-
Proteomic data in meningiomas: post-proteomic analysis can reveal novel pathophysiological pathways.Journal of Neuro-oncology Sep 2011Meningiomas account for approximately 20% of adult primary intracranial tumours. WHO I meningiomas are the most common and are generally benign, but can progress, recur... (Review)
Review
Meningiomas account for approximately 20% of adult primary intracranial tumours. WHO I meningiomas are the most common and are generally benign, but can progress, recur or transform to WHO II or WHO III grades over many years. A systematic review of multiple independent shotgun proteomic analyses of meningioma was performed to provide insight into underlying disease pathways. Shotgun proteomics has been conducted in seven meningioma related studies but there is considerable variation in aims, methodology, statistical power and the use of control tissue between these studies. Fifteen proteins which are different between WHO I and WHO II meningiomas and nine proteins which are different between WHO II and WHO III meningiomas have been described but without a view of their biological significance. Network analysis of proteins different between WHO I and WHO II meningiomas provided a coherent hypothesis for the involvement of these proteins in meningioma. Western blot analyses of meningioma tissue provided a measure of support for a core component in the network (involving VDAC2, APOA1 and HNF4α) but highlighted intrinsic difficulty of proteomic and biochemical analysis of meningiomas (as a consequence of gross alterations in tissue composition). Systematic review of shotgun proteomics and network analysis provides insight into meningioma pathophysiology despite the many barriers and difficulties that are inherent to this type of study.
Topics: Blotting, Western; Brain Neoplasms; Humans; Meningioma; Proteomics
PubMed: 21222216
DOI: 10.1007/s11060-010-0526-9 -
Journal of Neuro-oncology Nov 2021Glioblastoma is an aggressive cancer with a notoriously poor prognosis. Recent advances in treatment have increased overall survival, though this may be accompanied by...
INTRODUCTION
Glioblastoma is an aggressive cancer with a notoriously poor prognosis. Recent advances in treatment have increased overall survival, though this may be accompanied by an increased incidence of leptomeningeal disease (LMD). LMD carries a particularly severe prognosis and remains a late stage manifestation of glioblastoma without satisfactory treatment. The objective of this review is to survey the literature on treatment of LMD in glioblastoma and to more fully characterize the current therapeutic strategies.
METHODS
The authors performed a systematic review following PRISMA criteria on PubMed and OVID databases. Articles that included adult patients with LMD from glioblastoma were retrieved and reviewed.
RESULTS
LMD in glioblastoma patients is increasing in incidence, with reports of up to 21%. The overall survival without treatment is alarmingly brief, with patients surviving between 1.6-3.8 months. All studies showed that treatment does improve overall survival significantly, increasing to 11.7 months in one study. However, no one adjuvant or surgical therapy has been shown to improve survival in LMD significantly over another. Direct treatment methods include chemotherapy (standard, anti-angiogenic, intrathecal, immunotherapy), and radiation. Hydrocephalus is a complication in LMD that can be treated with ventriculoperitoneal shunt placement, however treating hydrocephalus and delivering intrathecal chemotherapy is a challenge.
CONCLUSION
Though evidence remains lacking and there is no consensus, treatments show a trend towards improving survival and should be considered on a case-by-case basis. Further studies are necessary in the pursuit of a standard of care.
Topics: Glioblastoma; Humans; Meningeal Neoplasms; Prognosis
PubMed: 34623599
DOI: 10.1007/s11060-021-03864-x -
Neurology Oct 2015Whether adiposity and lack of physical activity affect the risk for developing meningioma and glioma is poorly understood. Our objective was to characterize these... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Whether adiposity and lack of physical activity affect the risk for developing meningioma and glioma is poorly understood. Our objective was to characterize these associations in detail.
METHODS
We conducted a systematic review and meta-analysis of adiposity and physical activity in relation to meningioma and glioma using cohort and case-control studies published through February 2015. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
We identified 12 eligible studies of body mass index (BMI) and 6 studies of physical activity, comprising up to 2,982 meningioma cases and 3,057 glioma cases. Using normal weight as the reference group, overweight (summary relative risk [RR] = 1.21, 95% confidence interval [CI] = 1.01-1.43) and obesity (RR = 1.54, 95% CI = 1.32-1.79) were associated with increased risk of meningioma. In contrast, overweight (RR = 1.06, 95% CI = 0.94-1.20) and obesity (RR = 1.11, 95% CI = 0.98-1.27) were unrelated to glioma. Similarly, dose-response meta-analyses revealed a statistically significant positive association of BMI with meningioma, but not glioma. High vs low physical activity levels showed a modest inverse relation to meningioma (RR = 0.73, 95% CI = 0.61-0.88) and a weak inverse association with glioma (RR = 0.86, 95% CI = 0.76-0.97). Relations persisted when the data were restricted to prospective studies, except for the association between physical activity and glioma, which was rendered statistically nonsignificant (RR = 0.91, 95% CI = 0.77-1.07).
