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World Neurosurgery Jun 2024Meningiomas are the most common primary central nervous system tumors. The preferred treatment is maximum safe resection, and the heterogeneity of meningiomas results in... (Review)
Review
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.
Topics: Meningioma; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Neoplasm Recurrence, Local; Disease Progression; Machine Learning; Tumor Microenvironment
PubMed: 38499241
DOI: 10.1016/j.wneu.2024.03.051 -
Journal of Neurosurgical Sciences Jun 2022Management of grade II atypical meningiomas (AM) remains controversial. Conflicting evidence exist on the possible protective effect of adjuvant radiotherapy (ART) on... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Management of grade II atypical meningiomas (AM) remains controversial. Conflicting evidence exist on the possible protective effect of adjuvant radiotherapy (ART) on recurrence in grossly resected AMs. The aim of this meta-analysis is to evaluate the role of ART in grossly resected (Simpson grades 1-3) AMs on the recurrence and survival.
EVIDENCE ACQUISITION
Literature review was performed by the study investigators who handily queried the MEDLINE database using keywords and MeSH terms in different combinations using the Boolean operators "AND" or "OR," and database-related filters to maximize the chance to identify articles focusing on role of radiotherapy in atypical (WHO grade II) meningiomas. Data were retrieved from comparative studies of AMs undergone surgical resection alone vs. surgery + ART. Only grossly total resected AMs (Simpson grades 1-3) were included. The individual and pooled odds ratio (OR) for the crude recurrence, progression free survival (PFS) at 1, 3 and 5-years, as well as for the overall survival (OS) at 5-years were calculated by using the Mantel-Haenszel model in surgery alone vs. surgery + ART.
EVIDENCE SYNTHESIS
Eleven studies were considered eligible. 8 were included for the outcome "crude recurrence;" 6 for PFS at 1-3 years, 7 for PFS at 5-years; 6 for the OS at 5-years. Results suggest that surgery + ART might have a protective role on recurrence in gross-totally resected AMs (OR:1.66). Specifically, surgery + ART slightly improved PFS at 1-year (OR:0.92) and more consistently at 3- and 5-years (OR:0.31 and 0.35 respectively) hence favoring a combined approach.
CONCLUSIONS
Current literature on the impact of ART after gross total resection of AM are still heterogeneous and not systematically reported. The present meta-analysis suggests a possible protective role of postoperative RT against long-term recurrence as compared to surgical resection alone.
Topics: Child; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Neurosurgical Procedures; Radiotherapy, Adjuvant; Retrospective Studies
PubMed: 34763391
DOI: 10.23736/S0390-5616.21.05522-3 -
British Journal of Neurosurgery Feb 2023Chordoid meningioma is a rare, more aggressive subtype of meningioma. This study documents the histological, radiological and clinical features of seven tumours in five... (Review)
Review
Chordoid meningioma is a rare, more aggressive subtype of meningioma. This study documents the histological, radiological and clinical features of seven tumours in five patients among 131 meningioma patients who were treated in the Department of Neurosurgery at Istanbul Medipol University between 2014 and 2019. There were two males and three females. All tumours were supratentorial. Surgical Simpson grade II resection was achieved in two cases, grade I in one and grade IV in two. One case relapsed and underwent further surgeries and adjuvant treatment. The chances of survival without recurrence after the Simpson grade I-II resection are high but close follow-up is recommended particularly if grade I cannot be achieved.
Topics: Male; Female; Humans; Meningioma; Meningeal Neoplasms; Neurosurgical Procedures; Neurosurgery; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 33332220
DOI: 10.1080/02688697.2020.1861436 -
World Neurosurgery Sep 2018Intracranial hemorrhage stemming from a benign intracranial lesion is much less commonly seen than from malignant tumors such as gliomas or metastases. Cerebellopontine...
BACKGROUND
Intracranial hemorrhage stemming from a benign intracranial lesion is much less commonly seen than from malignant tumors such as gliomas or metastases. Cerebellopontine angle (CPA) lesions rarely present with hemorrhage.
CASE DESCRIPTION
We describe the case of a 49-year-old male with a recurrent right CPA meningioma arising from the petrous bone that was previously treated with a subtotal resection and postsurgical radiosurgery, presenting with acute left-sided hemiparesis secondary to intratumoral hemorrhage. Although surgical evacuation and decompression were recommended, the patient declined operative intervention and was managed medically.
CONCLUSIONS
Meningiomas can cause subarachnoid, intraparenchymal, and rarely intratumoral hemorrhage. Symptomatic hemorrhage can worsen the prognosis, with increased morbidity and mortality. Several etiologies have been proposed for this phenomenon including rupture of aberrant vasculature, intratumoral necrosis, and tearing of stretched bridging veins. Only 2 prior cases of CPA meningioma have been reported in the literature. Recognition of CPA meningioma hemorrhage as a clinical entity can help in future diagnoses and management.
