthmaticus with type 2 respiratory failure, based on the history of asthma, a “silent chest,” and the arterial blood gas results.
CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy. The patient’s chief presenting feature was severe respiratory distress, which combined with his background medical history of asthma, was misleading. Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.
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Affiliation(s)
- Alisha Narotam
- Department of Internal Medicine, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwa-Zulu Natal, South Africa
| | - Mikara Archary
- Department of Internal Medicine, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwa-Zulu Natal, South Africa
| | - Poobalan Naidoo
- Department of Internal Medicine, Nelson R Mandela, School of Medicine, University of Kwa-Zulu Natal, Durban 4001, Kwa-Zulu Natal, South Africa
| | - Yeshkhir Naidoo
- Department of Radiology, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwazulu-Natal, South Africa
| | - Vanesha Naidu
- Department of Radiology, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwazulu-Natal, South Africa
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Duba M, Mrlian A, Rošková I, Smrčka M, Fadrus P, Duba J, Hrdý O, Al Tukmachi D. Neurosurgical treatment and outcome patterns in patients with meningioma in South Moravian region-a population-based study. Neurol Sci 2024; 45:2311-2319. [PMID: 38151626 PMCID: PMC11021287 DOI: 10.1007/s10072-023-07244-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Meningiomas are usually slow-growing tumours, constituting about one third of all primary intracranial tumours. They occur more frequently in women. Clinical manifestation of meningiomas depends on their location, tumour size and growth rate. In most cases, surgical treatment is the procedure of choice. The success of this treatment is, however, associated with the radicality of the resection. Radiotherapy represents an additional or alternative treatment modality. Gamma knife surgery is another notable treatment method, especially in small and/or slow-growing tumours in eloquent areas or in elderly patients. MATERIAL AND METHODS Authors describe their experience with the diagnosis, treatment and outcome of the patients with meningioma (n = 857). Furthermore, they also assess the postoperative morbidity/mortality and recurrence rate. RESULTS AND CONCLUSIONS In view of the benign histology of meningiomas, the success of the treatment largely depends (besides the tumour grading) on the radicality of the resection. The emphasis is also put on appropriate follow-up of the patients. In certain patients, the watch and wait strategy should be also considered as a suitable treatment method.
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Affiliation(s)
- Miloš Duba
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Andrej Mrlian
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Ivana Rošková
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Smrčka
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pavel Fadrus
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Duba
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Anaesthesia, Resuscitation and Intensive Medicine, University Hospital Brno, Brno, Czech Republic
| | - Ondřej Hrdý
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Anaesthesia, Resuscitation and Intensive Medicine, University Hospital Brno, Brno, Czech Republic
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Li Y, Li Y, Liu J, Pang C, Li C. Concurrent spinal meningioma and giant invasive schwannoma without neurofibromatosis in children: A case report and literature review. Childs Nerv Syst 2024; 40:1623-1630. [PMID: 38349526 DOI: 10.1007/s00381-024-06300-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/23/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Spinal meningiomas coexisting with schwannomas in patients without neurofibromatosis are extremely rare lesions. There were only 15 cases reported to date, which were concurrent intradural tumors of different pathological types. CASE PRESENTATION Herein, we present a rare case of a 15-year-old child with concurrent spinal dorsal meningioma and ventral giant invasive schwannoma at C7-T3 and T10-S5 spinal levels. Preoperative magnetic resonance imaging and computed tomography indicated the schwannoma across the thoracic and lumbosacral transitional vertebra, with extensive bony erosion of the sacrum. The results of surgical resection were mostly satisfactory. CONCLUSIONS The present case is the youngest patient diagnosed with concurrent intradural tumors at different spinal levels. The pathogenetic mechanism remains unclear. The clinical presentations are always atypical. Surgical resection of the tumors is the first choice. We use the non-fusion surgery to preserve the function of the lumbar spine.
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Affiliation(s)
- Yaxiong Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, 89# Dong-Gang Road, Hebei Province, Shijiazhuang, 050000, China.
| | - Yan Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, 89# Dong-Gang Road, Hebei Province, Shijiazhuang, 050000, China
| | - Jianfeng Liu
- Department of Neurosurgery, The First Hospital of Hebei Medical University, 89# Dong-Gang Road, Hebei Province, Shijiazhuang, 050000, China
| | - Chao Pang
- Department of Pathology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Conghui Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University, 89# Dong-Gang Road, Hebei Province, Shijiazhuang, 050000, China
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Trabzonlu L, Martinez-Lage M, Deschler D, Paly JJ, Faquin WC. FNA of Meningioma with Rhabdoid Features Presenting as a Lateral Neck Mass. Head Neck Pathol 2024; 18:32. [PMID: 38658429 DOI: 10.1007/s12105-024-01644-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
Primary meningioma at extracranial head and neck sites is uncommon. Since fine needle aspiration (FNA) is often the first line diagnostic modality for the evaluation of masses in the head and neck, extracranial meningiomas can create a significant diagnostic pitfall for FNA. We report a case of meningioma with rhabdoid features and BAP1 loss in a 26-year-old woman, presenting as a large neck mass along the carotid sheath. FNA biopsy of the mass demonstrated a highly cellular specimen with clusters of uniform, epithelioid cells with round to ovoid nuclei and moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel performed on cell block sections showed that the tumor cells were weakly EMA positive, progesterone receptor was focally positive, and SSTR2A was diffuse and strongly positive. BAP1 immunohistochemistry showed a diffuse loss of expression in the tumor cells. After the cytologic diagnosis of meningioma, a tissue biopsy was performed, and the diagnosis of meningioma with rhabdoid features and BAP1 loss was confirmed. We also perform a literature review of meningioma cases presenting as a neck mass and evaluated by FNA. Our case highlights the significant diagnostic challenges that can be caused by extracranial meningiomas on FNA and the importance of ancillary studies to avoid diagnostic pitfalls.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA
| | - Maria Martinez-Lage
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
| | - Jonathan J Paly
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA.
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Liu X, Han T, Wang Y, Liu H, Zhao Z, Deng J, Xue C, Li S, Sun Q, Zhou J. T1 Pre- and Post-contrast Delta Histogram Parameters in Predicting the Grade of Meningioma and Their Relationship to Ki-67 Proliferation Index. Acad Radiol 2024:S1076-6332(24)00212-5. [PMID: 38653597 DOI: 10.1016/j.acra.2024.04.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
RATIONALE AND OBJECTIVES To explore the feasibility of delta histogram parameters (including absolute delta histogram parameters (AdHP) and relative delta histogram parameters (RdHP)) in predicting the grade of meningioma and to further investigate whether delta histogram parameters correlate with the Ki-67 proliferation index. METHODS 92 patients with meningioma who underwent MRI examination (including T1-weighted (T1) and contrast-enhanced T1-weighted images (T1C)) were enrolled in this retrospective study. A total of 46 low-grade cases formed the low-grade group (grade 1, LGM), and a total of 46 high-grade cases formed the high-grade group (38 grade 2, 8 grade 3, HGM). Histogram parameters (HP) of T1 and T1C were extracted. Subsequently, morphological MRI features, AdHP (AdHP=T1CHP-T1HP), and RdHP (RdHP=(T1CHP-T1HP)/T1HP) were recorded and compared, respectively. Binary logistic regression analysis was used to obtain combined performance of the significant parameters. Diagnostic performance was identified by ROC. Spearman's correlation coefficients were taken to assess the relationship between delta histogram parameters and the Ki-67 proliferation index. RESULTS In morphological MRI features, HGM is more prone to lobulation and necrosis/cystic changes (all p < 0.05). In delta histogram parameters, HGM exhibits higher mean, Perc.01, Perc.25, Perc.50, Perc.75, Perc.99, SD, and variance of AdHP, maximum, mean, Perc.25, Perc.50, Perc.75, and Perc.99 of RdHP, compared to LGM (all p < 0.00357). The optimal predictive performance was obtained by combining morphological MRI features and delta histogram parameters with an AUC of 0.945. Significant correlations were observed between significant delta histogram parameters and the Ki-67 proliferation index (all p < 0.05). CONCLUSION Delta histogram parameter is a promising potential biomarker, which may be helpful in noninvasive predicting the grade and proliferative activity of meningioma.
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Affiliation(s)
- Xianwang Liu
- Radiology of Department, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, 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
| | - Tao Han
- Radiology of Department, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, 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
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, People's Republic of China; Department of Nuclear Medicine, Gansu Provincial Cancer Hospital, Lanzhou, People's Republic of China
| | - Hong Liu
- Radiology of Department, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, 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
| | - Zhiqiang Zhao
- Pathology of Department, Lanzhou University Second Hospital, Lanzhou, People's Republic of China
| | - Juan Deng
- Radiology of Department, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, 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
| | - Caiqiang Xue
- Radiology of Department, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, 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
| | - Shenglin Li
- Radiology of Department, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, 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
| | - Qiu Sun
- Radiology of Department, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, 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
- Radiology of Department, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, 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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Nadeem M, Goyal-Honavar A, Sravya P, Beniwal M, Santosh V, Srinivas D. Prognostic factors and outcomes in WHO Grade 1 and Grade 2 intracranial meningiomas - 5 year institutional experience. World Neurosurg 2024:S1878-8750(24)00655-7. [PMID: 38649022 DOI: 10.1016/j.wneu.2024.04.082] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Meningiomas are the most frequent primary intracranial tumour. While histological grade and grade of excision are established predictors of recurrence, nuances such as the role of radical excision of dural attachment and postoperative radiotherapy in intermediate-risk groups remain unanswered. METHOD This report presented data from 451 WHO Grade 1 and 248 WHO Grade 2 intracranial meningiomas operated between 2010 and 2015, analysing their clinical and radiological features and surgical details. Outcomes were assessed among 352 WHO Grade 1 and 208 WHO Grade 2 meningiomas, studying the effect of extent of resection and use of radiotherapy. Kaplan Meier analysis was used to determine differences in survival by extent of resection and use of postoperative radiotherapy in the treatment of WHO Grade 1 and 2 meningiomas. RESULTS The mean age of the cohort was 46.3 years, with a female predominance. On univariate analysis, gender, WHO grade, and Simpson grade were significant predictors of recurrence. On multivariate analysis, WHO grade and Simpsons grade remained significant predictors of recurrence. Recurrence was significantly associated with poor performance status and mortality. Postoperative radiation significantly improved progression-free survival among Grade 2 meningioma that underwent gross total resection (GTR), but not among WHO Grade 1 and 2 meningioma after subtotal resection (STR). CONCLUSION WHO Grade and Simpson grade are independent predictors of recurrence among meningiomas. Irrespective of Grade, gross total resection must be effected when possible, and postoperative radiotherapy may be recommended in Grade 2 meningioma.
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Affiliation(s)
- Mohammed Nadeem
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Abhijit Goyal-Honavar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Palavalasa Sravya
- Research associate, Neuro-oncology laboratory, Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
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Keymakh M, Benton JA, Fluss R, Alavi SAN, Martin AM, Chin S, Kobets AJ. Clear cell meningiomas-case presentation, review of radiographic identifiers, and treatment approaches. Childs Nerv Syst 2024:10.1007/s00381-024-06390-z. [PMID: 38637336 DOI: 10.1007/s00381-024-06390-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
Spinal clear cell meningiomas (CCMs) are a rare histological subtype of meningiomas that post preoperative diagnostic challenges due to their radiographic similarities with other lesions. They are also more aggressive, exhibiting higher rates of recurrence, particularly in pediatric patients. Overcoming diagnostic challenges of these tumors can improve patient outcomes. In this report, we describe a case of a pediatric patient presenting with a lumbar CCM in whom we were able to obtain gross total resection. Our report reviews previously identified predictors of CCM recurrence, including the Ki-67 proliferation index, number of spinal segments involved, and hormonal influences related to age and sex. We describe the characteristic radiographic features that differentiate spinal CCMs from other tumors to improve pre-operative diagnosis. Furthermore, we provide our rationale for adjuvant therapy for pediatric patients to refine treatment protocols for these rare tumors.
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Affiliation(s)
- Margaret Keymakh
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA.
| | - Joshua A Benton
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Rose Fluss
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Seyed Ahmad Naseri Alavi
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Allison M Martin
- Department of Pediatrics, Albert Einstein College of Medicine and Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Steven Chin
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew J Kobets
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
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Gautam D, Findlay MC, Karsy M. Socioeconomic and Racial Disparities Impact Access to High Volume Centers During Meningioma Treatment. World Neurosurg 2024:S1878-8750(24)00639-9. [PMID: 38642832 DOI: 10.1016/j.wneu.2024.04.076] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Studies examining the relationship between hospital case volume, socioeconomic determinants of health, and patient outcomes are lacking. We sought to evaluate these associations in the surgical management of intracranial meningiomas. METHODS We queried the National Inpatient Sample (NIS) database for patients who underwent craniotomy for the resection of meningioma in 2013. We categorized hospitals into high (HVC) or low (LVC) volume centers. We compared outcomes in 2016 to assess the potential impact of the Affordable Care Act (ACA) on healthcare equity. Primary outcome measures included hospital mortality, length of stay (LOS), complications, and disposition. RESULTS A total of 10270 encounters were studied (LVC: n=5730 [55.8%], HVC n=4340 [44.2%]). 62.9% of LVC patients identified as white compared to 70.2% at HVC (p<0.01). A higher percentage of patients at LVC came from the lower two quartiles of median household income than HVC (49.9% vs 44.2% p<0.001). Higher mortality (1.3% vs 0.9% p = 0.041) was in LVCs. Multivariable regression analysis showed LVCs were significantly associated with increased complication (OR 1.36, 95% CI 1.30-1.426, p<0.001) and longer hospital LOS (OR -0.05, 95% CI -0.92,-0.45, p=<0.001). There was a higher proportion of white patients at HVCs in 2016 compared to 2013 (67.9% vs. 72.3%). More patients from top income quartiles (24.2% vs. 40.5%) were treated at HVC in 2016 compared to 2013. CONCLUSION This study demonstrated notable racial and socioeconomic disparities in LVC as well as access to HVCs over time. Disparities in meningioma treatment may persistent and require further study.
