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Neurocirugia (English Edition) 2023To evaluate the efficacy of treatment with linear accelerator-based stereotactic radiosurgery (LINAC) in cerebellopontine angle meningiomas.
OBJECTIVES
To evaluate the efficacy of treatment with linear accelerator-based stereotactic radiosurgery (LINAC) in cerebellopontine angle meningiomas.
METHODS
We analyzed 80 patients diagnosed with cerebellopontine angle meningiomas between 2001 and 2014, treated with stereotactic radiosurgery (SRS), of whom 81.9% (n=68) were women, with an average age of 59.1 years (32-79). SRS was applied as primary treatment in 83.7% (n=67) and in 16.3% (n=13) as an adjuvant treatment to surgery. SRS treatment was provided using LINAC (Varian 600, 6MeV) with M3 micromultilamines (brainLab) and stereotactic frame. The average tumor volume was 3.12cm (0.34-10.36cm) and the coverage dose was 14Gy (12-16Gy). We performed a retrospective descriptive analysis and survival analysis was performed with the Kaplan-Meier method and multivariate analysis to determine those factors predictive of tumor progression or clinical improvement.
RESULTS
After an average follow-up period of 86.9 months (12-184), the tumor control rate was 92.8% (n=77). At the end of the study, there was an overall reduction in tumor volume of 32.8%, with an average final volume of 2.11cm (0-10.35cm). The progression-free survival rate at 5, 10 and 12 years was 98%, 95% and 83.3% respectively. The higher tumor volume (p=0.047) was associated with progression. There was clinical improvement in 26.5% (n=21) of cases and clinical worsening in 16.2% (n=13). Worsening is related to the radiation dose received by the brainstem (p=0.02). Complications were 8.7% (7 cases) of hearing loss, 5% (4 cases) of brain radionecrosis, and 3.7% (3 cases) of cranial nerve V neuropathy. Hearing loss was related to initial tumor size (p=0.033) and maximum dose (p=0.037). The occurrence of radionecrosis with the maximum dose (p=0.037).
CONCLUSIONS
Treatment of cerebellopontine angle meningiomas with single-dose SRS using LINAC is effective in the long term. Better tumor control rates were obtained in patients with small lesions.
Topics: Humans; Female; Middle Aged; Male; Meningioma; Radiosurgery; Treatment Outcome; Meningeal Neoplasms; Retrospective Studies; Cerebellopontine Angle; Follow-Up Studies; Hearing Loss; Neuroma, Acoustic
PubMed: 36842609
DOI: 10.1016/j.neucie.2023.02.001 -
Operative Neurosurgery (Hagerstown, Md.) Apr 2024This approach is suitable for petroclival lesions medial to V cranial nerve that extend in both middle and posterior fossa. It provides multiple surgical corridors with...
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE
This approach is suitable for petroclival lesions medial to V cranial nerve that extend in both middle and posterior fossa. It provides multiple surgical corridors with minimal brain retraction.
ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT
Several critical neurovascular structures of the petrous bone are at risk during the approach. Meticulous reading of the preoperative images is fundamental. It is mandatory to perform a thin section computed tomography scan, an MRI, and, in case of petroclival meningiomas, a digital subtraction angiography.
ESSENTIAL STEPS OF THE PROCEDURE
In the first illustrative case, we present our current "mini-combined petrosectomy" with minimal drilling of the labyrinth. Positioning, skin incision, and craniotomy are illustrated in the video. Once all the important neurovascular structures are identified, we perform the anterior and the posterior petrosectomy, with preservation of the endolymphatic sac. We continue with dura mater opening and tentorium cutting. After tumor removal, we can appreciate an unique view of ipsilateral and contralateral cranial nerves, as well as pituitary stalk and major arteries.
PITFALLS/AVOIDANCE OF COMPLICATIONS
To avoid injuries to the main neurovascular structures, neuronavigation, neuromonitoring, and Doppler can be useful.
VARIANTS AND INDICATIONS FOR THEIR USE
The second illustrative case shows an extension of the combined petrosectomy to the anterior fossa, this made possible to perform a transsylvian approach for this giant sphenopetroclival meningioma. The patients consented to the procedure and to the publication of his/her images. Appropriate consent was obtained for the publication of the cadaveric images.
