Surgical Resection of Large Primary Intraosseous Meningiomas (6 Case Reports)

OBJECTIVE

The clinical features and surgical techniques related to patients undergoing resection of extracranial large primary intraosseous meningiomas are studied.

METHODS

The clinical characteristics, treatment, and prognosis of 6 patients with primary intraosseous meningiomas larger than 5 cm in diameter were retrospectively reviewed in the 10th Neurosurgical Department of Beijing Tiantan Hospital, Capital Medical University.

RESULTS

Five males and one female (18-57 years old) suffered from large primary intraosseous meningiomas. The main symptoms were headaches accompanied by head swelling. CT showed irregular thickening of the bone diploe with increased density and uneven surface. MRI showed partial bone destruction of the skull, local thickening of the internal and external plates, shell and palisade changes of the external cranial plate, and enhancement of the adjacent meninges. A horseshoe or coronary incision plus the "Mercedes-Benz" incision were chosen to expose the skull bone, and drilling was performed in the normal skull bone at the transition zone between abnormal and normal skull bone. After drilling, the sub flap dura was dissected, the hyperplastic skull was dissected with a milling cutter, and the residual tumor was then resected. A cranioplasty was performed 6 months to 1 year later (Fig 1-4).

CONCLUSIONS

Surgical treatment and precise perioperative management can achieve a better prognosis for large intraosseous meningiomas.

Role of hyaluronic acid intrauterine injection in the prevention of Asherman's syndrome in women undergoing uterine septum resection: An RCT

Background

Adhesion due to intrauterine surgery such as septal resection associated with damaged endometrium can increase the risk of Asherman's syndrome. The main goal of treatment in this syndrome is to repair the damaged endometrium for creating a physiological pregnancy.

Objective

To investigate the effect of intrauterine injection of hyaluronic acid on the prevention of Asherman's syndrome in women undergoing uterine septum resection.

Materials and Methods

In this double-blind randomized clinical trial, 65 women undergoing the uterine septum resection were divided into two groups; the case group (n = 34) and the control group (n = 31). Immediately after the septal resection with a resectoscope, 1cc of hyaluronic acid gel in the case group and 1cc normal saline solution as a placebo in the control group was injected into the uterine cavity. After two months, existence of intrauterine adhesions in the both groups was examined by the hysteroscope and assessment of menstrual patterns, according to the American Society for Reproductive Medicine criteria.

Results

Our results showed that after intervention, the incidence of Asherman's syndrome in the control group was higher than the case group (p = 0.012). In the case group, only four women had poor adhesion (Asherman's syndrome) at the end of the study, while the rest of them were free of any adhesions in the uterine cavity. In the control group, however, only 19 were free of intrauterine adhesions and 12 had mild symptoms.

Conclusion

The results of the study exhibited the hyaluronic acid capacity to reduce the risk of Asherman's syndrome in women with endometrial damage following a septal resection surgery.