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Affiliation(s)
- Diwas Gautam
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA; Department of Neurosurgery, Global Neuroscience Institute, Chester, PA, USA
| | - Matthew C Findlay
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA; Department of Neurosurgery, Global Neuroscience Institute, Chester, PA, USA
| | - Michael Karsy
- Global Neurosciences Institute, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
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10
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Orešković D, Madero Pohlen A, Cvitković I, Alen JF, Raguž M, Álvarez-Sala de la Cuadra A, Bazarra Castro GJ, Bušić Z, Konstantinović I, Ledenko V, Martínez Macho C, Müller D, Žarak M, Jovanov-Milosevic N, Chudy D, Marinović T. Chronic hyperglycemia and intracranial meningiomas. BMC Cancer 2024; 24:488. [PMID: 38632533 PMCID: PMC11022447 DOI: 10.1186/s12885-024-12243-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Meningiomas are among the most common primary tumors of the central nervous system. Previous research into the meningioma histological appearance, genetic markers, transcriptome and epigenetic landscape has revealed that benign meningiomas significantly differ in their glucose metabolism compared to aggressive lesions. However, a correlation between the systemic glucose metabolism and the metabolism of the tumor hasn't yet been found. We hypothesized that chronic levels of glycaemia (approximated with glycated hemoglobin (HbA1c)) are different in patients with aggressive and benign meningiomas. The study encompassed 71 patients with de novo intracranial meningiomas, operated on in three European hospitals, two in Croatia and one in Spain. Our results show that patients with WHO grade 2 meningiomas had significantly higher HbA1c values compared to patients with grade 1 lesions (P = 0.0290). We also found a significant number of patients (19/71; 26.7%) being hyperglycemic, harboring all the risks that such a condition entails. Finally, we found a significant correlation between our patients' age and their preoperative HbA1c levels (P = 0.0008, ρ(rho) = 0.388), suggesting that older meningioma patients are at a higher risk of having their glycaemia severely dysregulated. These findings are especially important considering the current routine and wide-spread use of corticosteroids as anti-edematous treatment. Further research in this area could lead to better understanding of meningiomas and have immediate clinical impact.
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Affiliation(s)
- D Orešković
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia.
| | - A Madero Pohlen
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - I Cvitković
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - J F Alen
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - M Raguž
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - G J Bazarra Castro
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - Z Bušić
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - I Konstantinović
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - V Ledenko
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - C Martínez Macho
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - D Müller
- Department of Pathology, Clinical Hospital Dubrava, Zagreb, Croatia
| | - M Žarak
- Clinical Department of Laboratory Diagnostics, Clinical Hospital Dubrava, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - N Jovanov-Milosevic
- Department of Biology, School of Medicine, University of Zagreb, Zagreb, Croatia
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, School of Medicine, Croatian Institute for Brain Research, University of Zagreb, Zagreb, Croatia
| | - D Chudy
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, School of Medicine, Croatian Institute for Brain Research, University of Zagreb, Zagreb, Croatia
| | - T Marinović
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
- Department of Neurology and Neurosurgery, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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11
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Mizrachi M, Hartley B, Saleem S, Hintz E, Ziemba Y, Li J, Goenka A, Schulder M. Ki-67 index as a predictive marker of meningioma recurrence following surgical resection. J Clin Neurosci 2024; 124:15-19. [PMID: 38631196 DOI: 10.1016/j.jocn.2024.04.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Meningiomas are the most common primary intracranial tumors in adults. Although benign in a majority of cases, they have a variable clinical course and may recur even after a thorough surgical resection. Ki-67, a nuclear protein involved in cell cycle regulation, has been widely studied as a marker of cellular proliferation in various cancers. However, the prognostic significance of Ki-67 in meningiomas remains controversial. Here, we investigate the Ki-67 index, as a predictive marker of meningioma recurrence following surgical resection and compare it to established prognostic markers such as WHO grade and degree of resection. METHODS The medical records of 451 patients with previously untreated cranial meningiomas who underwent resections from January 2011 to January 2021 at North Shore University Hospital (NSUH) were reviewed. Collected data included WHO grade, Ki-67 proliferative index, degree of resection - gross (GTR) vs subtotal (STR) - as judged by the surgeon, tumor location, and meningioma recurrence. This study was approved by the NSUH Institutional Review Board IRB 21-1107. RESULTS There were 290 patients with grade I, 154 with grade II, and 7 with grade III meningiomas. The average post-resection follow-up period was 4 years, and 82 tumors (18 %) recurred. Higher WHO grades were associated with higher rates of recurrence, with rates of 11.4 %, 27.9 %, and 71.4 % for grades 1, 2, and 3, respectively, and subtotal resection corresponded to a higher rate of recurrence than total resection (34.3 % and 13.4 %, respectively). Higher WHO grades also correlated with higher Ki-67 scores (2.59, 10.01, and 20.71) for grades 1, 2, and 3, respectively. A multivariate logistic regression model identified Ki-67 and degree of resection as independent predictive variables for meningioma recurrence, with Ki-67 specifically predicting recurrence in the WHO grade II subset when analyzed separately for WHO grades I and II. CONCLUSION Our 10-year retrospective study suggests that the Ki-67 index is an important predictive marker for recurrence of intracranial meningiomas following surgical resection, particularly among patients with WHO grade II tumors. Our findings add to a growing body of data that support inclusion of Ki-67 index in the WHO grading criteria for patients with meningiomas.
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Affiliation(s)
- Mark Mizrachi
- Department of Neurosurgery, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemsptead, NY 11549, USA.
| | - Benjamin Hartley
- Department of Neurosurgery, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemsptead, NY 11549, USA
| | - Shahzaib Saleem
- Department of Neurosurgery, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemsptead, NY 11549, USA
| | - Eric Hintz
- Department of Neurosurgery, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemsptead, NY 11549, USA
| | - Yonah Ziemba
- Department of Neurosurgery, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemsptead, NY 11549, USA
| | - Jianyi Li
- Department of Pathology and Laboratory Medicine, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemsptead, NY 11549, USA
| | - Anuj Goenka
- Department of Neurosurgery, USA; Department of Radiation Oncology, USA
| | - Michael Schulder
- Department of Neurosurgery, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemsptead, NY 11549, USA
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12
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Zhang Z, Miao Y, Wu J, Zhang X, Ma Q, Bai H, Gao Q. Deep learning and radiomics-based approach to meningioma grading: exploring the potential value of peritumoral edema regions. Phys Med Biol 2024. [PMID: 38593827 DOI: 10.1088/1361-6560/ad3cb1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND
Radiomics and deep learning techniques have become integral in meningioma grading. The combination of these approaches holds the potential to enhance classification accuracy. Given the frequent occurrence of peritumoral edema (PTE) in meningiomas, investigating the potential value of PTE requires further research.
Objectives:
To address the challenge of meningioma grading, this study introduces a unique approach that integrates radiomics and deep learning techniques. The primary focus is on the development of a Transfer Learning-based Meningioma Feature Extraction Model (MFEM), leveraging both Vision Transformer (ViT) and Convolutional Neural Network (CNN) architectures. Furthermore, the study explores the potential significance of the peritumoral edema (PTE) region in enhancing the grading process.
Materials and Methods:
A retrospective study was conducted involving 98 meningioma patients, with 60 classified as low-grade meningiomas and 38 as high-grade meningiomas. PTE was observed in 51.02% of low-grade meningiomas patients and 89.47% of high-grade meningiomas patients. Magnetic resonance images were acquired using a GE Signa HDxt 1.5T MRI scanner, incorporating T2-weighted Fluid-Attenuated Inversion Recovery (T2 Flair) sequences. A Transfer Learning-based Meningioma Feature Extraction Model (MFEM) was constructed by combining ViT and CNN models to extract deep features from the Transformer layer, alongside radiomics features. These were then utilized as input for a machine learning classifier to accurately grade meningiomas.
Results:
The proposed method demonstrated excellent grading accuracy and robustness on the meningioma dataset, offering valuable guidance for treatment decisions. The approach achieved 92.86% accuracy, 93.44% precision, 95% sensitivity, and 89.47% specificity.
Conclusion:
The radiomics and deep learning-based approach presented in this study offers a reliable method for preoperative meningioma grading. This innovative method not only enhances accuracy but also reduces observer subjectivity, thereby contributing to improved clinical decision-making.
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Affiliation(s)
- Zhuo Zhang
- Tiangong University, Tianjin, Tianjin, 300160, CHINA
| | - Ying Miao
- Qufu Normal University, Qufu Normal University, Qufu, Shandong, 273165, CHINA
| | - Juxuan Wu
- Tiangong University, Tianjin, Tianjin, Tianjin, 300387, CHINA
| | - Xiaochen Zhang
- Tianjin Huanhu Hospital, Tianjin, Tianjin, Tianjin, 300060, CHINA
| | - Quanfeng Ma
- Tianjin Huanhu Hospital, Tianjin, Tianjin, Tianjin, 300060, CHINA
| | - Hua Bai
- Tiangong University, Tianjin, Tianjin, Tianjin, 300387, CHINA
| | - Qiang Gao
- Tiangong University, Tianjin, Tianjin, Tianjin, 300387, CHINA
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13
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Teske N, Teske NC, Greve T, Karschnia P, Kirchleitner SV, Harter PN, Forbrig R, Tonn JC, Schichor C, Biczok A. Perifocal edema is a risk factor for preoperative seizures in patients with meningioma WHO grade 2 and 3. Acta Neurochir (Wien) 2024; 166:170. [PMID: 38581569 PMCID: PMC10998776 DOI: 10.1007/s00701-024-06057-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Patients with intracranial meningiomas frequently suffer from tumor-related seizures prior to resection, impacting patients' quality of life. We aimed to elaborate on incidence and predictors for seizures in a patient cohort with meningiomas WHO grade 2 and 3. METHODS We retrospectively searched for patients with meningioma WHO grade 2 and 3 according to the 2021 WHO classification undergoing tumor resection. Clinical, histopathological and imaging findings were collected and correlated with preoperative seizure development. Tumor and edema volumes were quantified. RESULTS Ninety-five patients with a mean age of 59.5 ± 16.0 years were included. Most tumors (86/95, 90.5%) were classified as atypical meningioma WHO grade 2. Nine of 95 tumors (9.5%) corresponded to anaplastic meningiomas WHO grade 3, including six patients harboring TERT promoter mutations. Meningiomas were most frequently located at the convexity in 38/95 patients (40.0%). Twenty-eight of 95 patients (29.5%) experienced preoperative seizures. Peritumoral edema was detected in 62/95 patients (65.3%) with a median volume of 9 cm3 (IR: 0-54 cm3). Presence of peritumoral edema but not age, tumor localization, TERT promoter mutation, brain invasion or WHO grading was associated with incidence of preoperative seizures, as confirmed in multivariate analysis (OR: 6.61, 95% CI: 1.18, 58.12, p = *0.049). Postoperative freedom of seizures was achieved in 91/95 patients (95.8%). CONCLUSIONS Preoperative seizures were frequently encountered in about every third patient with meningioma WHO grade 2 or 3. Patients presenting with peritumoral edema on preoperative imaging are at particular risk for developing tumor-related seizures. Tumor resection was highly effective in achieving seizure freedom.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Nina C Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Tobias Greve
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Sabrina V Kirchleitner
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Patrick N Harter
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Center for Neuropathology and Prion Research, LMU University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Annamaria Biczok
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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14
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Rickel JK, Zeeb D, Knake S, Urban H, Konczalla J, Weber KJ, Zeiner PS, Pagenstecher A, Hattingen E, Kemmling A, Fokas E, Adeberg S, Wolff R, Sebastian M, Rusch T, Ronellenfitsch MW, Menzler K, Habermehl L, Möller L, Czabanka M, Nimsky C, Timmermann L, Grefkes C, Steinbach JP, Rosenow F, Kämppi L, Strzelczyk A. Status epilepticus in patients with brain tumors and metastases: A multicenter cohort study of 208 patients and literature review. Neurol Res Pract 2024; 6:19. [PMID: 38570823 PMCID: PMC10993483 DOI: 10.1186/s42466-024-00314-7] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Brain tumors and metastases account for approximately 10% of all status epilepticus (SE) cases. This study described the clinical characteristics, treatment, and short- and long-term outcomes of this population. METHODS This retrospective, multi-center cohort study analyzed all brain tumor patients treated for SE at the university hospitals of Frankfurt and Marburg between 2011 and 2017. RESULTS The 208 patients (mean 61.5 ± 14.7 years of age; 51% male) presented with adult-type diffuse gliomas (55.8%), metastatic entities (25.5%), intracranial extradural tumors (14.4%), or other tumors (4.3%). The radiological criteria for tumor progression were evidenced in 128 (61.5%) patients, while 57 (27.4%) were newly diagnosed with tumor at admission and 113 (54.3%) had refractory SE. The mean hospital length of stay (LOS) was 14.8 days (median 12.0, range 1-57), 171 (82.2%) patients required intensive care (mean LOS 8.9 days, median 5, range 1-46), and 44 (21.2%) were administered mechanical ventilation. All patients exhibited significant functional status decline (modified Rankin Scale) post-SE at discharge (p < 0.001). Mortality at discharge was 17.3% (n = 36), with the greatest occurring in patients with metastatic disease (26.4%, p = 0.031) and those that met the radiological criteria for tumor progression (25%, p < 0.001). Long-term mortality at one year (65.9%) was highest in those diagnosed with adult-type diffuse gliomas (68.1%) and metastatic disease (79.2%). Refractory status epilepticus cases showed lower survival rates than non-refractory SE patients (log-rank p = 0.02) and those with signs of tumor progression (log-rank p = 0.001). CONCLUSIONS SE occurrence contributed to a decline in functional status in all cases, regardless of tumor type, tumor progression status, and SE refractoriness, while long-term mortality was increased in those with malignant tumor entities, tumor progressions, and refractory SE. SE prevention may preserve functional status and improve survival in individuals with brain tumors.