Topics: Cerebellopontine Angle; Diagnosis, Differential; Humans; Intracranial Hemorrhages; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Petrous Bone
PubMed: 29936208
DOI: 10.1016/j.wneu.2018.06.100 -
World Neurosurgery Jun 2016Tentorial meningiomas represent a heterogeneous group of tumors. Most of the published series deal with either a small number of patients or consider different locations...
OBJECTIVE
Tentorial meningiomas represent a heterogeneous group of tumors. Most of the published series deal with either a small number of patients or consider different locations as a whole, making indications for treatment and prognosis difficult to drawn. We analyzed the surgical management of the lateral tentorial meningiomas, a homogenous and rare subgroup.
METHODS
Fifty-two later tentorial meningiomas were operated on between 1990 and 2010. Clinical and radiologic features and surgical management of these patients were reviewed. Tumors were further subcategorized in to posterior/intermediate and in to supra-/infratentorial subgroups. Surgical outcome, long-term results, and prognostic factors are described.
RESULTS
Mean age was 57 years (41 female, 11 male). Mean tumor size was 46 mm; most had an infratentorial location (36 vs. 16). Prevailing presenting symptoms were headache (n = 28), vertigo/gait disturbances (n = 25), and confusion and visual disturbances (n = 16). The infratentorial group presented with a poorer clinical condition before as well as after operation. Extent of tumor resection was Simpson I in 10 patients, II in 26, III in 6, and IV in 10. Subtotal resection was statistically correlated with sinus invasion and tumor size. There was no surgical mortality. Permanent complications occurred in 3 patients. At latest follow-up (mean, 119 months) 42/46 had resumed their normal daily activity. Six cases recurred and remained stable after radiosurgery.
CONCLUSIONS
Lateral tentorial meningiomas are a homogeneous entity characterized by simple surgical approaches and favorable outcome (no mortality and low overall morbidity). Infratentorial location was more frequent and was characterized by poorer outcome. The limiting factors for surgical removal were tumor size and sinus invasion. The latter point strengthens the rationale for their classification into posterior and intermediate.
Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Neurosurgical Procedures; Postoperative Complications; Radiosurgery; Retrospective Studies; Treatment Outcome; Tumor Burden
PubMed: 26926797
DOI: 10.1016/j.wneu.2016.02.083 -
Operative Neurosurgery (Hagerstown, Md.) Aug 2021Radiation-induced meningiomas are the most common radiation-induced neoplasms. They exhibit a distinct aggressive clinical behavior as rapid growth, recurrences,...
Radiation-induced meningiomas are the most common radiation-induced neoplasms. They exhibit a distinct aggressive clinical behavior as rapid growth, recurrences, multiplicity, and malignant progression are common features.1-4 Atypical histological findings and aberrant cytogenetics are increasingly identified.5-7 Radical resection of aggressive radiation-induced meningiomas is the best treatment option and would offer the best chance for control of the disease. Wide bone and dural margins should be pursued in the resection. Parasellar extension creates significant surgical challenges. Cavernous sinus exploration through the multidirectional axis provided by the cranioorbital zygomatic approach allows radical resection of the tumor, cranial nerve decompression, and carotid artery preservation and control.8-11 This article describes a cavernous sinus radiation-induced meningioma after radiation for Cushing disease. It demonstrates the details of the extra- and intradural exploration and dissection of the neurovascular structures in the cavernous sinus, with proximal and distal control of the carotid artery. However, even after radical resection, recurrence is a common finding in this malignant behavioral radiation-induced tumor. Patient consented for surgery. Image at 9:41 comes from the Science Museum Group, United Kingdom. Refer to the Wellcome blog post (archive). This image is licensed under the CC-BY 4.0 International license.
Topics: Cavernous Sinus; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Neoplasms, Radiation-Induced
PubMed: 34133742
DOI: 10.1093/ons/opab195 -
Child's Nervous System : ChNS :... Oct 2021Pediatric meningiomas are relatively rare and have atypical clinical features compared to adults. The purpose of this work is to report our 15-year experience in the...
OBJECTIVE
Pediatric meningiomas are relatively rare and have atypical clinical features compared to adults. The purpose of this work is to report our 15-year experience in the management of pediatric meningiomas and assess their clinical characteristics, pathological features, and prognostic factors.
METHODS
A total of 40 children (age ≤ 15 years) who were diagnosed as pediatric meningiomas were enrolled in this study. Patient information including clinical presentation, gender, age at time of diagnosis, histopathological features, tumor location, tumor volume, treatment methods, and follow-up data were extracted and analyzed.
RESULTS
The mean age at diagnosis was 10.78 ± 3.50 years (range 2-15 years) in 40 patients with a male to female ratio of 1:1.11. Headache, epilepsy, visual disturbance, and limb weakness are common clinical manifestations. Two patients had multiple intracranial meningiomas. Fourteen (33.3%) of pediatric meningiomas were high grade meningiomas. Seven patients (17.5%) were treated with STR, while GTR was achieved in 33 patients (82.5%). The mean follow-up period was 82.1 months (range 9-173 months). Recurrence occurred in 9 patients (22.5%), and 5 patients (12.5%) passed away.