Topics: Humans; Male; Female; Neurosurgical Procedures; Cranial Fossa, Posterior; Meningioma; Craniotomy; Meningeal Neoplasms
PubMed: 38084942
DOI: 10.1227/ons.0000000000001025 -
International Journal of Molecular... Apr 2024Meningiomas are tumors of the central nervous system that vary in their presentation, ranging from benign and slow-growing to highly aggressive. The standard method for... (Review)
Review
Meningiomas are tumors of the central nervous system that vary in their presentation, ranging from benign and slow-growing to highly aggressive. The standard method for diagnosing and classifying meningiomas involves invasive surgery and can fail to provide accurate prognostic information. Liquid biopsy methods, which exploit circulating tumor biomarkers such as DNA, extracellular vesicles, micro-RNA, proteins, and more, offer a non-invasive and dynamic approach for tumor classification, prognostication, and evaluating treatment response. Currently, a clinically approved liquid biopsy test for meningiomas does not exist. This review provides a discussion of current research and the challenges of implementing liquid biopsy techniques for advancing meningioma patient care.
Topics: Humans; Biomarkers, Tumor; Extracellular Vesicles; Liquid Biopsy; Meningeal Neoplasms; Meningioma; Prognosis
PubMed: 38673779
DOI: 10.3390/ijms25084195 -
Neurosurgical Review Sep 2023Several studies through the years have proven how an unhealthy nutrition, physical inactivity, sedentary lifestyle, obesity, and smoking represent relevant risk factors... (Review)
Review
Several studies through the years have proven how an unhealthy nutrition, physical inactivity, sedentary lifestyle, obesity, and smoking represent relevant risk factors in cancer genesis. This study aims to provide an overview about the relationship between meningiomas and food assumption in the Mediterranean diet and whether it can be useful in meningioma prevention or it, somehow, can prevent their recurrence. The authors performed a wide literature search in PubMed and Scopus databases investigating the presence of a correlation between Mediterranean diet and meningiomas. The following MeSH and free text terms were used: "Meningiomas" AND "Diet" and "Brain tumors" AND "diet." Databases' search yielded a total of 749 articles. After duplicate removal, an abstract screening according to the eligibility criteria has been performed and 40 articles were selected. Thirty-one articles were excluded because they do not meet the inclusion criteria. Finally, a total of 9 articles were included in this review. It is widely established the key and protective role that a healthy lifestyle and a balanced diet can have against tumorigenesis. Nevertheless, studies focusing exclusively on the Mediterranean diet are still lacking. Thus, multicentric and/or prospective, randomized studies are mandatory to better assess and determine the impact of food assumptions in meningioma involvement.
Topics: Humans; Diet, Mediterranean; Meningioma; Prospective Studies; Brain Neoplasms; Meningeal Neoplasms
PubMed: 37736769
DOI: 10.1007/s10143-023-02128-8 -
The Journal of Craniofacial Surgery Oct 2023Solitary fibrous tumor (SFT) is a clinically rare tumor derived from mesenchymal spindle cells. Central nervous system SFT represents only 0.09% of tumors occurring on...
Solitary fibrous tumor (SFT) is a clinically rare tumor derived from mesenchymal spindle cells. Central nervous system SFT represents only 0.09% of tumors occurring on the meninges, while intracranial solitary fibrous tumors (ISFT) are even more rare. Due to the similar genetic characteristics it shares with hemangiopericytoma, in 2016, the World Health Organization (WHO) classified it as a single disease called solitary fibrous tumor (SFT)/hemangiopericytoma. We reported a case of a 60-year-old female with an intracranial solitary fibrous tumor (ISFT). The patient's magnetic resonance imaging showed a mass adhering extensively to the dura mater, with adjacent thickening of the meninges and evidence of a meningeal tail sign. These radiologic findings suggested a meningioma. The tumor was surgically removed and sent for pathologic examination, which confirmed that the tumor was consistent with a solitary fibrous tumor(WHO III). Due to its rarity and similarities with meningioma, ISFT is often misdiagnosed as other types of brain tumors. ISFT is poorly understood and poses a diagnostic challenge. Our case report presents several features suggestive of meningioma, but histopathological examination after surgery confirmed the diagnosis of SFT. Knowledge of these tumors is crucial for neurosurgeons to include them in preoperative differential diagnosis.