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Affiliation(s)
- Johanna K Rickel
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany
| | - Daria Zeeb
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Susanne Knake
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Hans Urban
- Dr Senckenberg Institute of Neurooncology, University Hospital and Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Katharina J Weber
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- Institute of Neurology (Edinger-Institute), Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Pia S Zeiner
- Dr Senckenberg Institute of Neurooncology, University Hospital and Goethe-University Frankfurt, Frankfurt, Germany
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Axel Pagenstecher
- Institute of Neuropathology, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - André Kemmling
- Department of Neuroradiology, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Emmanouil Fokas
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, UKGM Marburg, Marburg, Germany
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, UKGM Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Robert Wolff
- Gamma Knife Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Martin Sebastian
- Hematology/Oncology, Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Tillmann Rusch
- Department of Hematology, Oncology & Immunology, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Michael W Ronellenfitsch
- Dr Senckenberg Institute of Neurooncology, University Hospital and Goethe-University Frankfurt, Frankfurt, Germany
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Katja Menzler
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Lena Habermehl
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Leona Möller
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Christian Grefkes
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Joachim P Steinbach
- Dr Senckenberg Institute of Neurooncology, University Hospital and Goethe-University Frankfurt, Frankfurt, Germany
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany
| | - Leena Kämppi
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
- Epilepsia Helsinki, European Reference Network EpiCARE, Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany.
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany.
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15
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Baucher G, Troude L, Al-Shabibi T, Avinens V, Fernandes S, Roche PH. Predictive factors of the postoperative proptosis recovery in surgery of spheno-orbital meningiomas. Acta Neurochir (Wien) 2024; 166:164. [PMID: 38564027 DOI: 10.1007/s00701-024-06053-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This study aimed to identify factors affecting proptosis recovery in spheno-orbital meningioma (SOM) surgery and assess functional and oncological outcomes. METHODS Data from 32 consecutive SOM surgery cases (2002-2021) were analyzed. Clinical, radiological, operative, and oncological parameters were examined. Proptosis was assessed using the exophthalmos index (EI) on MRI or CT scans. Statistical analyses were performed to identify predictive factors for proptosis recovery. RESULTS Proptosis improved in 75% of patients post-surgery (EI decreased from 1.28 ± 0.16 to 1.20 ± 0.13, p = 0.048). Patients with stable or worsened EI had higher body mass index (28.5 ± 7.9 vs. 24.1 ± 4.7, p = 0.18), Simpson grade (IV 75% vs. 65%, p = 0.24), and middle sphenoid wing epicenter involvement (63% vs. 38%, p = 0.12), but no significant factors were associated with unfavorable exophthalmos outcomes. The improvement group had higher en plaque morphology, infratemporal fossa invasion, and radiation treatment for cavernous sinus residual tumor (88% vs. 75%, p = 0.25; 51% vs. 25%, p = 0.42; 41% vs. 25%, p = 0.42, respectively), but without statistical significance. Visual acuity remained stable in 78%, improved in 13%, and worsened in 9% during follow-up. Surgery had a positive impact on preoperative oculomotor nerve dysfunction in 3 of 4 patients (75%). Postoperative oculomotor nerve dysfunction was observed in 25%, of which 75% fully recovered. This occurrence was significantly associated with irradiation of an orbital tumor residue (p = 0.04). New postoperative trigeminal hypoesthesia was observed in 47%, of which 73% recovered. All SOMs were classified as WHO grade 1, and complementary treatments achieved oncological control, requiring gamma-knife radiosurgery in 53% and standard radiotherapy in 6%. CONCLUSIONS Surgery effectively improves proptosis in SOM, though complete resolution is rare. The absence of predictive factors suggests multifactorial causes, including body mass index and tumor resection grade. Postoperative oculomotor nerve dysfunction and trigeminal hypoesthesia are common but often recover. Gamma-knife radiosurgery maintains long-term oncological control for evolving tumor residue.
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Affiliation(s)
- Guillaume Baucher
- Assistance Publique - Hôpitaux de Marseille, AP-HM, Hôpital Universitaire Nord, Neurochirurgie Adulte, Chemin Des Bourrely, 13015, Marseille, France.
| | - Lucas Troude
- Assistance Publique - Hôpitaux de Marseille, AP-HM, Hôpital Universitaire Nord, Neurochirurgie Adulte, Chemin Des Bourrely, 13015, Marseille, France
| | - Talal Al-Shabibi
- Assistance Publique - Hôpitaux de Marseille, AP-HM, Hôpital Universitaire Nord, Neurochirurgie Adulte, Chemin Des Bourrely, 13015, Marseille, France
| | - Valentin Avinens
- Assistance Publique - Hôpitaux de Marseille, AP-HM, Hôpital Universitaire Nord, Neurochirurgie Adulte, Chemin Des Bourrely, 13015, Marseille, France
| | - Sara Fernandes
- Faculté de Médecine, Unité d'Aide Méthodologique, Aix-Marseille Université, Marseille, France
| | - Pierre-Hugues Roche
- Assistance Publique - Hôpitaux de Marseille, AP-HM, Hôpital Universitaire Nord, Neurochirurgie Adulte, Chemin Des Bourrely, 13015, Marseille, France
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Gadzhiagaev VS, Lasunin NV, Okishev DN, Konovalov AN, Golbin DA, Cherekaev VA, Serova NK, Grigorieva NN. One-step orbit reconstruction using PMMA implants following hyperostotic sphenoid wing meningioma removal: Evolution of the technique in short clinical series. World Neurosurg X 2024; 22:100281. [PMID: 38455245 PMCID: PMC10918255 DOI: 10.1016/j.wnsx.2024.100281] [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: 08/30/2022] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose To report our experience with patient specific implants for one-step orbit reconstruction following hyperostotic SWM removal and to describe the evolution of the technique through three surgical cases. Methods: Three cases of one-step SWM removal and orbit reconstruction are described. All cases are given consecutively to describe the evolution of the technique. Hyperostotic bone resection was facilitated by electromagnetic navigation and cutting guides (templates). Based on a 3D model, silicone molds were made using CAD/CAM. Then PMMA implant was fabricated from these molds. The implant was adjusted and fixed to the cranium with titanium screws after tumor removal. Results: Following steps of the procedure changed over these series: hyperostotic bone resection, implant thickness control, implant overlay features, anatomic adjustments, implant fixation. The proptosis resolved in all cases. In one patient the progressive visual acuity deterioration was recognized during the follow-up. No oculomotor disturbances and no tumor regrowth were found at the follow-up. Conclusion CAD/CAM technologies enable creation of implants of any size and configuration, and thereby, to increase the extent of bony resection and lower the risk of tumor progression. The procedure is performed in one step which decreases the risk of postoperative morbidity.
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Affiliation(s)
- Vadim S. Gadzhiagaev
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Nikolay V. Lasunin
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Dmitriy N. Okishev
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Anton N. Konovalov
- Burdenko Neurosurgical Center, Department of Cerebrovascular Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Denis A. Golbin
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Vasily A. Cherekaev
- Burdenko Neurosurgical Center, Department of Cranio-Facial Surgery, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Natalia K. Serova
- Burdenko Neurosurgical Center, Department of Neuro-ophthalmology, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
| | - Nadezhda N. Grigorieva
- Burdenko Neurosurgical Center, Department of Neuro-ophthalmology, 4th Tverskaya-Yamskaya Str. 16, Postal Index, Moscow, 125047, Russian Federation
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Burrows L, Patel J, Islim AI, Jenkinson MD, Mills SJ, Chen K. A semi-automatic segmentation method for meningioma developed using a variational approach model. Neuroradiol J 2024; 37:199-205. [PMID: 38146866 DOI: 10.1177/19714009231224442] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Meningioma is the commonest primary brain tumour. Volumetric post-contrast magnetic resonance imaging (MRI) is recognised as gold standard for delineation of meningioma volume but is hindered by manual processing times. We aimed to investigate the utility of a model-based variational approach in segmenting meningioma. METHODS A database of patients with a meningioma (2007-2015) was queried for patients with a contrast-enhanced volumetric MRI, who had consented to a research tissue biobank. Manual segmentation by a neuroradiologist was performed and results were compared to the mathematical model, using a battery of tests including the Sørensen-Dice coefficient (DICE) and JACCARD index. A publicly available meningioma dataset (708 segmented T1 contrast-enhanced slices) was also used to test the reliability of the model. RESULTS 49 meningioma cases were included. The most common meningioma location was convexity (n = 15, 30.6%). The mathematical model segmented all but one incidental meningioma, which failed due to the lack of contrast uptake. The median meningioma volume by manual segmentation was 19.0 cm3 (IQR 4.9-31.2). The median meningioma volume using the mathematical model was 16.9 cm3 (IQR 4.6-28.34). The mean DICE score was 0.90 (SD = 0.04). The mean JACCARD index was 0.82 (SD = 0.07). For the publicly available dataset, the mean DICE and JACCARD scores were 0.90 (SD = 0.06) and 0.82 (SD = 0.10), respectively. CONCLUSIONS Segmentation of meningioma volume using the proposed mathematical model was possible with accurate results. Application of this model on contrast-enhanced volumetric imaging may help reduce work burden on neuroradiologists with the increasing number in meningioma diagnoses.
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Affiliation(s)
- Liam Burrows
- Department of Mathematical Sciences and Centre for Mathematical Imaging Techniques, University of Liverpool, UK
| | - Jay Patel
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, UK
| | - Abdurrahman I Islim
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, UK
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northren Care Alliance NHS Foundation Trust, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK
| | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK
| | - Ke Chen
- Department of Mathematical Sciences and Centre for Mathematical Imaging Techniques, University of Liverpool, UK
- Department of Mathematics and Statistics, University of Strathclyde, UK
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Singh S, Lathoria K, Umdor SB, Singh J, Suri V, Sen E. A gain of function mutation in AKT1 increases hexokinase 2 and diminishes oxidative stress in meningioma. Cytokine 2024; 176:156535. [PMID: 38325141 DOI: 10.1016/j.cyto.2024.156535] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/06/2023] [Accepted: 01/27/2024] [Indexed: 02/09/2024]
Abstract
Increasing evidence suggests the oncogenic role of missense mutation (AKT1-E17K) of AKT1 gene in meningiomas. Upon investigating the connection between the pro-tumorigenic role of AKT1-E17K and cellular metabolic adaptations, elevated levels of glycolytic enzyme hexokinase 2 (HK2) was observed in meningioma patients with AKT1-E17K compared to patients harboring wild-type AKT1. In vitro experiments also suggested higher HK2 levels and its activity in AKT1-E17K cells. Treatment with the conventional drug of choice AZD5363 (a pan AKT inhibitor) enhanced cell death and diminished HK2 levels in AKT1 mutants. Given the role of AKT phosphorylation in eliciting inflammatory responses, we observed increased levels of inflammatory mediators (IL-1β, IL6, IL8, and TLR4) in AKT1-E17K cells compared to AKT1-WT cells. Treatment with AKT or HK2 inhibitors dampened the heightened levels of inflammatory markers in AKT1-E17K cells. As AKT and HK2 regulates redox homeostasis, diminished ROS generation concomitant with increased levels of NF-E2- related factor 2 (Nrf2) and superoxide dismutase 1 (SOD1) were observed in AKT1-E17K cells. Increased sensitivity of AKT1-E17K cells to AZD5363 in the presence of HK2 inhibitor Lonidamine was reversed upon treatment with ROS inhibitor NAC. By affecting metabolism, inflammation, and redox homeostasis AKT1-E17K confers a survival advantage in meningioma cells. Our findings suggest that targeting AKT-HK2 cross-talk to induce ROS-dependent cell death could be exploited as novel therapeutic approach in meningiomas.
