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Neurology India 2017
Topics: Biomarkers, Tumor; Cell Proliferation; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Grading
PubMed: 29133693
DOI: 10.4103/0028-3886.217989 -
Photodiagnosis and Photodynamic Therapy Sep 2016Though meningiomas are often benign and well circumscribed in nature, many are associated with recurrences and poor outcome because of their attachment to neurovascular... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Though meningiomas are often benign and well circumscribed in nature, many are associated with recurrences and poor outcome because of their attachment to neurovascular nearby structures or invasion of adjacent venous sinuses or bone, forcing incomplete excision and deployment of further salvage therapy. Recently, ALA-FIGS has been reported as an aid to increase the chances of complete resection and minimizing collateral damage.
METHODS
Critical review and meta-analyses of the literature published to date. All studies reporting ALA-FIGS in meningiomas were critically reviewed. Nineteen studies fulfilled the inclusion criteria with a total of 222 patients, of which 206 were included in the meta-analyses.
RESULTS
ALA-FIGS was highly specific, and highly sensitive (95%, range 91.8-97.7%). There was no correlation between WHO grading (WHO grade I versus WHO grades II & III) and fluorescence (odds ratio 1.2, p>0.05). ALA-FIGS altered the surgical plan intraoperatively in 75% of high-grade and 19% of low-grade meningiomas, improving the extent of surgical excision. ALA-FIGS was also highly sensitive and specific in differentiating hypertrophy and tumor invasion of adjacent dura and bone.
CONCLUSIONS
ALA-FIGS in meningiomas is very selective, highly sensitive, and improves the extent of surgical resection in meningiomas. Long-term outcome of these tumors in the future should be categorized into those with and without residual fluorescent tissue. A new surgical resection grading system based on ALA-FIGS is proposed.
Topics: Aged; Aged, 80 and over; Aminolevulinic Acid; Contrast Media; Female; Fluorescent Dyes; Humans; Male; Margins of Excision; Meningeal Neoplasms; Meningioma; Microscopy, Fluorescence; Middle Aged; Neoplasm Grading; Prevalence; Reproducibility of Results; Sensitivity and Specificity; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 27235278
DOI: 10.1016/j.pdpdt.2016.05.006 -
Neurology India 2021Endoscopic trans-nasal surgery has evolved a long way from the days of narrow corridors with high rates of cerebrospinal fluid (CSF) leak to the present state of HD...
AIM
Endoscopic trans-nasal surgery has evolved a long way from the days of narrow corridors with high rates of cerebrospinal fluid (CSF) leak to the present state of HD optics with better tissue differentiation, extended approaches, and use of vascularized flaps for defect closure. Trans-nasal approach is an established technique for pituitary tumors practiced worldwide. However, trans-nasal endoscopic excision of suprasellar meningiomas provides a tougher challenge in terms of instrument manipulation, tumor excision with good visual outcome, and a robust defect closure to prevent CSF leaks.
MATERIALS AND METHODS
Out of 83 cases of midline anterior cranial fossa meningiomas operated over 14 years, our experience in 12 cases of suprasellar meningiomas for radical resection via the trans-nasal endoscopic route is discussed.
RESULTS
Amongst these, six were excised via primary extended endoscopic trans-sphenoidal surgery, four cases had a residual lesion or recurrence after primary transcranial surgery, and two cases involved a combined transcranial and extended endoscopic approach. Visual improvement along with resolution of headache was seen in all patients postoperatively. None of the patients had CSF leak requiring further repair. Syndrome of inappropriate antidiuretic hormone was found in one patient, which was transient and easily corrected.
CONCLUSION
Trans-nasal endoscopic surgery for suprasellar meningiomas is an effective technique that provides results of tumor excision comparable to the transcranial approach in suitable cases. Visual outcome was found to be superior, and rates of CSF leak were remarkably reduced with vascularized flap. However, each case must be assessed individually and lateral extension beyond the optic canals with internal carotid artery encasement must be considered before planning surgery.
Topics: Endoscopy; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Neurosurgical Procedures; Retrospective Studies; Skull Base Neoplasms; Treatment Outcome
PubMed: 34169857
DOI: 10.4103/0028-3886.319224 -
Journal of Neurosurgery Dec 2022The role of adjuvant radiation therapy following incomplete resection of WHO grade I skull base meningiomas (SBMs) is controversial, and little is known regarding the...
OBJECTIVE
The role of adjuvant radiation therapy following incomplete resection of WHO grade I skull base meningiomas (SBMs) is controversial, and little is known regarding the behavior of residual tumors. The authors investigated the factors that influence regrowth of residual WHO grade I SBMs following incomplete resection.
METHODS
From 2005 to 2019, a total of 710 patients underwent surgery for newly diagnosed WHO grade I SBMs. The data of 115 patients (16.2%) with incomplete resection and without any adjuvant radiotherapy were retrospectively assessed during a mean follow-up of 78 months (range 27-198 months). Pre-, intra-, and postoperative clinical and molecular factors were analyzed for relevance to regrowth-free survival (RFS).