Topics: Female; Humans; Middle Aged; Meningioma; Meningeal Neoplasms; Solitary Fibrous Tumors; Hemangiopericytoma; Magnetic Resonance Imaging
PubMed: 37801720
DOI: 10.1097/SCS.0000000000009598 -
Ophthalmology Apr 2024
Topics: Humans; Meningioma; Orbit; Meningeal Neoplasms; Orbital Neoplasms
PubMed: 37367702
DOI: 10.1016/j.ophtha.2023.05.033 -
International Journal of Surgical... Sep 2023Snail family transcriptional repressor 2 (SNAI2, Slug) is a transcription factor that belong to the Slug/Snail superfamily. Site specific phosphorylation of slug (pSlug)...
Snail family transcriptional repressor 2 (SNAI2, Slug) is a transcription factor that belong to the Slug/Snail superfamily. Site specific phosphorylation of slug (pSlug) is detected during the M phase, and thus, this phosphorylated protein is considered a novel marker for detecting mitotic figures. Herein, we investigated whether the detection of mitosis using pSlug expression can be used in the histological grading of meningioma. We performed immunohistochemistry for pSlug and PHH3 in tissue samples of 61 patients with meningioma and examined the association between mitotic counts using pSlug and recurrence-free survival (RFS). The nuclear expression of pSlug was observed in the cell with mitotic figures. Tumor grading based on pSlug was significantly associated with the RFS ( < .001). It can be concluded that pSlug is a useful and practical marker to detect mitosis and seems to be reliable for the counting of mitoses in histological grading of meningioma.
Topics: Humans; Meningioma; Histones; Mitotic Index; Immunohistochemistry; Mitosis; Neoplasm Grading; Meningeal Neoplasms; Biomarkers, Tumor
PubMed: 36172742
DOI: 10.1177/10668969221126121 -
Clinical Infectious Diseases : An... Dec 2023
Topics: Humans; Meningioma; Frontal Lobe; Meningeal Neoplasms
PubMed: 38102806
DOI: 10.1093/cid/ciad521 -
Asian Journal of Surgery Oct 2023
Topics: Humans; Meningioma; Radiosurgery; Treatment Outcome; Retrospective Studies; Meningeal Neoplasms
PubMed: 37244825
DOI: 10.1016/j.asjsur.2023.04.135 -
Atypical meningioma: Histopathological, genetic, and epigenetic features to predict recurrence risk.Histology and Histopathology Mar 2024Grading assessed according to World Health Organization (WHO) criteria is a major prognostic factor for determining the risk of recurrence in patients with meningiomas... (Review)
Review
Grading assessed according to World Health Organization (WHO) criteria is a major prognostic factor for determining the risk of recurrence in patients with meningiomas and establishing the most appropriate therapeutic strategy after surgery. However, the main issue is to predict the recurrence risk of WHO grade 2 meningioma and, more specifically, of the atypical subtype. Indeed, owing to a reported recurrence rate of 50%, either radiotherapy or observation is currently considered an option after gross total surgical resection of atypical meningiomas. These heterogeneous clinical outcomes are likely related to the broad histopathological diagnostic criteria for this subtype, and whether meningiomas only present as brain invasion should be classified as atypical remains controversial. Over the last few years, several studies have shown that DNA methylation profiling, next-generation sequencing, and transcriptomics can better stratify meningiomas for their recurrence risk than histology. The main limitations to the widespread use of these approaches to classify meningiomas are their high cost and the need for sophisticated technologies. However, all studies concurred that atypical meningiomas without chromosome 1p deletion display a low recurrence risk, suggesting that the assessment of this cytogenetic alteration could represent an easy and quick method to determine which patients could benefit from adjuvant treatment after surgery. In addition, prognostically unfavorable molecular groups can be distinguished using specific immunostainings, although further validation is required.
Topics: Humans; Meningioma; Prognosis; Radiotherapy, Adjuvant; Neoplasm Recurrence, Local; Retrospective Studies; Meningeal Neoplasms; Epigenesis, Genetic
PubMed: 37921468
DOI: 10.14670/HH-18-670