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Affiliation(s)
- Swati Singh
- Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kirti Lathoria
- Division of Cellular and Molecular Neurosciences, National Brain Research Centre, Manesar, Haryana 122052, India
| | - Sonia B Umdor
- Division of Cellular and Molecular Neurosciences, National Brain Research Centre, Manesar, Haryana 122052, India
| | - Jyotsna Singh
- Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vaishali Suri
- Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ellora Sen
- Division of Cellular and Molecular Neurosciences, National Brain Research Centre, Manesar, Haryana 122052, India.
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Giraldi L, Heerfordt IM, Windfeld-Mathiasen J, Dalhoff KP, Andersen JT, Horwitz H. Extensive androgen exposure and meningioma risk - A matched cohort study. Clin Neurol Neurosurg 2024; 239:108217. [PMID: 38452714 DOI: 10.1016/j.clineuro.2024.108217] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Meningiomas frequently occur within the field of neuro-oncology, but it is unclear whether exogenous or imbalanced endogenous hormones are involved in the pathophysiology. A previous case-control study found an almost 20-fold increase in the risk of developing meningioma among users of androgenic anabolic steroids. We, therefore, investigated this hypothesis. METHODS We compared the incidence rate of meningioma in a cohort of males sanctioned for the use of androgenic anabolic steroids with age- and sex-matched controls with an identical enrollment date. RESULTS We followed 1189 males sanctioned for using androgenic anabolic steroids for a total of 13,305 person-years and found 0 cases of meningioma. The control cohort of 59,450 males was followed for a total of 654,938 person-years, and 16 were diagnosed with meningioma. Thus, the incidence rate ratio was 0 (95% CI: 0-12.8). CONCLUSION We did not find any evidence supporting the hypothesis of an increased risk of meningioma development with the use of androgenic anabolic steroids. Due to the limited sample size, we cannot exclude androgenic anabolic steroids as a potential risk factor for meningioma development, despite the lack of apparent evidence in this study.
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Affiliation(s)
- Laura Giraldi
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ida M Heerfordt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | | | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Horwitz
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Dokponou YCH, Djimrabeye A, Hakkou M, Oudrhiri MY, Rifi L, Boutarbouch M, Melhaoui A, Arkha Y, El Ouahabi A. Surgical Management and Outcome of the Planum Sphenoidale Meningioma: A Single-Center Strobe Compliant Study. World Neurosurg 2024; 184:e647-e658. [PMID: 38340800 DOI: 10.1016/j.wneu.2024.02.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The resection of the jugum (planum) sphenoidale meningioma (JSM) is challenging, and there is a scarcity of available data in the literature. This study aimed to describe the surgical management and long-term outcome of jugum sphenoidale meningioma. METHODS This was a retrospective, single-center, cohort study of 91 JSM patients treated in our department from 2005 to 2022. All the included patients have undergone surgical treatment. Clinical, radiologic, and surgical data were extracted with specific attention to the age at onset, family history, duration from symptoms to diagnosis, clinical presentation, quality of excision, recurrence, and treatment outcome. RESULTS WHO grade I and grade II meningioma were 83.5% (n = 76) and 16.5% (n = 15) respectively. Fronto-lateral 42.9% (n = 39) and pterional approaches 57.1% (n = 52) were the 2 major surgical approaches used for the management of planum sphenoidale meningioma. Twelve patients needed emergency surgical treatment at admission: 4 (4.4%) External CSF Shunt and 8 (8.8%) VP-Shunt. We have found a statistically significant (P = 0.032) association between the quality of excision and the risk of recurrence. The GTR (Hazard ratio = 1) of the planum meningioma protects the patient from recurrence within 60 months of follow-up. Postoperative complications encountered were CSF-Leak in 2.2%, Meningitis 4.4%, surgical site infection 2.2%, and surgical site hematoma 3.3%. The overall postoperative favorable outcome was 68.1% (n = 62). CONCLUSIONS The pterional approach has allowed the achievement of GTR for jugum sphenoidale meningioma with protective odds from recurrence risk.
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Affiliation(s)
| | - Alngar Djimrabeye
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Mehdi Hakkou
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Mohammed Yasaad Oudrhiri
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Loubna Rifi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Mahjouba Boutarbouch
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Adyl Melhaoui
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Yasser Arkha
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Abdessamad El Ouahabi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
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Demiraslan A, Çelikoğlu E, Hakan T, Hazneci J. Recurrence and Mortality Rate in a 42 Patient Cohort of Giant Meningiomas. World Neurosurg 2024:S1878-8750(24)00520-5. [PMID: 38570092 DOI: 10.1016/j.wneu.2024.03.133] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Giant meningiomas may show special features in terms of biological behavior and management. We aimed to research recurrence and mortality of giant meningiomas. METHODS Medical files of patients with meningioma with at least one dimension of ≥5 cm in any plane in radiological investigations between December 2012 and January 2022 were retrospectively reviewed. Tumor dimensions were measured on magnetic resonance images except one. All patients except two underwent clinical follow-up at a mean of 27.19 ± 29.87 (range, 4-112) months. RESULTS There were 42 patients, 26 (61.9%) women and 16 (38.1%) men who ranged in age from 31 to 85 (mean, 60.31 ± 14.86) years. Headache (57.1%) was the most common symptom. The mean tumor size was 70.14 ± 19.03 (range, 50-152) mm. Tumors were most located at the frontal convexity (40.5%). Simpson grade I resection was achieved in 19% of the cases. The tumors were World Health Organization (WHO) grade 1 in 74% and grade 2 in 26% of the cases. Major complications developed in 26.1% of the patients. Recurrence happened in 5 (11.9%) cases. The number of WHO grade 2 tumors (p = 0.013; p<0.05) and tumor size (p = 0.006; p<0.01) were significantly higher in the recurrent cases. Mortality was % 11.9 and statistically significantly higher in the recurrence group (p = 0.025; p<0.05). CONCLUSION Giant intracranial meningiomas are challenging because of surgical experience, tumor size, peritumoral edema, blood supply, anatomical changes, and limited visibility. They have a high risk of recurrence and mortality.
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Affiliation(s)
- Ali Demiraslan
- Şehit Kamil State Hospital, Neurosurgery Clinic, Neurosurgery Clinic, Şehitkamil, Gaziantep, Turkey
| | - Erhan Çelikoğlu
- Department of Neurosurgery, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey; Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Tayfun Hakan
- Department of Neurosurgery, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey; Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
| | - Jülide Hazneci
- Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
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22
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Knapp J, Babu H, Benjamin S, Shapiro A. Hepatocellular carcinoma metastatic to the pituitary gland without an identifiable primary lesion. Radiol Case Rep 2024; 19:1263-1267. [PMID: 38292788 PMCID: PMC10825538 DOI: 10.1016/j.radcr.2023.12.030] [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: 09/20/2023] [Revised: 12/02/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024] Open
Abstract
Hepatocellular carcinoma is one of the most common malignancies worldwide. However, brain metastases from this cancer are incredibly rare. While the hepatocellular carcinoma mortality rate in the United States has been increasing, hepatocellular carcinoma is rare among patients without underlying liver disease. Here we present a patient with a history of left optic nerve meningioma treated with stereotactic radiosurgery who presented with acute vision loss. Magnetic resonance imaging revealed an enhancing mass lesion in the region of the sella turcica. Neurosurgical histopathology revealed a metastatic lesion consistent with hepatocellular carcinoma. Systemic workup failed to identify a primary liver lesion.
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Affiliation(s)
- Jacquelyn Knapp
- Department of Radiation Oncology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Harish Babu
- Department of Neurosurgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Sam Benjamin
- Department of Medical Oncology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Anna Shapiro
- Department of Radiation Oncology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
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Duan C, Hao D, Cui J, Wang G, Xu W, Li N, Liu X. An MRI-Based Deep Transfer Learning Radiomics Nomogram to Predict Ki-67 Proliferation Index of Meningioma. J Imaging Inform Med 2024; 37:510-519. [PMID: 38343220 PMCID: PMC11031553 DOI: 10.1007/s10278-023-00937-3] [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] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 04/20/2024]
Abstract
The objective of this study was to predict Ki-67 proliferation index of meningioma by using a nomogram based on clinical, radiomics, and deep transfer learning (DTL) features. A total of 318 cases were enrolled in the study. The clinical, radiomics, and DTL features were selected to construct models. The calculation of radiomics and DTL score was completed by using selected features and correlation coefficient. The deep transfer learning radiomics (DTLR) nomogram was constructed by selected clinical features, radiomics score, and DTL score. The area under the receiver operator characteristic curve (AUC) was calculated. The models were compared by Delong test of AUCs and decision curve analysis (DCA). The features of sex, size, and peritumoral edema were selected to construct clinical model. Seven radiomics features and 15 DTL features were selected. The AUCs of clinical, radiomics, DTL model, and DTLR nomogram were 0.746, 0.75, 0.717, and 0.779 respectively. DTLR nomogram had the highest AUC of 0.779 (95% CI 0.6643-0.8943) with an accuracy rate of 0.734, a sensitivity value of 0.719, and a specificity value of 0.75 in test set. There was no significant difference in AUCs among four models in Delong test. The DTLR nomogram had a larger net benefit than other models across all the threshold probability. The DTLR nomogram had a satisfactory performance in Ki-67 prediction and could be a new evaluation method of meningioma which would be useful in the clinical decision-making.
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Affiliation(s)
- Chongfeng Duan
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16, Jiang Su Road, Shinan District, Qingdao City, Shandong Province, China
| | - Dapeng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16, Jiang Su Road, Shinan District, Qingdao City, Shandong Province, China
| | - Jiufa Cui
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16, Jiang Su Road, Shinan District, Qingdao City, Shandong Province, China
| | - Gang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16, Jiang Su Road, Shinan District, Qingdao City, Shandong Province, China
| | - Wenjian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16, Jiang Su Road, Shinan District, Qingdao City, Shandong Province, China
| | - Nan Li
- Department of Information Management, The Affiliated Hospital of Qingdao University, No. 16, Jiang Su Road, Shinan District, Qingdao City, Shandong Province, China
| | - Xuejun Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16, Jiang Su Road, Shinan District, Qingdao City, Shandong Province, China.
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Iwata T, Hirayama R, Yamada S, Kijima N, Okita Y, Kagawa N, Kishima H. Automated volumetry of meningiomas in contrast-enhanced T1-Weighted MRI using deep learning. World Neurosurg X 2024; 22:100353. [PMID: 38455247 PMCID: PMC10918322 DOI: 10.1016/j.wnsx.2024.100353] [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: 04/25/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Meningiomas are among the most common intracranial tumors. In these tumors, volumetric assessment is not only important for planning therapeutic intervention but also for follow-up examination.However, a highly accurate automated volumetric method for meningiomas using single-modality magnetic resonance imaging (MRI) has not yet been reported. Here, we aimed to develop a deep learning-based automated volumetry method for meningiomas in MRI and investigate its accuracy and potential clinical applications. METHODS For deep learning, we used MRI images of patients with meningioma who were referred to Osaka University Hospital between January 2007 and October 2020. Imaging data of eligible patients were divided into three non-overlapping groups: training, validation, and testing. The model was trained and tested using the leave-oneout cross-validation method. Dice index (DI) and root mean squared percentage error (RMSPE) were measured to evaluate the model accuracy. Result: A total of 178 patients (64.6 ± 12.3 years [standard deviation]; 147 women) were evaluated. Comparison of the deep learning model and manual segmentation revealed a mean DI of 0.923 ± 0.051 for tumor lesions. For total tumor volume, RMSPE was 9.5 ± 1.2%, and Mann-Whitney U test did not show a significant difference between manual and algorithm-based measurement of the tumor volume (p = 0.96). CONCLUSION The automatic tumor volumetry algorithm developed in this study provides a potential volume-based imaging biomarker for tumor evaluation in the field of neuroradiological imaging, which will contribute to the optimization and personalization of treatment for central nervous system tumors in the near future.
