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Clinical Neurology and Neurosurgery Nov 2020Spinal intradural tumors can be classified as intradural extramedullary or intramedullary tumors. Spinal meningiomas are among the most frequent intradural,...
BACKGROUND
Spinal intradural tumors can be classified as intradural extramedullary or intramedullary tumors. Spinal meningiomas are among the most frequent intradural, extramedullary tumors (IDEMs), representing 12 % of all meningiomas and 25-45 % of all intradural spinal tumors.
OBJECTIVE
To evaluate postoperative outcome, defined by mortality, tumor recurrence and modified Rankin Scale in patients with spinal meningiomas. Furthermore, to identify factors related to these outcome measures and define possible prognosticators.
METHODS
A large single center retrospective analysis of 166 consecutive spinal meningioma patients during a 29-year period (1989-2018).
RESULTS
Female to male ratio was 5.15 to 1. Of all 166 resected tumors, 159 were WHO grade I and seven were WHO grade II. Histopathologically, the psammomatous type was most common (42.8 %). The thoracic region was the most frequent location (71.1 %), followed by cervical and lumbar locations. A complete resection (Simpson I-III) was achieved in 88.7 %. In 12 cases (7.2 %) recurrences of a spinal meningioma occurred after an interval of 0.70-13.78 years. Postoperative complications consisted of CSF leakage and wound healing problems. Three patients died of direct postoperative complications (1.8 %), nine patients died in follow-up due to unrelated causes. Post-operative complications were related to the overall outcome (p = 0.029). Clinical outcome showed improvement in 117 patients out of 148 (79.1 %) according to modified Rankin Scale; 24 patients remained stable and 7 patients deteriorated. Patients with pre-existing bladder/bowel problems and incomplete resections had higher chance of recurrences. Younger patients also had a higher recurrence rate. Follow-up ranged from 0 to 23 years, median of 0.77 years, most were discontinued after 2 years.
CONCLUSIONS
The primary treatment of spinal meningiomas remains surgery. Complete resection of spinal meningiomas is achieved in most of the cases, however preserving and improving neurological status has priority over complete tumor resection. Morbidity and mortality is relatively low. Longer follow-up periods are recommended, since recurrences can occur after 10-15 years.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Meningeal Neoplasms; Meningioma; Microsurgery; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Spinal Cord Neoplasms; Treatment Outcome; Young Adult
PubMed: 33096449
DOI: 10.1016/j.clineuro.2020.106238 -
Neurosurgical Review Feb 2022Beyond microsurgical resection and radiation therapy, there are currently no established treatment alternatives for meningioma patients. In selected cases, peptide radio...
Beyond microsurgical resection and radiation therapy, there are currently no established treatment alternatives for meningioma patients. In selected cases, peptide radio receptor therapy (PRRT) can be implemented. For this purpose, a radionuclide is bound to a substance targeting specific receptors in meningiomas. One of them is somatostatin receptor 2, which can be found in most meningiomas. However, other somatostatin receptors (SSTR) exist, but their expressions have only been described in small case series. In this study, we analyzed the expression of SSTR1, 2A, 3, 4, and 5 in a large cohort of meningiomas in order to enable further refinement of this innovative treatment option. Overall, 726 tumor samples were processed into tissue microarrays and stained for SSTR1, 2A, 3, 4, and 5 immunohistochemically. Microscopic evaluation was done with an established semiquantitative score regarding percentual quantification and staining intensity, and results were correlated with clinical data. There was a significant lower rate of SSTR1 expression in meningiomas of male patients. Older age was associated with higher expression of SSTR1, 2A, and 5 and lower scores for SSTR3 and 4. Tumors treated with radiotherapy before resection showed lower rates of SSTR1 and 5 expression, while recurrent meningiomas had lower SSTR1 scores. Tumor tissue from patients suffering from neurofibromatosis type 2 had lower expression scores for SSTR1, 2, and 5. For SSTR3 and 4, NF2 patients showed higher scores than sporadic tumors. Spinal meningiomas had higher scores for SSTR1, 4, and 5 compared tumor location of the skull base and convexity/falx. Overall, higher WHO grade was associated with lower SSTR scores. While all SSTRs were expressed, there are marked differences of SSTR expression between meningioma subgroups. This has the potential to drive the development of more selective PRRT substances with higher treatment efficacy.