RESULTS
Eighty patients were eligible for analysis, excluding those who were lost to follow-up (n = 10) or had adjuvant radiotherapy (n = 25). Regrowth occurred in 39 patients (48.7%), with a mean RFS of 50 months (range 3-191 months). Significant predictors of regrowth were Ki-67 proliferative index (PI) ≥ 4% (p = 0.017), Simpson resection grades IV and V (p = 0.005), and invasion of the cavernous sinus (p = 0.027) and Meckel's cave (p = 0.027). After Cox regression analysis, only Ki-67 PI ≥ 4% (hazard ratio [HR] 9.39, p = 0.003) and Simpson grades IV and V (HR 8.65, p = 0.001) showed significant deterioration of RFS. When stratified into 4 scoring groups, the mean RFSs were 110, 70, 38, and 9 months for scores 1 (Ki-67 PI < 4% and Simpson grade III), 2 (Ki-67 PI < 4% and Simpson grades IV and V), 3 (Ki-67 PI ≥ 4% and Simpson grade III), and 4 (Ki-67 PI ≥ 4% and Simpson grades IV and V), respectively. RFS was significantly longer for score 1 versus scores 2-4 (p < 0.01). Tumor consistency, histology, location, peritumoral edema, vascular encasement, and telomerase reverse transcriptase promoter mutation had no impact on regrowth.
CONCLUSIONS
Ki-67 PI and Simpson resection grade showed significant associations with RFS for WHO grade I SBMs following incomplete resection. Ki-67 PI and Simpson resection grade could be utilized to stratify the level of risk for regrowth.
Topics: Humans; Meningioma; Meningeal Neoplasms; Retrospective Studies; Ki-67 Antigen; Neurosurgical Procedures; Neoplasm Recurrence, Local; Skull Base; World Health Organization; Treatment Outcome
PubMed: 35453107
DOI: 10.3171/2022.3.JNS2299 -
Seminars in Neurology Feb 2024Meningiomas are the most frequent nonmalignant tumors of the central nervous system (CNS). Despite their benign nature and slow-growing pattern, if not diagnosed early,... (Review)
Review
Meningiomas are the most frequent nonmalignant tumors of the central nervous system (CNS). Despite their benign nature and slow-growing pattern, if not diagnosed early, these tumors may reach relatively large sizes causing significant morbidity and mortality. Some variants are located in hard-to-access locations, compressing critical neurovascular structures, and making the surgical management even more challenging. Although most meningiomas have a good long-term prognosis after treatment, there are still controversies over their management in a subset of cases. While surgery is the first-line treatment, the use of fractionated radiotherapy or stereotactic radiosurgery is indicated for residual or recurrent tumors, small lesions, and tumors in challenging locations. Advances in molecular genetics and ongoing clinical trial results have recently helped both to refine the diagnosis and provide hope for effective biomolecular target-based medications for treatment. This article reviews the natural history and current therapeutic options for CNS meningiomas.
Topics: Humans; Meningioma; Meningeal Neoplasms; Neoplasm Recurrence, Local; Radiosurgery; Treatment Outcome
PubMed: 38052237
DOI: 10.1055/s-0043-1777352 -
The Journal of Craniofacial Surgery May 2022The extensive bone infiltration and carpet-like growth characteristics of spheno-orbital meningioma (SOM) make it hard to remove entirely, and recurrence and proptosis...
OBJECTIVE
The extensive bone infiltration and carpet-like growth characteristics of spheno-orbital meningioma (SOM) make it hard to remove entirely, and recurrence and proptosis are the main reasons for reoperation. The authors report 20 cases of surgical treatment for recurrence of SOM, including surgical technique and symptom improvement.
METHODS
The clinical data and follow-up results of 20 cases of recurrent SOM at our institution from 2000 to 2017 were retrospectively analyzed.
RESULTS
All of the 20 patients with recurrence had received at least one operation before admission, with a mean age of 56 years and 70% female. The mean follow-up time was 36 months (172 months). All patients mainly showed symptoms such as proptosis and headache, and were found to be affected by supraorbital fissure during the operation. in 17 patients with recurrence, the affected sphenoid wing became tumor-like hyperplasia. Patients with extraocular muscle involvement have obvious protrusion and are often accompanied by diplopia. After surgical removal of the tumor, the symptoms of proptosis in 19 patients were significantly improved. During the follow-up, only 3 cases of proptosis recurred. After 15 patients underwent Simpson grade IV resection, 4 patients (27%) relapsed again. Five patients underwent Simpson III resection, and only 1 patient (20%) had tumor recurrence 18th months after surgery, and no proptosis recurred.
CONCLUSIONS
The complete surgical removal of recurrent SOM is practically impossible. The main direction of surgical treatment should be to improve the symptoms of proptosis.