CONCLUSION
The incidence of pediatric meningiomas increases with advancing age. In pediatric patients, the percentage of high-grade tumors is higher than adults. Younger children were more likely to have high-grade meningiomas, while patients with tumors located in skull base or parasagittal/falx tend to have low-grade meningiomas. The WHO grade III meningiomas were significantly correlated with poor prognosis. Adjuvant radiotherapy after surgery can improve prognosis and may be a potential treatment strategy in children with malignant meningiomas.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Retrospective Studies; Treatment Outcome
PubMed: 34292388
DOI: 10.1007/s00381-021-05296-4 -
BMJ Case Reports Oct 2021Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early...
Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.
Topics: Delusional Parasitosis; Humans; Male; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Neuroimaging
PubMed: 34667042
DOI: 10.1136/bcr-2021-245249 -
Acta Neurochirurgica Nov 2017The clinical relevance of Health-Related Quality of Life (HRQoL) in meningioma patients has been increasingly acknowledged in recent years. Various questionnaires have... (Review)
Review
BACKGROUND
The clinical relevance of Health-Related Quality of Life (HRQoL) in meningioma patients has been increasingly acknowledged in recent years. Various questionnaires have been used. However, almost none of these questionnaires has been particularly developed for and/or validated in this patient group. Therefore, the aim of this study was to assess the relevance and comprehensiveness of existing HRQoL questionnaires used in meningioma research and to assess the agreement between patients and health care professionals (HCPs) on the most relevant and important HRQoL issues.
METHODS
A systematic literature search, following the PRISMA statement, was conducted to identify all HRQoL questionnaires used in meningioma research. Semi-structured interviews were organized with patients and HCPs to (1) assess the relevance of all issues covered by the questionnaires (score 0-3: not relevant-highly relevant), (2) assess the ten most important issues, and (3) identify new relevant HRQoL issues.
RESULTS
Fourteen different questionnaires were found in the literature, comprising 140 unique issues. Interviews were conducted with 20 patients (median age 57, 71% female) and 10 HCPs (4 neurosurgeons, 2 neurologists, 2 radiotherapists, 1 rehabilitation specialist, 1 neuropsychologist; median experience 13 years). Meningioma patients rated 17-80% of the issues in each of the questionnaires as relevant, HCPs 90-100%. Patients and HCPs agreed on the relevance of only 49 issues (35%, Cohen's kappa: 0.027). Both patients and HCPs considered lack of energy the most important issue. Patients and HCPs suggested five additional relevant issues not covered by current HRQoL questionnaires.
CONCLUSIONS
Existing HRQoL questionnaires currently used in meningioma patients do not fully cover all relevant issues to these patients. Agreement between patients and HCPs on the relevance of issues was poor. Both findings support the need to develop and validate a meningioma-specific HRQoL questionnaire.
Topics: Health Personnel; Health Status; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Grading; Quality of Life; Surveys and Questionnaires; World Health Organization
PubMed: 28952044
DOI: 10.1007/s00701-017-3332-8 -
BMC Cancer Mar 2021Meningiomas are common brain tumours that are usually defined by benign clinical course. However, some meningiomas undergo a malignant transformation and recur within a... (Comparative Study)
Comparative Study
BACKGROUND
Meningiomas are common brain tumours that are usually defined by benign clinical course. However, some meningiomas undergo a malignant transformation and recur within a short time period regardless of their World Health Organization (WHO) grade. The current study aimed to identify potential markers that can discriminate between benign and malignant meningioma courses.
METHODS
We profiled the metabolites from 43 patients with low- and high-grade meningiomas. Tumour specimens were analyzed by nuclear magnetic resonance analysis; 270 metabolites were identified and clustered with the AutoPipe algorithm.
RESULTS
We observed two distinct clusters marked by alterations in glycine/serine and choline/tryptophan metabolism. Glycine/serine cluster showed significantly lower WHO grades and proliferation rates. Also progression-free survival was significantly longer in the glycine/serine cluster.
CONCLUSION
Our findings suggest that alterations in glycine/serine metabolism are associated with lower proliferation and more recurrent tumours. Altered choline/tryptophan metabolism was associated with increases proliferation, and recurrence. Our results suggest that tumour malignancy can be reflected by metabolic alterations, which may support histological classifications to predict the clinical outcome of patients with meningiomas.
Topics: Aged; Algorithms; Biomarkers, Tumor; Choline; Cluster Analysis; Disease Progression; Female; Glycine; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Grading; Nuclear Magnetic Resonance, Biomolecular; Progression-Free Survival; Serine; Treatment Outcome; Tryptophan
PubMed: 33648471
DOI: 10.1186/s12885-021-07887-5