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Affiliation(s)
- Takamitsu Iwata
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryuichi Hirayama
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shuhei Yamada
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Kijima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiko Okita
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Ge H, Yan Z, Chen J, Liu Y. Surgically resected brain tumors from 2015 to 2020. Asian J Surg 2024; 47:2019-2020. [PMID: 38220532 DOI: 10.1016/j.asjsur.2023.11.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Honglin Ge
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zheng Yan
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiu Chen
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yong Liu
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Zhao Z, Nie C, Zhao L, Xiao D, Zheng J, Zhang H, Yan P, Jiang X, Zhao H. Multi-parametric MRI-based machine learning model for prediction of WHO grading in patients with meningiomas. Eur Radiol 2024; 34:2468-2479. [PMID: 37812296 PMCID: PMC10957672 DOI: 10.1007/s00330-023-10252-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The purpose of this study was to develop and validate a nomogram combined multiparametric MRI and clinical indicators for identifying the WHO grade of meningioma. MATERIALS AND METHODS Five hundred and sixty-eight patients were included in this study, who were diagnosed pathologically as having meningiomas. Firstly, radiomics features were extracted from CE-T1, T2, and 1-cm-thick tumor-to-brain interface (BTI) images. Then, difference analysis and the least absolute shrinkage and selection operator were orderly used to select the most representative features. Next, the support vector machine algorithm was conducted to predict the WHO grade of meningioma. Furthermore, a nomogram incorporated radiomics features and valuable clinical indicators was constructed by logistic regression. The performance of the nomogram was assessed by calibration and clinical effectiveness, as well as internal validation. RESULTS Peritumoral edema volume and gender are independent risk factors for predicting meningioma grade. The multiparametric MRI features incorporating CE-T1, T2, and BTI features showed the higher performance for prediction of meningioma grade with a pooled AUC = 0.885 (95% CI, 0.821-0.946) and 0.860 (95% CI, 0.788-0.923) in the training and test groups, respectively. Then, a nomogram with a pooled AUC = 0.912 (95% CI, 0.876-0.961), combined radiomics score, peritumoral edema volume, and gender improved diagnostic performance compared to radiomics model or clinical model and showed good calibration as the true results. Moreover, decision curve analysis demonstrated satisfactory clinical effectiveness of the proposed nomogram. CONCLUSIONS A novel nomogram is simple yet effective in differentiating WHO grades of meningioma and thus can be used in patients with meningiomas. CLINICAL RELEVANCE STATEMENT We proposed a nomogram that included clinical indicators and multi-parameter radiomics features, which can accurately, objectively, and non-invasively differentiate WHO grading of meningioma and thus can be used in clinical work. KEY POINTS • The study combined radiomics features and clinical indicators for objectively predicting the meningioma grade. • The model with CE-T1 + T2 + brain-to-tumor interface features demonstrated the best predictive performance by investigating seven different radiomics models. • The nomogram potentially has clinical applications in distinguishing high-grade and low-grade meningiomas.
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Affiliation(s)
- Zhen Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuansheng Nie
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhao
- International Education College of Henan University, Kaifeng, China
| | - Dongdong Xiao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianglin Zheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Zhang
- Department of Geriatric Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengfei Yan
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Hongyang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Hamamoto R, Kawasaki T, Oda M, Sumiyoshi S, Hayashi K, Kobayashi T, Ioroi Y, Uchiyama T, Takayama M, Saiki M. Primary extranodal marginal zone mucosa-associated lymphoid tissue-type B-cell lymphoma involving the dura: A case report. Surg Neurol Int 2024; 15:113. [PMID: 38628522 PMCID: PMC11021089 DOI: 10.25259/sni_792_2023] [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: 09/22/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
Background Primary extranodal marginal zone mucosa-associated lymphoid tissue-type B-cell lymphoma (EMZMBCL), which presents as a dural mass, is a rare intracranial tumor that mimics a subdural hematoma or meningioma. Case Description A 49-year-old woman presented to our hospital with transient right upper limb paresis, dysarthria for 10 min, and ongoing right upper-limb numbness. Computed tomography (CT) of the head revealed extra-axial lesions in the left frontal and parietal lobes. Based on the initial CT findings in the emergency room, an acute subdural hematoma was suspected. However, meningiomas and other intracranial tumors were also listed as differential diagnoses because there was no history of head trauma or coagulation abnormalities on blood examination, and further imaging studies were performed. Imaging findings suggested a subdural neoplastic lesion. A partial resection was performed for the lesion. Based on histopathological and immunohistochemical examinations, the patient was diagnosed with EMZMBCL. Whole-brain and intensity-modulated radiation therapies were administered as adjuvant therapies. The patient was discharged without neurological deficits. Conclusion EMZMBCL is a rare disease that should be considered in the differential diagnosis of subdural lesions, especially when there is no history of trauma or abnormalities in the coagulation system. The patient had a favorable outcome after selecting radiotherapy as the adjuvant therapy.
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Affiliation(s)
- Ryo Hamamoto
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Toshinari Kawasaki
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masashi Oda
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Sosuke Sumiyoshi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Kosuke Hayashi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Tamaki Kobayashi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yoshihiko Ioroi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Tatsuki Uchiyama
- Department of Hematology Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Motohiro Takayama
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaaki Saiki
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
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Ye Y, Xu L, Zhang L, Zhao P, Cai W, Fu G, Wang T, Tao Z, Shi W, Gu W, Hu J, Yuan G, Wei Y, Xu K, Bao Z, Chao H, Liu N, Zhao L, Tu Y, Ji J. Meningioma achieves malignancy and erastin-induced ferroptosis resistance through FOXM1-AURKA-NRF2 axis. Redox Biol 2024; 72:103137. [PMID: 38642502 DOI: 10.1016/j.redox.2024.103137] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024] Open
Abstract
The oncogene Aurora kinase A (AURKA) has been implicated in various tumor, yet its role in meningioma remains unexplored. Recent studies have suggested a potential link between AURKA and ferroptosis, although the underlying mechanisms are unclear. This study presented evidence of AURKA upregulation in high grade meningioma and its ability to enhance malignant characteristics. We identified AURKA as a suppressor of erastin-induced ferroptosis in meningioma. Mechanistically, AURKA directly interacted with and phosphorylated kelch-like ECH-associated protein 1 (KEAP1), thereby activating nuclear factor erythroid 2 related factor 2 (NFE2L2/NRF2) and target genes transcription. Additionally, forkhead box protein M1 (FOXM1) facilitated the transcription of AURKA. Suppression of AURKA, in conjunction with erastin, yields significant enhancements in the prognosis of a murine model of meningioma. Our study elucidates an unidentified mechanism by which AURKA governs ferroptosis, and strongly suggests that the combination of AURKA inhibition and ferroptosis-inducing agents could potentially provide therapeutic benefits for meningioma treatment.
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Affiliation(s)
- Yangfan Ye
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Lei Xu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Liuchao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Pengzhan Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Wanzhi Cai
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Guoqiang Fu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Tian Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Zeqiang Tao
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Wenqian Shi
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Wei Gu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Jingming Hu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Guangyao Yuan
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yutian Wei
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ke Xu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Zhongyuan Bao
- Department of Neurosurgery, Jiangnan University Medical Center, Wuxi, China
| | - Honglu Chao
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Ning Liu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Lin Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Yiming Tu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Jing Ji
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China; Institute for Brain Tumors, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China; Gusu School, Nanjing Medical University, Suzhou, China; Department of Neurosurgery, The Affiliated Kizilsu Kirghiz Autonomous Prefecture People's Hospital of Nanjing Medical University, Artux, Xinjiang, China.
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Wada H, Shimauchi-Ohtaki H, Tosaka M, Kawashima T, Osawa T, Osawa S, Horiguchi K, Nakata S, Yoshimoto Y. Comparison of Early Postoperative Diffusion Weighted Magnetic Resonance Imaging Findings After Resection of Gliomas and Meningiomas. World Neurosurg 2024:S1878-8750(24)00512-6. [PMID: 38548056 DOI: 10.1016/j.wneu.2024.03.126] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Glioma and meningioma require vastly different surgical approaches, even if only involving a simple craniotomy procedure. Diffusion weighted imaging (DWI) is useful for the postoperative evaluation of ischemic damage. The present study evaluated the expected but unproven differences in DWI findings. METHODS A total of 41 patients with meningiomas and 63 with gliomas met the inclusion criteria for adult cases with superficial lesions treated through simple supratentorial craniotomy. Postoperative DWI findings of DWI-positive rate, DWI-positive area type, and relationship with neurological deficits were evaluated. RESULTS The DWI-positive rate (P = 0.01) and the proportion of rim-type lesions (P < 0.01) were significantly more common in gliomas. Patients with meningiomas and DWI-positive areas presented with higher rates of new neurological deficits (P < 0.01), and patients with meningiomas on the left side were more likely to develop new neurological deficits (P = 0.02). Patients with gliomas tended to develop new deficits with larger DWI-positive area volumes (P = 0.04). CONCLUSIONS Postoperative early DWI-positive rate and rim-type lesions are more common after glioma resection than meningioma resection. Larger volumes of DWI-positive areas may be associated with postoperative neurological symptoms in gliomas. DWI-positive finding is less common after meningioma than glioma resection but more likely to be associated with new neurological symptoms. These differences are important for adequate postoperative DWI evaluation of common supratentorial brain tumors.
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Affiliation(s)
- Hajime Wada
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroya Shimauchi-Ohtaki
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Masahiko Tosaka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takahiro Kawashima
- Department of Neurosurgery, Tatebayashi Kosei General Hospital, Tatebayashi, Gunma, Japan
| | - Tadashi Osawa
- Department of Neurosurgery, Hidaka Hospital, Takasaki, Gunma, Japan
| | - Sho Osawa
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Keishi Horiguchi
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Satoshi Nakata
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Mastronardi L, Campione A, Alomari AA. Posterior cranial fossa meningiomas: Comparison of results between patients older and younger than 70 years. Brain Spine 2024; 4:102790. [PMID: 38584865 PMCID: PMC10995794 DOI: 10.1016/j.bas.2024.102790] [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] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
Introduction Surgical strategy for meningioma resection in the elderly is controversial: diverse studies in the literature have pointed at the age as a negative prognostic factor in terms of postoperative results. Research question The aim of this study is to compare surgical outcomes after resection of posterior fossa meningiomas in <70 and ≥ 70 years-old age groups. Material and methods We reviewed 72 patients affected by posterior fossa meningiomas who underwent surgical treatment at San Filippo Neri Hospital, Rome, Italy between September 2010 and December 2022. We analyzed data regarding tumor size, clinical presentation, extent of resection and complication/mortality. Results The groups consisted of 52 (72,2%) young and 20 (27,8%) elderly patients. Gross total resection rate was significantly higher among youngsters (p = 0,013), mainly for planned subtotal removal in older patients. At 3-month follow-up, clinical improvement was seen in 19 (36,5%) young and 7 (35,0%) elderly patients, which raised at last follow-up, being 84,6% (44) and 80,0% (16), respectively (p = 0,406). Two cases of progression/recurrence among the elderly and 1 among youngsters were observed; one case of mortality among the elderly was reported. Discussion and conclusions Safety data regarding postoperative complications and mortality in our series seem to confirm that there is no significant difference between older and younger patients, as long as older patients are carefully selected. Therefore, if surgery is proposed, it should be radical if gross total resection could be safely attempted.
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Affiliation(s)
| | - Alberto Campione
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy
| | - Amer Ahmad Alomari
- Department of Neurosurgery, San Filippo Neri Hospital/ASLRoma1, Rome, Italy
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Watanabe S, Nonaka T, Maeda M, Yamada M, Sugii N, Hashimoto K, Takano S, Koyanagi T, Arakawa Y, Ishikawa E. Recent Status of Phase I Clinical Trials for Brain Tumors: A Regulatory Science Study of Exploratory Efficacy Endpoints. Ther Innov Regul Sci 2024:10.1007/s43441-024-00644-3. [PMID: 38530629 DOI: 10.1007/s43441-024-00644-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Appropriate exploratory efficacy data from Phase I trials are vital for subsequent phases. Owing to the uniqueness of brain tumors (BTs), use of different strategies to evaluate efficacy is warranted. We studied exploratory efficacy evaluation in Phase I trials involving BTs. METHODS Using Clarivate's Cortellis™, 42 Phase I trials of BT interventions conducted from 2020 to 2022 were analyzed for efficacy endpoints, which were set as primary endpoints (PEs) or secondary endpoints (SEs). Additionally, these metrics were compared in two subgroups: trials including only BTs (Group-A) and those including BTs among mixed solid tumors (Group-B). RESULTS Selected studies included a median of 1.5 PEs (range, 1-6) and 5 SEs (range, 0-19). Efficacy endpoints were included as PEs and SEs in 2 (5%) and 31 (78%) trials, respectively. Among the latter 31 trials that included 94 efficacy endpoints, 24, 22, 20, 9, and 8 reflected overall response rate (ORR), progression-free survival (PFS), overall survival (OS), duration of response (DOR), and disease control rate (DCR), respectively. ORR for BT was determined using various methods; however, the Response Evaluation Criteria in Solid Tumors (RECIST) was used less frequently in Group-A than in Group-B (p = 0.0039). CONCLUSIONS Recent Phase I trials included efficacy endpoints as SEs, with ORR, PFS, or OS included in ~ 50% trials and DOR or DCR in ~ 25%. No established criteria exist for imaging evaluation of BTs. Phase I trials involving mixed solid tumor cohorts revealed challenges in designing methods to assess the exploratory efficacy of BTs.
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Affiliation(s)
- Shinya Watanabe
- Department of Neurosurgery, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, 3-2-7 Miyamachi, Mito, 310-0015, Ibaraki, Japan.