CONCLUSIONS
Adiposity is related to enhanced risk for meningioma but is unassociated with risk for glioma. Based on a limited body of evidence, physical activity is related to decreased risk of meningioma but shows little association with risk of glioma.
Topics: Body Mass Index; Brain Neoplasms; Case-Control Studies; Exercise; Glioma; Humans; Meningeal Neoplasms; Meningioma; Motor Activity; Obesity; Prospective Studies; Risk Factors
PubMed: 26377253
DOI: 10.1212/WNL.0000000000002020 -
World Neurosurgery Aug 2019Preoperative embolization (POE) of meningioma has been established to facilitate surgical resection, which may reduce intraoperative blood loss and surgical time.... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Preoperative embolization (POE) of meningioma has been established to facilitate surgical resection, which may reduce intraoperative blood loss and surgical time. However, no consensus has been achieved in meningioma treatment and no meta-analysis has been conducted. The purpose of this study was to perform a systematic review and meta-analysis and provide evidence of the efficacy of meningioma treatment with POE and direct surgery.
METHODS
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic search was performed using PubMed and EMBASE. Meta-analysis was performed using the risk ratio of overall complication, mean difference (MD) of blood loss, and surgical time. The I statistic was used to assess the heterogeneity.
RESULTS
Eight studies (1 randomized controlled trial and 7 non-randomized controlled trials) were included, in which 510 patients met the inclusion criteria. We found that preoperative embolization for patients with meningioma did not increase the overall complication rate (risk ratio = 0.92, 95% confidence interval [CI] 0.61-1.38) and can significantly reduce intraoperative blood loss (MD = -65.10, 95% CI -124.76 to -20.82) and surgical time (MD = -38.48, 95% CI -64.03 to -12.93) compared with the control patients. No significant publication bias was observed.
CONCLUSIONS
This meta-analysis supports the hypothesis that POE of meningioma is a useful adjunct in meningioma treatment. This technique helps reduce blood loss and surgical time during meningioma resection.
Topics: Blood Loss, Surgical; Embolization, Therapeutic; Humans; Meningeal Neoplasms; Meningioma; Neurosurgical Procedures; Operative Time; Postoperative Complications; Preoperative Care
PubMed: 30954743
DOI: 10.1016/j.wneu.2019.02.223 -
Clinical Neurology and Neurosurgery Aug 2021The proportion of elderly patients with intracranial meningiomas is increasing as the life expectancy has improved. Increasing age is classically believed to be... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The proportion of elderly patients with intracranial meningiomas is increasing as the life expectancy has improved. Increasing age is classically believed to be associated with higher perioperative morbidity and mortality in neurosurgical patients.
METHODS
We performed a systematic literature search in 'PUBMED' and 'EMBASE' databases and reviewed all the studies comparing outcomes of surgery between young and elderly patients with intracranial meningiomas (IM). Data related to 3-month mortality rates, length of hospital stay and complications, preoperative status and comorbidity, meningioma size, location, histology, peritumoral edema, and grade of excision were extracted and analyzed.
RESULTS
Thirteen retrospective studies fulfilled the eligibility criteria out of the 893 reviewed articles. Pooled analysis showed that the 3-month mortality rate (4.65% versus 1.42%) and length of stay (10d versus 6.8d) for elderly patients were significantly higher as compared to the young population. The rates of cardio-respiratory complications (16.3% v/s 8.3%), intracranial hemorrhage (10.2% v/s 4.2%) and new-onset neurologic deficit (20.7% v/s 10.1%) were also significantly high in the elderly group as compared to the young patients. Moreover, a higher prevalence of associated comorbidities and poor performance score was noted in the elderly patients of IM.
CONCLUSIONS
The overall mortality rate and rates of perioperative complications (cardio-respiratory, neurologic, intracranial hemorrhage) after surgery in elderly patients with IM patients are higher as compared to young patients and should be kept in mind when formulating treatment strategy for IM in this patient population.
Topics: Adult; Age Factors; Aged; Brain Neoplasms; Humans; Meningeal Neoplasms; Meningioma; Middle Aged; Treatment Outcome
PubMed: 34245986
DOI: 10.1016/j.clineuro.2021.106772 -
Maturitas Aug 2004Thousands of women are treated each year for cancer; many of these are already in menopause, while other younger patients will go into early menopause due to surgery, or... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Thousands of women are treated each year for cancer; many of these are already in menopause, while other younger patients will go into early menopause due to surgery, or chemotherapy, or the need for radiotherapy to the pelvic region. In most cases the oncologist and the gynaecologist would advise these women against the use of HRT. The purpose of this paper is to review biological and clinical evidences in favour and against HRT use in the different tumours and to propose an algorithm that can help choosing the treatment for the single woman.