Topics: Aged; Humans; Immunohistochemistry; Male; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Receptors, Somatostatin
PubMed: 33899156
DOI: 10.1007/s10143-021-01552-y -
Neurologia Medico-chirurgica Mar 2020Observation has been a mainstay in asymptomatic meningiomas, but it may increase the risk associated with treatment due to tumor enlargement and the aging of patients.... (Meta-Analysis)
Meta-Analysis
Observation has been a mainstay in asymptomatic meningiomas, but it may increase the risk associated with treatment due to tumor enlargement and the aging of patients. Understanding the natural course of meningiomas is important to provide appropriate treatment. The majority of previous studies investigated factors related to their growth, but failed to demonstrate their relationship with symptomatic progression (sympP) because of its rarity. We reviewed and meta-analyzed 27 studies that investigated natural courses in asymptomatic or untreated meningiomas to find clinico-radiological factors predictive of radiological progression (radioP), growth speed, and sympP. In results of time-growth analysis, two-thirds of meningiomas showed radioP defined by a volume criterion and the rate approached a plateau at 4-5 years. In growth curve analyses, about half of incidental meningiomas presented decelerating or no growth, while less than one-quarter of them grew exponentially. RadioP, growth speed [annual volume change (AVC) or relative growth rate], and sympP each had different factors related to them. Younger age, non-calcification, and high intensity on T2-weighted image were related to radioP and rapid growth speed, but not to sympP. Tumors in males and those of larger size were likely to be symptomatic in the meta-analysis. AVC (≥2.1 cm/year) was the strongest indicator of sympP. Apart from perifocal edema, radiological features at up-front imaging may not be useful for predicting sympP. This may be due to dynamic changes of those radiological markers in the long term. Quantified tumor size and growth speed, especially AVC, are important markers for deciding on treatment.
Topics: Humans; Meningeal Neoplasms; Meningioma
PubMed: 32009127
DOI: 10.2176/nmc.ra.2019-0213 -
Journal of Cancer Research and... 2020Meningiomas are common slow-growing primary intracranial neoplasms attached to the dura mater and are composed of neoplastic meningothelial cells. Increased incidence of...
BACKGROUND
Meningiomas are common slow-growing primary intracranial neoplasms attached to the dura mater and are composed of neoplastic meningothelial cells. Increased incidence of meningiomas in women with an increased tumor growth during pregnancy and a possible association with breast cancer suggested that female sex hormones have been involved in the growth of meningiomas. Antihormonal-targeted therapy would be beneficial in such patients.
AIM
The aim of this study is to correlate the expression of estrogen receptor (ER) and progesterone receptor (PR) in meningiomas with gender, location, histological subtypes, and grade.
MATERIALS AND METHODS
This is a 3½-year prospective and retrospective study of intracranial and intraspinal meningiomas. Clinical details of all the patients were noted from the computerized hospital information system. Immunohistochemistry for ER and PR was performed. Statistical analysis was performed using Chi-square test.
RESULTS
During the study period, there were 80 Grade I, 18 Grade II, and 2 Grade III meningiomas categorized as per the World Health Organization 2007 classification. The female-to-male ratio was 1.9:1 and the mean age was 47.8 years. ER was expressed in 2% of meningiomas. PR was expressed in 67.5% of Grade I and 66.6% of Grade II and none of Grade III meningiomas. Brain-invasive meningiomas showed 54.5% PR immunopositivity and negative for ER.