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Takahiro Nonaka
- Department of Health and Medical Innovation, Graduate School of Medicine, Osaka Metropolitan University School, Osaka, Japan
| | - Makoto Maeda
- Department of, Pharmacy, National Cancer Center Hospital, Tokyo, Japan
| | - Masanobu Yamada
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan
| | - Narushi Sugii
- Department of Neurosurgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Koichi Hashimoto
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan
| | - Shingo Takano
- Department of Neurosurgery, University of Tsukuba Hospital, Tsukuba, Japan
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan
| | - Tomoyoshi Koyanagi
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan
| | - Yoshihiro Arakawa
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Watanabe G, Young K, Rauber E, Khan MF, Suzuki R, Riestenberg R, Umana GE, Palmisciano P. A systematic review of extraneural meningioma metastasis: timing, evolution and outlook. J Neurooncol 2024:10.1007/s11060-024-04659-6. [PMID: 38530549 DOI: 10.1007/s11060-024-04659-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Extraneural meningioma metastasis is a rare occurrence and may pose a clinical challenge due to its unclear prognosis. In this systematic review, we analyze patient demographics, clinical characteristics, management strategies, and outcomes. METHODS PubMed, EMBASE, Scopus, Cochrane, and Web of Science databases were searched from inception to February 23, 2024 for cases of metastatic meningioma according to PRISMA guidelines. Descriptive statistics, Mann-Whitney U test, Fisher's exact tests, Kaplan-Meier curves, and log-rank tests were used for selected analyses. RESULTS A total of 288 patients (52% male) were included with an average age of 49 years at meningioma diagnosis. Tumors were distributed across WHO grade 1 (38%), 2 (36%), and 3 (26%). Most patients experienced intracranial recurrence (79%) and mean time to first metastasis was approximately 8 years. No change in WHO grade between primary and metastasis was observed for most cases (65%). Treatment of the initial metastasis was most often with surgery (43%), chemotherapy (20%), or no treatment (14%). Half of the patients were alive (50%) with an average follow-up of 3 years following metastasis. Overall median survival was 36 months for the entire cohort. This differed significantly between WHO grade 1 versus 2/3 meningioma primaries (168 vs. 15 months, p < 0.005). CONCLUSION Metastatic meningioma appears to be associated with more positive prognosis than other brain tumor types with extra-neural metastasis or metastasis in general. This is particularly true for cases arising from a WHO grade 1 meningioma.
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Affiliation(s)
- Gina Watanabe
- John A. Burns School of Medicine, University of Hawaii at Manoa, 5080 Likini St #417, Honolulu, HI, 96818, USA.
| | - Kurtis Young
- Department of Otolaryngology, University of Nevada, Las Vegas, NV, USA
| | - Erin Rauber
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | | | - Reannon Suzuki
- John A. Burns School of Medicine, University of Hawaii at Manoa, 5080 Likini St #417, Honolulu, HI, 96818, USA
| | - Robert Riestenberg
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
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Trevisi G, Giovanni P, Ciaffi G, Auricchio AM, Sturiale CL. Venous Sinus Thrombosis-Associated with Posterior Cranial Fossa Surgery. A Systematic Review and Meta-Analysis of Natural History, Risk Factors, Treatment, and Outcome. World Neurosurg 2024; 186:122-132. [PMID: 38531470 DOI: 10.1016/j.wneu.2024.03.087] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Venous sinus thromboses (VSTs) are rare complications of neurosurgical procedures in the proximity of the dural sinuses. Surgery of the posterior cranial fossa (PCF) and particularly of the cerebellopontine angle (CPA) shows increased risk of VST. VST management is challenging because anticoagulant therapy must be balanced with the risk of postoperative bleeding. We performed a systematic review and meta-analysis to summarize the most important neuroradiologic and clinical aspects of VST after PCF/CPA surgery. METHODS We performed a comprehensive literature search to identify articles reporting data on VST after PCF/CPA surgery. We selected only comparative studies providing adequate neuroimaging assessing VST and a control group. RESULTS We included 13 articles reporting 1855 patients. VST occurred in 251/1855 cases (estimated incidence, 17.3%; 95% confidence interval [CI], 12.4%-22.2%). Only presigmoid approach (odds ratio [OR], 2.505; 95% CI, 1.161-5.404; P = 0.019) and intraoperative sinus injury (OR, 8.95; 95% CI, 3.43-23.34; P < 0.001) showed a significant association with VST. VST-related symptoms were reported in 12/251 patients with VST (pooled incidence, 3.1%; 95% CI, 1%-5.2%). In particular, we found a significantly increased OR of cerebrospinal fluid leak (OR, 3.197; 95% CI, 1.899-5.382; P < 0.001) and cerebrospinal fluid dynamic alterations in general (OR, 3.625; 95% CI, 2.370-5.543; P < 0.001). Indications for VST treatment were heterogeneous: 58/251 patients underwent antithrombotics, with 6 treatment-related bleedings. Recanalization overall occurred in 56.4% (95% CI, 40.6%-72.2%), with no significant difference between treated and untreated patients. However, untreated patients had a favorable outcome. CONCLUSIONS VST is a relatively frequent complication after PCF/CPA surgery and a presigmoid approach and intraoperative sinus injury represent the most significant risk factors. However, the clinical course is generally benign, with no advantage of antithrombotic therapy.
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Affiliation(s)
- Gianluca Trevisi
- Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Pennisi Giovanni
- Fondazione Policlinico Universitario A, GemelliIRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Ciaffi
- Fondazione Policlinico Universitario A, GemelliIRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Maria Auricchio
- Fondazione Policlinico Universitario A, GemelliIRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Lucio Sturiale
- Fondazione Policlinico Universitario A, GemelliIRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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Villalobos-Diaz R, Marian-Magaña R, Sangrador-Deitos MV, Vazquez-Gregorio R, Rodriguez-Hernandez LA, Lopez-Valencia G, Aragon-Arreola JF, Lara-Olivas JA, Guinto-Nishimura GY, Eguiluz-Melendez AG, Gomez-Amador JL. Surgical treatment of pituitary neuroendocrine tumors with coexisting intracranial lesions: A case series and review of the literature. Surg Neurol Int 2024; 15:96. [PMID: 38628542 PMCID: PMC11021101 DOI: 10.25259/sni_22_2024] [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: 01/08/2024] [Accepted: 02/13/2024] [Indexed: 04/19/2024] Open
Abstract
Background Pituitary neuroendocrine tumors (PitNETs) are a diverse group of benign neoplasms that account for a significant proportion of intracranial tumors (13%). The coexistence of PitNET with other intracranial lesions, such as meningiomas and intracranial aneurysms, has been constantly reported in the literature; yet, the pathophysiological mechanisms remain unknown, and the appropriate management is controversial. This study aims to describe the clinical characteristics, surgical treatment, and outcomes of patients with PitNET with coexisting intracranial lesions in a single healthcare center. Methods A retrospective analysis was conducted on 12 patients who underwent surgical treatment for PitNET and another intracranial lesion at our single tertiary referral center over 15 years from January 2008 to May 2023. Results Among these coexisting lesions, aneurysms were the most commonly found (41.67%), followed by meningiomas (33.33%). Surgical intervention for both lesions was performed in a single-stage procedure for most cases (75%), employing transcranial, endoscopic endonasal, and combined approaches. We found low preoperative Karnofsky Performance Scale scores in three patients, with significant differences in functional outcomes. Conclusion These findings contribute to the limited knowledge about PitNET coexisting with other intracranial lesions and emphasize the importance of patient-tailored, multidisciplinary management in these unusual scenarios.
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Affiliation(s)
- Rodolfo Villalobos-Diaz
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Ricardo Marian-Magaña
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Rafael Vazquez-Gregorio
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - German Lopez-Valencia
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | - Aldo Gabriel Eguiluz-Melendez
- Department of Neurosurgery, Salvador Zubirán National Institute of Health Sciences and Nutrition, Mexico City, Mexico
| | - Juan Luis Gomez-Amador
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Huang Y, Wu Z, Peng Z, Liu A, Yuan W, Han D, Peng J. Hsa_circ_0004872 alleviates meningioma progression by sponging miR-190a-3p/PTEN signaling. BMC Cancer 2024; 24:345. [PMID: 38500077 PMCID: PMC10949562 DOI: 10.1186/s12885-024-12084-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Meningioma, the most prevalent intracranial tumor, possesses a significant propensity for malignant transformation. Circular RNAs (circ-RNAs), a class of non-coding RNAs, have emerged as crucial players in tumorigenesis. This study explores the functional relevance of hsa_circ_0004872, a specific circ-RNA, in the context of meningioma. METHODS Molecular structure and stability of hsa_circ_0004872 were elucidated through PCR identification. Meningioma cell proliferation and apoptosis were assessed using the CCK-8 assay and flow cytometry, respectively. Gene and protein expression were analyzed via qRT-PCR and western blot. Molecular interactions were confirmed through dual-luciferase reporter gene and RIP assays. RESULTS Hsa_circ_0004872, derived from exons 2 to 4 of the host gene MAPK1, demonstrated enhanced stability compared to its host MAPK1. Clinical data described that hsa_circ_0004872 was reduced in meningioma tissues and cell lines, and negatively correlated to poor survival rate of meningioma patients. Overexpression of hsa_circ_0004872 exhibited inhibitory effects on cell proliferation and promotion of apoptosis in vitro. Subsequent investigations unveiled a direct interaction between hsa_circ_0004872 and miR-190a-3p, leading to the activation of the PI3K/AKT signaling pathway through targeting PTEN. Notably, miR-190a-3p silence accelerated the apoptosis and proliferation inhibition of meningioma cells by inactivating PTEN/PI3K/AKT signaling, while miR-190a-3p overexpression showed an opposite effect, which greatly reversed the anti-tumor effects of hsa_circ_0004872 overexpression. CONCLUSION In summary, our findings highlighted the intricate role of hsa_circ_0004872 in meningioma, shedding light on the regulatory mechanisms involving circ-RNAs in tumor progression. This positions hsa_circ_0004872 as a potential key regulatory factor in meningioma with implications for future therapeutic interventions.
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Affiliation(s)
- Yongkai Huang
- Neurosurgery Department, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, 412000, Zhuzhou, Hunan Province, China
| | - Zhihui Wu
- Surgery Department, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, 412000, Zhuzhou, Hunan Province, China
| | - Zewei Peng
- Neurosurgery Department, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, 412000, Zhuzhou, Hunan Province, China
| | - Anmin Liu
- Emergency Department, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, 412000, Zhuzhou, Hunan Province, China
| | - Wen Yuan
- Neurosurgery Department, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, 412000, Zhuzhou, Hunan Province, China
| | - Deqing Han
- Neurosurgery Department, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, 412000, Zhuzhou, Hunan Province, China
| | - Junmin Peng
- Department of Anesthesiology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, 412000, Zhuzhou, Hunan Province, China.
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Szulzewsky F, Thirimanne HN, Holland EC. Meningioma: current updates on genetics, classification, and mouse modeling. Ups J Med Sci 2024; 129:10579. [PMID: 38571886 PMCID: PMC10989216 DOI: 10.48101/ujms.v129.10579] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024] Open
Abstract
Meningiomas, the most common primary brain tumors in adults, are often benign and curable by surgical resection. However, a subset is of higher grade, shows aggressive growth behavior as well as brain invasion, and often recurs even after several rounds of surgery. Increasing evidence suggests that tumor classification and grading primarily based on histopathology do not always accurately predict tumor aggressiveness and recurrence behavior. The underlying biology of aggressive treatment-resistant meningiomas and the impact of specific genetic aberrations present in these high-grade tumors is still only insufficiently understood. Therefore, an in-depth research into the biology of this tumor type is warranted. More recent studies based on large-scale molecular data such as whole exome/genome sequencing, DNA methylation sequencing, and RNA sequencing have provided new insights into the biology of meningiomas and have revealed new risk factors and prognostic subtypes. The most common genetic aberration in meningiomas is functional loss of NF2 and occurs in both low- and high-grade meningiomas, whereas NF2-wildtype meningiomas are enriched for recurrent mutations in TRAF7, KLF4, AKT1, PI3KCA, and SMO and are more frequently benign. Most meningioma mouse models are based on patient-derived xenografts and only recently have new genetically engineered mouse models of meningioma been developed that will aid in the systematic evaluation of specific mutations found in meningioma and their impact on tumor behavior. In this article, we review recent advances in the understanding of meningioma biology and classification and highlight the most common genetic mutations, as well as discuss new genetically engineered mouse models of meningioma.
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Affiliation(s)
- Frank Szulzewsky
- Human Biology Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Eric C. Holland
- Human Biology Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Seattle Translational Tumor Research Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
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Han T, Liu X, Zhou J. Progression/Recurrence of Meningioma: An Imaging Review Based on Magnetic Resonance Imaging. World Neurosurg 2024; 186:98-107. [PMID: 38499241 DOI: 10.1016/j.wneu.2024.03.051] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Meningiomas are the most common primary central nervous system tumors. The preferred treatment is maximum safe resection, and the heterogeneity of meningiomas results in a variable prognosis. Progression/recurrence (P/R) can occur at any grade of meningioma and is a common adverse outcome after surgical treatment and a major cause of postoperative rehospitalization, secondary surgery, and mortality. Early prediction of P/R plays an important role in postoperative management, further adjuvant therapy, and follow-up of patients. Therefore, it is essential to thoroughly analyze the heterogeneity of meningiomas and predict postoperative P/R with the aid of noninvasive preoperative imaging. In recent years, the development of advanced magnetic resonance imaging technology and machine learning has provided new insights into noninvasive preoperative prediction of meningioma P/R, which helps to achieve accurate prediction of meningioma P/R. This narrative review summarizes the current research on conventional magnetic resonance imaging, functional magnetic resonance imaging, and machine learning in predicting meningioma P/R. We further explore the significance of tumor microenvironment in meningioma P/R, linking imaging features with tumor microenvironment to comprehensively reveal tumor heterogeneity and provide new ideas for future research.