Topics: Exophthalmos; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Orbital Neoplasms; Retrospective Studies; Sphenoid Bone; Treatment Outcome
PubMed: 34743161
DOI: 10.1097/SCS.0000000000008346 -
World Neurosurgery Aug 2017Meningiomas account for 36% of primary brain tumors. The pathogenesis of these tumors is not completely established, hindering development of effective chemotherapy.... (Review)
Review
BACKGROUND
Meningiomas account for 36% of primary brain tumors. The pathogenesis of these tumors is not completely established, hindering development of effective chemotherapy. Numerous studies have identified alterations in several growth factors and receptor kinases that regulate meningioma growth. These may be targets for new therapies. One of these, sometimes overlooked, is the transforming growth factor beta (TGF-β) family of proteins. Its receptors and signaling pathways play a critical role in development or progression of many forms of neoplasia.
METHODS
Evidence suggesting a potential role for TGF-β, bone morphogenetic protein, and their mediators is reviewed.
RESULTS
TGF-β inhibition of growth in normal leptomeninges may be lost in neoplasia. Moreover, loss of TGF-β and bone morphogenetic protein signaling components and TGF-β type III receptor likely contribute to the development and/or progression of higher grade meningiomas.
CONCLUSIONS
Accumulating evidence suggests that derangement of TGF-β family signaling contributes to development and progression of meningiomas. The TGF-β family may represent new targets for chemotherapy and could include inhibitors of kinases activated by TGF-β.
Topics: Animals; Antineoplastic Agents; Evidence-Based Medicine; Gene Expression Regulation, Neoplastic; Humans; Meningeal Neoplasms; Meningioma; Molecular Targeted Therapy; Neoplasm Proteins; Transforming Growth Factor beta; Treatment Outcome
PubMed: 28344175
DOI: 10.1016/j.wneu.2017.03.058 -
Chinese Clinical Oncology Jul 2017Maximal safe resection has long been the cornerstone of treatment for WHO grade I benign meningioma. However, as technology for both imaging and radiation delivery has... (Review)
Review
Maximal safe resection has long been the cornerstone of treatment for WHO grade I benign meningioma. However, as technology for both imaging and radiation delivery has advanced, radiation therapy has played an increasingly important role in the management of patients with WHO grade I meningioma. Radiation therapy, whether delivered as standard fractionated treatment over several weeks, stereotactic radiosurgery over 1 session, or multisession stereotactic radiation therapy, has been shown to provide excellent local control when used as an adjunct to surgery or as primary treatment. Here, we review the indications for radiation therapy for patients with WHO grade I meningioma, as well as the various techniques that have been developed. We also review the toxicities and late effects associated with treatment.
Topics: Adult; Brain Neoplasms; Dose Fractionation, Radiation; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Grading; Radiosurgery
PubMed: 28758408
DOI: 10.21037/cco.2017.06.01 -
Neurologia Medico-chirurgica 2015Meningiomas are the most common intracranial primary neoplasm in adults. Although the spectrum of clinical and molecular genetic issues regarding meningiomas remains... (Review)
Review
Meningiomas are the most common intracranial primary neoplasm in adults. Although the spectrum of clinical and molecular genetic issues regarding meningiomas remains undefined, novel genetic alterations that are associated with tumor morphology, malignancy, or location have recently been discovered. This review focuses on recent advances in understanding of the heterogenous pathology of meningiomas, particularly on associations between the clinical, histological, etiological, epidemiological, and molecular genetical aspects of the neoplasm.
Topics: Humans; Immunohistochemistry; Meningeal Neoplasms; Meningioma; Molecular Biology
PubMed: 25744347
DOI: 10.2176/nmc.ra.2014-0233 -
World Neurosurgery Feb 2019To review the published data to create a more comprehensive natural history of multiple meningiomas (MM). (Review)
Review
OBJECTIVE
To review the published data to create a more comprehensive natural history of multiple meningiomas (MM).
METHODS
A review of MM published until now was carried out through a Medline search up to August 2018. The use of the "multiple meningiomas" keyword returned 278 articles, and the characteristics analyzed in our present cohort were searched on those publications. Articles without detailed description of clinical findings, neuroimaging confirmation of tumor multiplicity, follow-up at least of 5 years, and clear description of clinical findings were excluded. We added series to this review.
RESULTS
293 patients with MM were analyzed: 220 women and 73 men, with a total of 932 tumors (3.1 tumors per patient). The majority of tumors were located in the convexity (653% to 74.5%). The total number of tumors treated was 429 (43.9%): 338 (78.8%) by surgical resection and 91 (21.2%) by radiotherapy. Histopathologic description was available in 303 of 429 cases, being grade I in 272 (90.3%) cases, with a predominance of the meningothelial subtype (30.7%). Tumor recurrence was described in 32 (8.07%) among 397 and only 10 deaths (3.4%) of 281 reported cases, where this characteristic was evaluated.
CONCLUSIONS
World Health Organization grade I predominance was observed among multiple meningiomas in similarity to single meningiomas. Only a fraction of MM patients (43.89%) needed treatment. A benign tumor behavior was corroborated by the observed low frequency of recurrence and mortality.
Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary
PubMed: 30471445
DOI: 10.1016/j.wneu.2018.11.097