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Neurosurgery 1978The author has reviewed the topic of meningiomas. He has discussed especially the clinical presentations of such tumors according to location and has summarized their... (Review)
Review
The author has reviewed the topic of meningiomas. He has discussed especially the clinical presentations of such tumors according to location and has summarized their pathological nature and biological behavior.
Topics: Adult; Child; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local
PubMed: 360097
DOI: 10.1227/00006123-197809000-00016 -
Clinical Neurology and Neurosurgery Sep 2018Leptomeningeal metastasis (LM), which occurs when malignant cells spread to the central nervous system, is becoming an increasingly common complication in patients with... (Review)
Review
Leptomeningeal metastasis (LM), which occurs when malignant cells spread to the central nervous system, is becoming an increasingly common complication in patients with breast cancer. Diagnosis and treatment of LM is challenging. Moreover, prognosis of patients with LM is poor, with a median survival of 6 months after diagnosis. This review highlights the strengths and limitations of currently available diagnostic tools and therapies for LM. The current treatments for LM, including radiotherapy, systemic therapy, and intrathecal treatment, aim to maintain the quality of life of patients by correcting neurological deficits and arresting neurological degeneration. However, there is no standardized therapy for LM because of a lack of randomized trials on this condition.
Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Combined Modality Therapy; Humans; Meningeal Carcinomatosis; Meningeal Neoplasms; Neoplasm Metastasis
PubMed: 30015053
DOI: 10.1016/j.clineuro.2018.07.001 -
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 -
Current Treatment Options in Oncology May 2019Recurrent and refractory meningiomas are a clinical challenge and treatment at the time of recurrence is not well delineated. Treatment with surgery and/or radiation... (Review)
Review
Recurrent and refractory meningiomas are a clinical challenge and treatment at the time of recurrence is not well delineated. Treatment with surgery and/or radiation remain the mainstay, but each has their limitations and risks. The search for an adjuvant systemic therapy continues and as many of the initially promising approaches have not had reproducible responses. Bevacizumab has shown some efficacy in controlling recurrent disease and could be useful in disease that is multifocal or in close proximity to critical structures. Other targeted therapies, as well as immunotherapy, are being studied and trials are in development. Though we are hopeful that these novel therapies will benefit patients with refractory meningiomas, we approach them with some trepidation. This is due to prior failures of immunotherapy and targeted therapy in central nervous system disease. In addition, there is known difficulty in developing trials and assessing response with these slow-growing tumors.
Topics: Combined Modality Therapy; Disease Management; Drug Resistance, Neoplasm; Humans; Meningeal Neoplasms; Meningioma; Recurrence; Retreatment; Treatment Outcome
PubMed: 31073797
DOI: 10.1007/s11864-019-0648-z -
Handbook of Clinical Neurology 2020The incidence of meningiomas is rising and the number of incidental cases is increasing steadily. The efficiency and the safety of each treatment strategy are also...
The incidence of meningiomas is rising and the number of incidental cases is increasing steadily. The efficiency and the safety of each treatment strategy are also improving over time. Therefore the indications to treat meningiomas are constantly changing. The aim of meningioma treatment is keeping the patient fully functional while achieving long-term relief or prevention from problems related to intracranial tumor growth. This chapter reviews the natural history and treatment results and aims to put together the information for the most objective decision-making in treating meningiomas. Factors acting on the treatment decision such as anatomical localization, symptomatology, variations in tumor biology, recurrence status, age and co-morbidities, operative gains, and patient preference are individually discussed.
Topics: Aging; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32553292
DOI: 10.1016/B978-0-12-804280-9.00015-9 -
Journal of Neurosurgery. Pediatrics Aug 2014Meningeal fibromas are rare intracranial tumors that mimic meningiomas radiologically as well as histologically. The authors report 2 cases of meningeal fibroma with...
Meningeal fibromas are rare intracranial tumors that mimic meningiomas radiologically as well as histologically. The authors report 2 cases of meningeal fibroma with detailed clinical, radiological, histopathological, and immunohistochemical features, and discuss the differential diagnosis of this entity. Knowledge of this rare tumor is essential for pathologists to be able distinguish it from more common meningeal tumors, especially in younger patients. This knowledge is also essential for neurosurgeons, as incomplete resection may lead to tumor recurrence, and such patients require close follow-up.
Topics: Adolescent; Child; Diagnosis, Differential; Fibroma; Humans; Male; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local
PubMed: 24950471
DOI: 10.3171/2014.5.PEDS13556 -
Cancer Apr 1988Single meningiomas are histologically classified as benign tumors, but clearly malignant types have been encountered. The standard mode of management is total... (Review)
Review
Single meningiomas are histologically classified as benign tumors, but clearly malignant types have been encountered. The standard mode of management is total macroscopic removal with excision of the dural attachment and abnormal bone, if there is any. Despite this aggressive surgery, recurrence rates of approximately 9% have been reported with the removal of benign tumors, and the rate is much higher with the removal of malignant meningiomas. Recurrence most frequently occurs at the original tumor site and is most often explained by incomplete removal, which, in turn, is a function of the anatomic location of the tumor. Less common are regional recurrences, which may be explained on the basis of the multicentric origin of meningiomas. This theory may also explain the rare entity, "multiple meningioma." This article documents an unexpected regional recurrence of meningioma. The pertinent literature is reviewed.