METHODS
We performed a systematic literature review through April 2002 concerning: (1) biological basis of hormonal modulation of tumour growth; (2) epidemiological data on the impact of HRT on different cancers risk in healthy women; (3) safety of HRT use in cancer survivors; (4) alternatives to HRT.
RESULTS
With the exception of meningioma, breast and endometrial cancer, there is no biological evidence that HRT may increase recurrence risk. In women with previous breast and endometrial cancer HRT is potentially hazardous on a biological basis, even if published data do not show any worsening of prognosis.
CONCLUSIONS
Even if a cautious approach to hormonal-dependent neoplasias is fully comprehensible and the available alternative treatment should be taken into greater consideration, the reticence to prescribe HRT in women previously treated for other non hormone-related tumours has neither a biological nor a clinical basis. An algorithm based on present knowledge is proposed.
Topics: Breast Neoplasms; Colonic Neoplasms; Endometrial Neoplasms; Female; Hormone Replacement Therapy; Humans; Kidney Neoplasms; Liver Neoplasms; Lung Neoplasms; Melanoma; Meningioma; Menopause; Neoplasms; Ovarian Neoplasms; Risk Factors; Survivors; Thyroid Neoplasms; Urinary Bladder Neoplasms; Uterine Cervical Neoplasms; Vulvar Neoplasms
PubMed: 15283925
DOI: 10.1016/j.maturitas.2003.09.031 -
Acta Neurochirurgica Oct 2017Surgical innovation is different from the introduction of novel pharmaceuticals. To help address this, in 2009 the IDEAL Collaboration (Idea, Development, Exploration,... (Review)
Review
BACKGROUND
Surgical innovation is different from the introduction of novel pharmaceuticals. To help address this, in 2009 the IDEAL Collaboration (Idea, Development, Exploration, Assessment, Long-term follow-up) introduced the five-stage framework for surgical innovation. To evaluate the framework feasibility for novel neurosurgical procedure introduction, two innovative surgical procedures were examined: the endoscopic endonasal approach for skull base meningiomas (EEMS) and the WovenEndobridge (WEB device) for endovascular treatment of intracranial aneurysms.
METHODS
The published literature on EEMS and WEB devices was systematically reviewed. Identified studies were classified according to the IDEAL framework stage. Next, studies were evaluated for possible categorization according to the IDEAL framework.
RESULTS
Five hundred seventy-six papers describing EEMS were identified of which 26 papers were included. No prospective studies were identified, and no studies reported on ethical approval or patient informed consent for the innovative procedure. Therefore, no clinical studies could be categorized according to the IDEAL Framework. For WEB devices, 6229 articles were screened of which 21 were included. In contrast to EEMS, two studies were categorized as 2a and two as 2b.
CONCLUSION
The results of this systematic review demonstrate that both EEMS and WEB devices were not introduced according to the (later developed in the case of EEMS) IDEAL framework. Elements of the framework such as informed consent, ethical approval, and rigorous outcomes reporting are important and could serve to improve the quality of neurosurgical research. Alternative study designs and the use of big data could be useful modifications of the IDEAL framework for innovation in neurosurgery.
Topics: Humans; Informed Consent; Intracranial Aneurysm; Meningioma; Neurosurgical Procedures; Prospective Studies; Skull Base Neoplasms; Therapies, Investigational; Treatment Outcome
PubMed: 28780715
DOI: 10.1007/s00701-017-3280-3 -
Endonasal endoscopic transsphenoidal excision of tuberculum sellae meningiomas: a systematic review.Journal of Neurosurgical Sciences Dec 2016The endonasal endoscopic approach (EEA) for the resection of tuberculum sellae meningiomas (TSMs) has, more recently, been advocated as an alternative approach to deal... (Review)
Review
INTRODUCTION
The endonasal endoscopic approach (EEA) for the resection of tuberculum sellae meningiomas (TSMs) has, more recently, been advocated as an alternative approach to deal with this challenging tumor. The aim of this study was to conduct a systematic review of publications of TSMs excised through the transsphenoidal route in the past 10 years and review data on the extent of excision, visual outcomes and complication rates.
EVIDENCE ACQUISITION
We performed a thorough systematic review of the medical literature following the PRISMA guidelines. A medical librarian retrieved a list of 3443 articles published from 2006-2015 from the MEDLINE, EMBASE and Cochrane Central databases. Two of the authors independently screened for titles and abstracts and excluded 3340 of them. We reviewed the full text of the remaining 103 articles and included in our analysis 12 that met the following inclusion criteria: 1) 5 or more cases reported; 2) the extent of resection, visual outcomes and complication rates that were specifically documented for TSMs excised through the transsphenoidal route.