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Affiliation(s)
- Tao Han
- Department of Radiology, Lanzhou University Second Hospita, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Xianwang Liu
- Department of Radiology, Lanzhou University Second Hospita, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospita, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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Che WQ, Wang YJ, Yang L, Wang HQ, Wang XY, Lyu J. Single-cell transcriptome analysis upon ECM-remodeling meningioma cells. Neurosurg Rev 2024; 47:118. [PMID: 38491247 DOI: 10.1007/s10143-024-02349-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/25/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
Meningiomas are the most common tumours that primarily arise in the central nervous system, but their intratumoural heterogeneity has not yet been thoroughly studied. We aimed to investigate the transcriptome characteristics and biological properties of ECM-remodeling meningioma cells. Single-cell RNA sequencing (ScRNA-seq) data from meningioma samples were acquired and used for analyses. We conducted comprehensive bioinformatics analyses, including screening for differentially expressed genes (DEGs), Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway and Gene Ontology (GO) term enrichment analyses, Gene Set Enrichment Analysis (GSEA), protein-protein interaction (PPI) analysis, and copy number variation (CNV) analysis on single-cell sequencing data from meningiomas. Eighteen cell types, including six meningioma subtypes, were identified in the data. ECM-remodeling meningioma cells (MGCs) were mainly distributed in brain-tumour interface tissues. KEGG and GO enrichment analyses revealed that 908 DEGs were mainly related to cell adhesion, extracellular matrix organization, and ECM-receptor interaction. GSEA analysis demonstrated that homophilic cell adhesion via plasma membrane adhesion molecules was significantly enriched (NES = 2.375, P < 0.001). CNV analysis suggested that ECM-remodeling MGCs showed considerably lower average CNV scores. ECM-remodeling MGCs predominantly localized at the brain-tumour interface area and adhere stably to the basement membrane with a lower degree of malignancy. This study provides novel insights into the malignancy of meningiomas.
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Affiliation(s)
- Wen-Qiang Che
- Department of Neurosurgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu-Jiao Wang
- Department of Pathology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Liu Yang
- Department of Neurosurgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hong-Qin Wang
- Department of Neurosurgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Xiang-Yu Wang
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Jun Lyu
- Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, 510632, China.
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Du Q, Ma XL, Dong SB, Zhao HF. Solitary fibrous tumor of frontal region masquerading as meningioma: Report of a rare case. Asian J Surg 2024:S1015-9584(24)00477-9. [PMID: 38493035 DOI: 10.1016/j.asjsur.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/01/2024] [Indexed: 03/18/2024] Open
Affiliation(s)
- Qian Du
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Heping Xi Road, Shijiazhuang, 050000, Hebei Province, China.
| | - Xiao-Li Ma
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Heping Xi Road, Shijiazhuang, 050000, Hebei Province, China.
| | - Shi-Bo Dong
- Department of Imaging, Hebei General Hospital, Shijiazhuang, Heping Xi Road, Shijiazhuang, 050000, Hebei Province, China.
| | - Huan-Fen Zhao
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Heping Xi Road, Shijiazhuang, 050000, Hebei Province, China.
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40
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Keister A, Wu KC, Finger G, Prevedello D. Endoscopic endonasal decompression of the optic nerve in the setting of compressive lesions: how I do it. Acta Neurochir (Wien) 2024; 166:129. [PMID: 38467944 DOI: 10.1007/s00701-024-05994-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/07/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Many lesions in the anterior skull base may compress the optic nerve (ON), leading to vision loss, and even irreversible blindness. Although decompression of the optic nerve has traditionally been achieved transcranially, the endoscopic endonasal approach (EEA) is gaining traction as a minimally invasive approach recently. METHOD We describe the key steps of an EEA ON decompression. The relevant surgical anatomy with illustration is described. Additionally, a video detailing our technique and instruments on an illustrative case is provided. CONCLUSION Endoscopic endonasal approach ON decompression with a straight feather blade is a feasible, minimally invasive procedure to decompress the ON in the setting of anterior skull base mass lesions.
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Affiliation(s)
- Alexander Keister
- The Ohio State University College of Medicine, Columbus, OH, USA.
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Kyle C Wu
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Guilherme Finger
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel Prevedello
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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Rusidi HA, Rosyidi RM, Wardhana DPW, Baskoro W, Ramadhana GA. The role of preoperative hematological inflammatory markers as a predictor of meningioma grade: A systematic review and meta-analysis. Surg Neurol Int 2024; 15:77. [PMID: 38628519 PMCID: PMC11021116 DOI: 10.25259/sni_849_2023] [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: 10/19/2023] [Accepted: 02/09/2024] [Indexed: 04/19/2024] Open
Abstract
Background Inflammatory processes play an important role in the aggressiveness of a tumor. However, the relationship between inflammatory markers in meningioma grade is not well known. Knowledge of preoperative meningioma grade plays an important role in the prognosis and treatment of this tumor. This study aims to assess preoperative hematological inflammatory markers as a predictor of the pathological grade of meningioma. Methods To ensure comprehensive retrieval of relevant studies, we searched the following key databases, PubMed, Science Direct, and Biomed Central, with evidence related to preoperative hematological inflammatory markers among meningioma up to September 2023. The studies involved were selected based on established eligibility criteria. The analysis in this study uses Review Manager 5.4. Results Six studies were obtained from the search results. The total number of patients 2789 (469 high-grade meningioma and 2320 low-grade meningioma) analysis shows elevated neutrophil-to-lymphocyte ratio (NLR) (mean difference [MD]: 0.29; 95% confidence interval [CI] 0.13-0.45; P = 0.0004), monocyte-to-lymphocyte ratio (MLR) (MD: 0.02; 95% CI 0.00-0.04; P = 0.003), and low lymphocyte-to-monocyte ratio (LMR) (MD: -0.82; 95% CI -1.46--0.18; P = 0.005) significantly associated with high-grade meningioma compared to low-grade meningioma. No significant correlation between high-grade and low-grade meningioma based on platelet-lymphocyte ratio value is observed. Conclusion The parameters of NLR, MLR, and LMR have been found to be cost-effective preoperative methods that demonstrate potential value in the prediction of meningioma grade. To enhance the reliability of the findings, it is imperative to do further prospective study.
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Affiliation(s)
- Hanan Anwar Rusidi
- Department of Neurosurgery, Dr. Soeradji Tirtonegoro Central Public Hospital, Klaten, Indonesia
| | - Rohadi Muhammad Rosyidi
- Department of Neurosurgery, Faculty of Medicine, Mataram University/West Nusa Tenggara General Hospital, Mataram City Lombok Island, Indonesia
| | - Dewa Putu Wisnu Wardhana
- Department of Neurosurgery, Faculty of Medicine, Udayana University/Prof. Dr. I Goesti Ngoerah Gde Ngoerah Hospital, Denpasar, Indonesia
| | - Wisnu Baskoro
- Department of Neurosurgery, Dr. Soeradji Tirtonegoro Central Public Hospital, Klaten, Indonesia
| | - Geizar Arsika Ramadhana
- Department of Neurosurgery, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi General Public Hospital, Surakarta, Indonesia
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Graillon T, Salgues B, Horowitz T, Padovani L, Appay R, Tabouret E, Guedj E, Chinot O. Peptide radionuclide radiation therapy with Lutathera in multirecurrent nonanaplastic meningiomas: antitumoral activity study by growth rate analysis. J Neurooncol 2024:10.1007/s11060-024-04622-5. [PMID: 38451361 DOI: 10.1007/s11060-024-04622-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Several retrospective studies and meta-analyses of Peptide Radionuclide Radiation Therapy in meningiomas suggest six-month progression-free survival improvement for WHO grade 1 and 2 meningiomas. In the present study, we aimed to evaluate the impact of such treatment on three-dimensional volume growth rate (3DVGR) in nonanaplastic meningiomas. METHODS The authors performed a retrospective study including eight patients treated with Lutathera®. Millimetric 3D T1-weighted with gadolinium enhancement magnetic resonance imaging sequences were requested for volume measurement. Then, tumor growth rate was classified following a previously described 3DVGR classification (Graillon et al.). RESULTS Patients harbored seven WHO grade 2 meningiomas and one aggressive WHO grade 1. All patients, except one, underwent four treatment cycles. 3DVGR significantly decreased at 3, 6, and 12 months after treatment initiation analyzing each lesion separately. Mean and median 3DVGR from all patients were respectively at 29.5% and 44.5%/6 months before treatment initiation, then at 16.5% and 25%/6 months at three months post-treatment initiation, 9.5% and 4.5%/6 months after 6 months, as well as 9.5% and 10.5%/6 months after 12 months. At 3, 6, and 12 months after treatment initiation, 4/8, 6/7, and 5/6 patients were class 2 (stabilization or severe 3DVGR slowdown), respectively. No patient was class 1 at 6 and 12 months, suggesting a lack of drug response. CONCLUSION In nonanaplastic meningiomas, Lutathera®'s antitumoral activity appeared delayed and more likely observed at six months, while no major response was observed under treatment. Moreover, its antitumoral activity persisted for 12-18 months following treatment initiation.
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Affiliation(s)
- Thomas Graillon
- Department of Neurosurgery, Aix Marseille Univ, INSERM, APHM, MMG, UMR1251, Marmara Institute, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France.
| | - Betty Salgues
- CERIMED, Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Tatiana Horowitz
- CERIMED, Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, Aix-Marseille University, Marseille, France
| | | | - Romain Appay
- Service d'Anatomie Pathologique et de Neuropathologie, APHM, CHU Timone, Marseille, France
- Inst Neurophysiopathol, GlioME Team, Aix-Marseille Univ, CNRS, INP, PETRA network, Marseille, France
| | - Emeline Tabouret
- Neuro-Oncology Department, APHM, Timone Hospital, Marseille, France
- Aix Marseille Univ, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, Marseille, France
| | - Eric Guedj
- CERIMED, Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Olivier Chinot
- Neuro-Oncology Department, APHM, Timone Hospital, Marseille, France
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Adelhoefer SJ, Feghali J, Rajan S, Eberhart CG, Staedtke V, Cohen AR. An unusual finding of an anaplastic meningioma in NF2-related schwannomatosis. Childs Nerv Syst 2024:10.1007/s00381-024-06350-7. [PMID: 38451298 DOI: 10.1007/s00381-024-06350-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
NF2-related schwannomatosis (NF2) is a rare autosomal-dominant genetic disorder characterized by bilateral vestibular schwannomas and multiple meningiomas. This case report presents the extremely rare occurrence of an anaplastic meningioma in a 12-year-old male with previously undiagnosed NF2. The patient presented with a history of abdominal pain and episodic emesis, gait unsteadiness, right upper and lower extremity weakness, and facial weakness. He had sensorineural hearing loss and wore bilateral hearing aids. MR imaging revealed a sizable left frontoparietal, dural-based meningioma with heterogeneous enhancement with mass effect on the brain and midline shift. Multiple additional CNS lesions were noted including a homogenous lesion at the level of T5 indicative of compression of the spinal cord. The patient underwent a frontotemporoparietal craniotomy for the removal of his large dural-based meningioma, utilizing neuronavigation and transdural ultrasonography for precise en bloc resection of the mass. Histopathology revealed an anaplastic meningioma, WHO grade 3, characterized by brisk mitotic activity, small-cell changes, high Ki-67 proliferation rate, and significant loss of P16. We report an anaplastic meningioma associated with an underlying diagnosis of NF2 for which we describe clinical and histopathological features.