Topics: Brain; Combined Modality Therapy; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Postoperative Care; Tomography, X-Ray Computed
PubMed: 3278800
DOI: 10.1002/1097-0142(19880401)61:7<1447::aid-cncr2820610728>3.0.co;2-s -
Neurosurgery Clinics of North America Jul 2023High-grade meningiomas (atypical and anaplastic/malignant) are at increased risk of recurrence following primary treatment with maximum safe surgical resection. Evidence... (Review)
Review
High-grade meningiomas (atypical and anaplastic/malignant) are at increased risk of recurrence following primary treatment with maximum safe surgical resection. Evidence based on several retrospective and prospective observational studies suggests an important role of radiation therapy (RT) in both adjuvant and salvage settings. At present, adjuvant RT is recommended for incompletely resected atypical meningiomas and anaplastic meningiomas irrespective of resection extent with disease control benefit. In completely resected atypical meningiomas, the role of adjuvant RT remains debatable but should be considered given the aggressive and resistant nature of recurrent disease. Randomized trials are currently underway and may guide optimal postoperative management.
Topics: Humans; Meningioma; Meningeal Neoplasms; Retrospective Studies; Radiotherapy, Adjuvant; Neoplasm Recurrence, Local; Observational Studies as Topic
PubMed: 37210135
DOI: 10.1016/j.nec.2023.02.013 -
Neurosurgery Clinics of North America Apr 2006Total excision is an appropriate treatment option for patients with benign meningiomas that are resectable with minimal morbidity. It is particularly appropriate for... (Review)
Review
Total excision is an appropriate treatment option for patients with benign meningiomas that are resectable with minimal morbidity. It is particularly appropriate for patients with significant mass effect causing symptoms. Fractionated conformal radiotherapy is an appropriate primary treatment option for patients with benign meningiomas of all sizes and all sites. It is particularly appropriate and preferred for optic nerve sheath meningiomas, for which there are few alternatives. Planned subtotal resection is appropriate if decompression is expected to relieve acute symptoms. After subtotal resection, it is appropriate to offer single-fraction radiosurgery or multifraction radiotherapy, depending on the size, location, and extent of residual tumor, so as to achieve progression-free survival and cause-specific survival rates comparable to those of other approaches.
Topics: Dose Fractionation, Radiation; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Neoplasm Staging; Neurosurgical Procedures; Radiosurgery; Survival Rate
PubMed: 16793503
DOI: 10.1016/j.nec.2006.03.002 -
Cancer Treatment Reviews Feb 2016Leptomeningeal metastasis (LM), i.e. the seeding of tumor cells to the cerebrospinal fluid (CSF) and the leptomeninges, is a devastating and mostly late-stage... (Review)
Review
Leptomeningeal metastasis (LM), i.e. the seeding of tumor cells to the cerebrospinal fluid (CSF) and the leptomeninges, is a devastating and mostly late-stage complication of various solid tumors. Clinical signs and symptoms may include cranial nerve palsies, radicular symptoms, signs of increased intracranial pressure such as headache, nausea and vomiting, and cognitive dysfunction. In cases of suspected LM, the highest diagnostic sensitivity is provided by the combination of CSF cytology and contrast-enhanced MRI (cranial as well as complete spine). The therapeutic spectrum includes radiotherapy of the clinically involved region as well as systemic and intrathecal chemotherapy. The choice of treatment modalities depends on the type of LM (non-adherent tumor cells in the CSF vs. nodular contrast-enhancing tumor growth), additional systemic involvement (uncontrolled vs. controlled systemic disease) and additional involvement of the CNS parenchyma (LM as the only CNS involvement vs. LM+parenchymal CNS metastases). Larger contrast-enhancing nodular LM or symptomatic lesions of the spine may be treated with radiotherapy. In case of uncontrolled systemic disease, the treatment regimen should include systemic chemotherapy. The choice of systemic treatment should take into account the histology of the primary tumor. Intrathecal chemotherapy is most important in cases of LM of the non-adherent type. There are three substances for routine use for intrathecal chemotherapy: methotrexate, cytarabine, and thiotepa. Liposomal cytarabine shows advantages in terms of longer injection intervals, a sufficient distribution in the entire subarachnoid space after lumbar administration and improved quality-of-life. The role of new agents (e.g. rituximab and trastuzumab) for intrathecal therapy is still unclear.
Topics: Antineoplastic Agents; Cytarabine; Humans; Injections, Spinal; Meningeal Neoplasms; Methotrexate; Neoplasm Seeding; Neoplasm Staging; Radiotherapy; Thiotepa; Treatment Outcome
PubMed: 26827696
DOI: 10.1016/j.ctrv.2015.12.004