EVIDENCE SYNTHESIS
Twelve studies that included 150 patients were analyzed. The mean age was 55 years. The mean tumor volume, reported in 2 studies, was 6.6 cc and mean maximum diameter, reported in 11 studies, was 25 mm. The gross total resection rate was 77.2%. Vision improved in 79.5% of cases and deteriorated in 7.3%. CSF leak postoperatively occurred in 15.3% of patients. In the 11 studies that reported hormonal outcomes, there was a 9.4% transient hyponatremia or diabetes insipidus and 2.2% of patients developed a new permanent endocrine dysfunction. A symptomatic vascular injury was reported in 2.6% of patients. There was one mortality (0.6%).
CONCLUSIONS
The endonasal endoscopic transsphenoidal excision of TSMs is a feasible, safe and effective surgical option with a low morbidity and mortality. The use of this approach has evolved in the last 10 years and in some centers has replaced the transcranial route for selected cases. Given the limited availability and heterogeneity of comparative observational studies, a direct comparison with transcranial approaches was not performed for the purpose of this review analysis. Likewise, from an epidemiological and statistical perspective a meta-analysis was deemed inappropriate.
Topics: Endoscopy; Humans; Meningeal Neoplasms; Meningioma; Neurosurgical Procedures; Skull Base Neoplasms; Supratentorial Neoplasms
PubMed: 27280544
DOI: No ID Found -
Neuro-oncology Oct 2017With the release of the 2016 edition of the World Health Organization (WHO) Classification of Central Nervous System Tumors, brain invasion in meningiomas has been added... (Review)
Review
With the release of the 2016 edition of the World Health Organization (WHO) Classification of Central Nervous System Tumors, brain invasion in meningiomas has been added as a stand-alone criterion for atypia and can therefore impact grading and indirectly adjuvant therapy. Regarding this rising clinical importance, we have reviewed the current knowledge about brain invasion with emphasis on its implications on current and future clinical practice. We found various definitions of brain invasion and approaches for evaluation in surgically obtained specimens described over the past decades. This heterogeneity is reflected by weak correlation with prognosis and remains controversial. Similarly, associated clinical factors are largely unknown. Preoperative, imaging-guided detection of brain invasion is unspecific, and intraoperative assessment using standard and new high-magnification microscopic techniques remains imprecise. Despite the increasing knowledge about molecular alterations of the tumor/ brain surface, pharmacotherapeutic options targeting brain invasive meningiomas are lacking. Finally, we summarize the impact of brain invasion on histopathological grading in the WHO classifications of brain tumors since 1979.In conclusion, standardized neurosurgical sampling and neuropathological analyses could improve diagnostic reliability and reproducibility of future studies. Further research is needed to improve pre- and intraoperative visualization of brain invasion and to develop adjuvant, targeted therapies.
Topics: Brain Neoplasms; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Grading; Neoplasm Invasiveness; World Health Organization
PubMed: 28419308
DOI: 10.1093/neuonc/nox071 -
Journal of Neurosurgery Aug 2013As endovascular techniques have become more advanced, preoperative embolization has become an increasingly used intervention in the management of meningiomas. To date,... (Review)
Review
OBJECT
As endovascular techniques have become more advanced, preoperative embolization has become an increasingly used intervention in the management of meningiomas. To date, however, no consensus has been reached on the use of this technique. To clarify the role of preoperative embolization in the management of meningiomas, the authors conducted a systematic review of case reports, case series, and prospective studies to increase the current understanding of the management options for these common lesions and complications associated with preoperative embolization.
METHODS
A PubMed search was performed to include all relevant studies in which the management of intracranial meningiomas with preoperative embolization was reported. Immediate complications of embolization were reported as major (sustained) or minor (transient) deficits, death, or no neurological deficits.
RESULTS
A total of 36 studies comprising 459 patients were included in the review. Among patients receiving preoperative embolization for meningiomas, 4.6% (n = 21) sustained complications as a direct result of embolization. Of the 21 patients with embolization-induced complications, the incidence of major complications was 4.8% (n = 1) and the mortality rate was 9.5% (n = 2).
CONCLUSIONS
Preoperative embolization is associated with an added risk for morbidity and mortality. Preoperative embolization may be associated with significant complications, but careful selection of ideal cases for embolization may help reduce any added morbidity with this procedure. Although not analyzed in the authors' study, embolization may still reduce rates of surgical morbidity and mortality and therefore may still have a potential benefit for selected patients. Future prospective studies involving the use of preoperative embolization in certain cases of meningiomas may further elucidate its potential benefit and risks.
Topics: Combined Modality Therapy; Embolization, Therapeutic; Humans; Meningeal Neoplasms; Meningioma; Preoperative Care
PubMed: 23581584
DOI: 10.3171/2013.3.JNS121328