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Affiliation(s)
- Siegfried J Adelhoefer
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
- Faculty of Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - James Feghali
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Sharika Rajan
- Division of Neuropathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Charles G Eberhart
- Division of Neuropathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Verena Staedtke
- Comprehensive Neurofibromatosis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Alan R Cohen
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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Bayatli E, Ozgural O, Dogan I, Ozpiskin OM, Hasimoglu S, Kuzukiran YC, Zaimoglu M, Eroglu U, Kahilogullari G, Ugur HC, Caglar YS. Prediction of Meningioma Grade Using Hematological Parameters. World Neurosurg 2024:S1878-8750(24)00361-9. [PMID: 38453007 DOI: 10.1016/j.wneu.2024.02.148] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Predicting the aggressiveness of meningiomas may influence the surgical strategy timing. Because of the paucity of robust markers, the systemic immune-inflammation (SII) index is a novel biomarker to be an independent predictor of poor prognosis in various cancers including gliomas. We aimed to investigate the value of SII as well as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) indices in predicting prognosis. METHODS Records including demographic, clinical, and laboratory data of patients operated on due to intracranial meningioma in 2017-2023 were retrospectively reviewed. RESULTS A total of 234 patients were included in this study. All of SII index, NLR, and PLR values at presentation were significantly higher in grade ≥2 meningiomas. A positive correlation was observed between SII index and Ki67 index (r=0.313; P<0.001); between NLR and Ki67 index (r=0.330; P<0.001); and between PLR and Ki67 index (r=0.223; P<0.01). SII index (optimal cutoff level >618), NLR (optimal cutoff level >3.53), and PLR (optimal cutoff level >121.2) showed significant predictive values. CONCLUSIONS This is the first study to assess the prognostic value of the SII index in patients with intracranial meningiomas. Increased SII index, NLR and PLR were correlated with higher grade and higher Ki-67 index. They also harbor the potential to screen patients that may need more aggressive treatments or more frequent follow-up examinations.
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Affiliation(s)
- Eyup Bayatli
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Onur Ozgural
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Ihsan Dogan
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey.
| | - Omer Mert Ozpiskin
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Siavash Hasimoglu
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Yusuf Cem Kuzukiran
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Murat Zaimoglu
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Umit Eroglu
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Gokmen Kahilogullari
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Hasan Caglar Ugur
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Y Sukru Caglar
- Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey
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45
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Feng JJ, deJong JL, Douglas EA, Fisher-Hubbard AO, Prahlow JA. Lethal Complications of Meningiomas: A Case Series. Acad Forensic Pathol 2024; 14:3-9. [PMID: 38505637 PMCID: PMC10947708 DOI: 10.1177/19253621241228625] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/01/2024] [Indexed: 03/21/2024]
Abstract
Background Meningiomas are the most prevalent type of primary intracranial tumor in adults, comprising nearly one-third of all intracranial tumors. They are typically benign, slow-growing, and asymptomatic but may cause neurological symptoms as they expand due to mass effect. Classification is determined by World Health Organization (WHO) grades 1 to 3 following pathological examination corresponding to benign, atypical, and anaplastic (malignant), respectively, reflecting their rate of growth and risk of recurrence. The vast majority are WHO grade 1 and their slow growth permits timely presentation for elective resection; however, meningiomas in vulnerable locations and coexisting morbidities can result in sudden death. Objectives We present a series of four adult patients with meningiomas which resulted in death, including a case of fatal seizure, midline hemorrhagic meningioma, postresection meningitis, and compression of the cerebellum. Research design Retrospective review of the authors' cases was conducted. Available pathology, medical, and autopsy records including gross images were reviewed in each case. The inclusion criteria were adult patients (>18 years old) and that the cause of death had to include meningioma. Subjects The four patients included a 61-year-old male, an 84-year-old female, a 62-year-old male, and a 37-year-old female. Measures Qualitative; autopsy reports describing cause of death and pathology report findings including gross and microscopic analysis. Conclusions Meningiomas are often benign in nature but can rarely result in death. Size and location of the tumor and risk factors are contributory. Autopsy examination can be instrumental in identifying the cause and mechanism of deaths associated with meningiomas.
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Affiliation(s)
- Jeffrey J. Feng
- Jeffrey J. Feng, MS, Western Michigan University Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007,
| | | | | | | | - Joseph A. Prahlow
- Jeffrey J. Feng, MS, Western Michigan University Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007,
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46
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Sung SY, Song JH, Kim BH, Kwak YK, Kim KS, Yoo GS, Byun HK, Kim YJ, Kim YS. Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 1. Brain and head and neck. Radiat Oncol J 2024; 42:17-31. [PMID: 38549381 PMCID: PMC10982054 DOI: 10.3857/roj.2023.00899] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 04/04/2024] Open
Abstract
Advances in radiotherapy (RT) techniques, including intensity-modulated RT and image-guided RT, have allowed hypofractionation, increasing the fraction size over the conventional dose of 1.8-2.0 Gy. Hypofractionation offers advantages such as shorter treatment times, improved compliance, and under specific conditions, particularly in tumors with a low α/β ratio, higher efficacy. It was initially explored for use in RT for prostate cancer and adjuvant RT for breast cancer, and its application has been extended to various other malignancies. Hypofractionated RT (HFRT) may also be effective in patients who are unable to undergo conventional treatment owing to poor performance status, comorbidities, or old age. The treatment of brain tumors with HFRT is relatively common because brain stereotactic radiosurgery has been performed for over two decades. However, re-irradiation of recurrent lesions and treatment of elderly or frail patients are areas under investigation. HFRT for head and neck cancer has not been widely used because of concerns regarding late toxicity. Thus, we aimed to provide a comprehensive summary of the current evidence for HFRT for brain tumors and head and neck cancer and to offer practical recommendations to clinicians faced with the challenge of choosing new treatment options.
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Affiliation(s)
- Soo-Yoon Sung
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byoung Hyuck Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoo-Kang Kwak
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Kyung Su Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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47
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Zhou JJ, Farber SH, de Andrada Pereira B, DiDomenico JD, Williams GP, Almefty KK, Kakarla UK, Uribe JS, Turner JD. Metastasis of Intracranial Meningioma to the Osseous Spine: Systematic Literature Review and Case Report. World Neurosurg 2024; 183:192-203. [PMID: 37995989 DOI: 10.1016/j.wneu.2023.11.056] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Osseous spinal metastases from intracranial meningiomas are rare but represent a serious disease progression. A literature review was performed on this topic to understand the clinical course of patients with this disease entity. We also present a case of spinal metastasis in a patient with a World Health Organization grade III meningioma. METHODS The PubMed/MEDLINE database was queried on August 15, 2021, using the keywords (meningioma) AND (metastasis) AND (vertebra∗ OR spin∗). All publications reporting outcomes of patients with meningioma metastatic to the spine were included. Disease characteristics, treatment modality, and outcomes were extracted from each study. Because data availability varied widely between studies, no meta-analysis was performed. RESULTS A total of 30 articles with 33 cases were included. Outcome data varied greatly in terms of quality and length of follow-up. Of 28 cases with reported outcomes data, 20 resulted in patient mortality ranging from a few weeks to 5 years after spinal metastasis. Mean (standard deviation) survival time was 5.8 (6.4) years following initial diagnosis, but only 1.4 (3.2) years from spinal metastasis. The longest survivor was noted to have no recurrence of disease 4 years after spinal metastasis. CONCLUSIONS Bony spinal metastasis from intracranial meningioma is an extremely rare occurrence. Within the limits of the available literature, outcomes of patients with this disease appear to be poor. However, data reporting is inconsistent, and several articles did not report any outcome data. Further study is needed to better clarify the course and prognosis of this disease.
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Affiliation(s)
- James J Zhou
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Bernardo de Andrada Pereira
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph D DiDomenico
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Gabriella P Williams
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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48
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He W, Liu Z, Zheng D, Xu C, Jie D, Tang L, Teng H, Xu J. Management of cavernous sinus meningiomas: Clinical features, treatment strategies, and long-term outcomes. Asian J Surg 2024; 47:1366-1377. [PMID: 38087690 DOI: 10.1016/j.asjsur.2023.12.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES The purpose of this research was to summarize the clinical and prognostic features of cavernous sinus meningiomas (CSM), evaluate the treatment strategies and long-term prognosis of CSM, and improve the management of CSM and the treatment effect for patients. METHODS We retrospectively studied the data of 54 patients who received initial surgical resection and 45 patients who received initial gamma knife radiosurgery (GKRS) for CSM at West China Hospital of Sichuan University from 2009 to 2021. Progression-free survival (PFS), Karnofsky Performance Scale (KPS) scores and neurological function recovery were adopted to assess a comprehensive management strategy for CSM. RESULTS Gross total resection (GTR) was performed in 51.9 % of cases with 3.7 % surgical mortality. The average follow-up time was 48.7 months, with a progression rate of 29.3 %. The overall improvement rate for cranial nerve function deficits was 50.0 %. By survival analysis, the extent of resection and the histological grade were significantly related to the prognosis. The role of postoperative GKRS is uncertain. For patients who received initial GKRS, the progression rate was 17.8 %, and the overall improvement rate for cranial nerve function deficits was 61.1 %. Primary treatment with GKRS showed better long-term tumor control in patients with CSM (P = 0.046). CONCLUSIONS Maximum safe resection of CSM can improve the neurological function and quality of life of patients, but aggressive resection will cause high perioperative mortality and complication rates. For CSM patients who are suitable for initial gamma knife treatment, choosing GKRS can achieve better long-term tumor control and neurological outcomes.
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Affiliation(s)
- Wenbo He
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Zhiyong Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Datong Zheng
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Chongxi Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Danyang Jie
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Liansha Tang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Haibo Teng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Brown NJ, Hartke JN, Pacult M, Burkett KR, Gendreau J, Catapano JS, Lawton MT. Tranexamic Acid Demonstrates Efficacy without Increased Risk for Venous Thromboembolic Events in Cranial Neurosurgery: Systematic Review of the Evidence and Current Applications in Nontraumatic Pathologies. World Neurosurg 2024; 183:29-40. [PMID: 38052364 DOI: 10.1016/j.wneu.2023.11.148] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The cautionary stance normally taken towards tranexamic acid (TXA) is rooted in concerns regarding its complication profile, namely its purported risk for venous thromboembolic events (VTEs). In the present review, we intend to bring increased attention to TXA as a remarkably valuable tool that does not appear to increase the risk for VTE when used as indicated in select patients. METHODS We queried three databases to identify reporting use of TXA during nontraumatic cranial neurosurgery procedures (excluded traumatic brain injury). Data gathered included VTE complications, deep venous thrombosis, use of allogeneic blood transfusions, estimated blood loss, and operative duration. RESULTS Twenty-eight studies were deemed eligible for inclusion in the present meta-analysis, including nine studies on surgical resection of intracranial neoplasms, ten studies on aneurysmal subarachnoid hemorrhage, and nine studies on craniosynostosis. In brain tumor surgery, TXA appears to successfully reduce blood loss without predisposing patients to VTE or seizure (P < 0.01). However, it does not appear to reduce rates of vasospasm in aneurysmal subarachnoid hemorrhage (P = 0.27), and its administration is not associated with clinically meaningful differences in long term neurological outcomes. For pediatric patients undergoing craniosynostosis procedures, TXA similarly reduces blood loss (P < 0.01). Nonetheless, low dosing protocols should be used because they appear effective and the effects of high dose TXA in children have not been studied. CONCLUSIONS TXA is an effective hemostatic agent that can be administered to reduce blood loss and transfusion requirements for a wide range of neurosurgical applications in a broad spectrum of patient populations.
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Affiliation(s)
- Nolan J Brown
- Department of Neurological Surgery, University of California-Irvine, Orange, California, USA
| | - Joelle N Hartke
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark Pacult
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kyle R Burkett
- Department of Neurological Surgery, University of California-Irvine, Orange, California, USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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50
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Wilson TA, Kang Jr JI, Huang L, Vacaru A, Martins KN, Boling WW. Adjuvant proton beam therapy in patients with grade 2 meningiomas. Surg Neurol Int 2024; 15:62. [PMID: 38468681 PMCID: PMC10927181 DOI: 10.25259/sni_485_2023] [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: 06/08/2023] [Accepted: 01/25/2024] [Indexed: 03/13/2024] Open
Abstract
Background The World Health Organization (WHO) grade 2 meningiomas behave aggressively with a high proclivity toward recurrence despite maximal surgical resection. Our institution, a pioneer of proton therapy, uses exclusively proton beam radiation, and thus, we present a retrospective cohort analysis of patients with WHO grade 2 meningiomas treated with adjuvant proton beam therapy (PBT) at our institution between 2007 and 2019. The effects of adjuvant PBT were evaluated. Methods Data collected include diagnosis, gender, histological subtype, WHO grade, the extent of surgical resection, adjuvant PBT radiation, details of the PBT radiation, recurrence, any additional PBT radiation, systemic medical therapy, and disease-specific survival. Results Among the WHO grade 2 meningiomas (n = 50) recommended PBT, 80% and 78% of patients with gross-total resection (GTR) and subtotal resection (STR), respectively, followed through with PBT. The median radiation dose of PBT was 59.5 Gy and 59.92 Gy for patients with GTR and STR, respectively, with a median of 33 fractions delivered in 1.8 Gy doses for both groups. Combined 3-year progression-free survival (PFS) was 96%, and 5-year PFS was 92%. Combined overall survival was 95% at five years. Minimal radiation side effects were reported with no grade 3 or higher toxicities. Conclusion Our results suggest that adjuvant PBT is well tolerated with minimal radiation toxicity. Alternative to photon radiation, PBT may be considered at least as safe and effective for adjuvant treatment of WHO grade 2 meningiomas when it is available.
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Affiliation(s)
- Taylor Anne Wilson
- Department of Neurology, Loma Linda University Medical Center, Loma Linda, California, United States
| | | | - Lei Huang
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
| | - Alexandra Vacaru
- School of Medicine, Loma Linda University, Loma Linda, California, United States
| | | | - Warren W. Boling
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
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