CONCLUSION
ER and PR were expressed in 2% and 66% of meningiomas, respectively. Statistically significant relationship was not found between the positivity of PR in females and males of Grade I and Grade II/III meningiomas, intracranial and spinal tumors, Grade I and Grade II/III cases, and various histological subtypes of meningiomas.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Immunohistochemistry; Male; Meningeal Neoplasms; Meninges; Meningioma; Middle Aged; Neoplasm Grading; Prospective Studies; Receptors, Estrogen; Receptors, Progesterone; Retrospective Studies; Risk Factors; Sex Factors; Young Adult
PubMed: 33342817
DOI: 10.4103/jcrt.JCRT_1075_16 -
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 -
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 -
Pigment Cell & Melanoma Research Jul 2020In February 2018, the Melanoma Research Foundation and the Moffitt Cancer Center hosted the Second Summit on Melanoma Central Nervous System Metastases in Tampa,... (Review)
Review
In February 2018, the Melanoma Research Foundation and the Moffitt Cancer Center hosted the Second Summit on Melanoma Central Nervous System Metastases in Tampa, Florida. The meeting included investigators from multiple academic centers and disciplines. A consensus summary of the progress and challenges in melanoma parenchymal brain metastases was published (Eroglu et al., Pigment Cell & Melanoma Research, 2019, 32, 458). Here, we will describe the current state of basic, translational, clinical research, and therapeutic management, for melanoma patients with leptomeningeal disease. We also outline key challenges and barriers to be overcome to make progress in this deadly disease.
Topics: Cell-Free Nucleic Acids; Clinical Trials as Topic; Humans; Melanoma; Meningeal Neoplasms; Molecular Targeted Therapy; Neoplastic Cells, Circulating
PubMed: 31916400
DOI: 10.1111/pcmr.12861 -
Neurosurgery Jan 2022Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities...
BACKGROUND
Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors.
OBJECTIVE
To determine factors that contribute to different clinical outcomes in racial populations.
METHODS
We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences.
RESULTS
Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival.
CONCLUSION
Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.
Topics: Brain Neoplasms; Healthcare Disparities; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Retrospective Studies; Socioeconomic Factors
PubMed: 34982878
DOI: 10.1227/NEU.0000000000001751 -
Journal of Cancer Research and Clinical... Jan 2023Meningioma is a common type of benign tumor that can be managed in several ways, ranging from close observation, surgical resection, and various types of radiation. We... (Review)
Review
PURPOSE
Meningioma is a common type of benign tumor that can be managed in several ways, ranging from close observation, surgical resection, and various types of radiation. We present here results from a 10 year experience treating meningiomas with a hypofractionated approach.
MATERIALS AND METHODS
To define the rate of tumor control and factors associated with the relief of symptoms and radiation-related complications after radiosurgery and hypofractionated radiosurgery for patients with imaging-defined intracranial meningiomas. We reviewed the charts of 48 patients treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (SRT) from 2002 to 2018. A total of 37 (82%) patients had WHO Grade 1 disease, and 11 (22%) had Grade 2. Outcomes that were analyzed included local control rates and the rate and grade of any reported toxicity.
RESULTS
Only 36 patients with 38 lesions, who underwent the follow-up regime, were enrolled in the retrospective analysis. The follow-up mean was 40 months (12-120 months). 25/34 patients had surgery before the radiotherapy. Sixteen underwent SRS with a median dose of 13, 5, and 20 received hypofractionated SBRT with a median dose of 26.9 (22-45 Gy) in median six fractions (5-13 fractions). Local control at 2 and 5 years for all patients was 90 and 70%, respectively. No patient suffered from toxicity > 2 CTC. 21/36 patients showed stable disease, while 8/36 patients showed partial Remission. 7/36 developed recurrent meningioma (five in-field), only one patient with grade 1 meningioma, in a median of 22 months (13-48 months).
CONCLUSION
SFRT was superior to SRS for local control in our analysis of Grade I meningiomas. This might be due to a tendency for higher EQD2 in the PTV with SFRT compared to SRS, which was reduced to avoid brain necrosis in large PTVs. Therefore, SFRT appears preferable for typical meningioma PTVs.
Topics: Humans; Meningioma; Radiosurgery; Meningeal Neoplasms; Retrospective Studies; Radiation Dose Hypofractionation; Follow-Up Studies; Neoplasm Recurrence, Local; Particle Accelerators; Treatment Outcome
PubMed: 36307558
DOI: 10.1007/s00432-022-04450-y