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1.
World Neurosurg. 2018 Oct;118:399. doi: 10.1016/j.wneu.2018.07.094.

Dynamic Intraoperative Assessment of Draining Veins in Parasagittal Meningiomas: Changing the Paradigm?

Author information

1
Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", Milan, Italy.
2
Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", Milan, Italy. Electronic address: francesco.acerbi@istituto-besta.it.
PMID:
30248822
DOI:
10.1016/j.wneu.2018.07.094
[Indexed for MEDLINE]
Icon for Elsevier Science
2.
Clin Nucl Med. 2018 Sep;43(9):648-654. doi: 10.1097/RLU.0000000000002233.

Combined 68Ga-NOTA-PRGD2 and 18F-FDG PET/CT Can Discriminate Uncommon Meningioma Mimicking High-Grade Glioma.

Author information

1
Department of Nuclear Medicine, Beijing Tiantan Hospital, Beijing, China.
2
Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD.
3
Department of Radiology, Stanford University, Stanford, CA.

Abstract

OBJECTIVES:

Uncommon pathological subtypes of meningioma may present with severe peritumoral brain edema and mimic high-grade glioma (HGG). In a prospective cohort study of Ga-NOTA-PRGD2 PET/CT to evaluate glioma, we occasionally observed that a combination of Ga-NOTA-PRGD2 and F-FDG was able to differentiate these 2 lesion types.

METHODS:

From 2013 to 2016, 21 patients suspected of HGG by MRI were recruited for evaluation using Ga-NOTA-PRGD2 PET/CT. Brain F-FDG PET/CT was performed within 3 days for comparison, and the tumor was surgically removed. The PET results were compared with integrin αvβ3 expression and microvascular density quantification of tumor samples.

RESULTS:

Of the 21 recruited patients, 5 patients were finally pathologically diagnosed as uncommon meningioma with severe peritumoral brain edema, including chordoid meningioma (n = 1), angiomatous meningioma (n = 1), and mixed angiomatous and microcystic meningioma (n = 3). Sixteen were diagnosed as HGG. All the meningioma lesions (n = 5) exhibited intense and homogeneous Ga-NOTA-PRGD2 uptake with higher SUVmax on Ga-NOTA-PRGD2 PET (1.64-7.86; mean ± SD, 4.23 ± 2.48) than the HGG lesions (0.81-2.99; mean ± SD, 1.57 ± 0.33; P = 0.0047). Moreover, the uptake ratios of Ga-NOTA-PRGD2 over F-FDG, normalized as lg100 * SUVmax (RGD / FDG), in the uncommon meningiomas were significantly higher than those in HGG (1.87 ± 1.36 vs 1.04 ± 0.87, P = 0.0001). A cutoff value of 1.58 was able to discriminate between these lesion types. There were positive correlations among the expression level of integrin αvβ3, microvascular density, and the tumor-to-background ratio derived from Ga-NOTA-PRGD2 PET (P < 0.05).

CONCLUSIONS:

This study reveals a specific imaging pattern of uncommon meningioma mimicking HGG, in which Ga-NOTA-PRGD2 PET provided added value to F-FDG PET.

PMID:
30052597
DOI:
10.1097/RLU.0000000000002233
[Indexed for MEDLINE]
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3.
World Neurosurg. 2018 Aug;116:474. doi: 10.1016/j.wneu.2018.03.168.

Letter to the Editor Regarding "Minimally Invasive Approaches for Anterior Skull Base Meningiomas: Supraorbital Eyebrow, Endoscopic Endonasal, or Combination of Both? Anatomic Study, Limitations, and Surgical Application".

Author information

1
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr City, Cairo, Egypt. Electronic address: nagm@shinshu-u.ac.jp.
2
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
PMID:
30049028
DOI:
10.1016/j.wneu.2018.03.168
[Indexed for MEDLINE]
Icon for Elsevier Science
4.
World Neurosurg. 2018 Sep;117:366-370. doi: 10.1016/j.wneu.2018.06.162. Epub 2018 Jul 20.

Multiple Extradural Spinal Meningiomas in a Patient with Acquired Immunodeficiency Syndrome: Case Report and Literature Review.

Author information

1
Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA.
2
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. Electronic address: ohariri@stanford.edu.
3
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.

Abstract

BACKGROUND:

Purely extradural spinal meningiomas are uncommon. Due to their typical location in the neural foramen, they are often mistaken for schwannomas, neurofibromas, and epidural metastases. In addition, comorbid conditions such as immunodeficiency may obscure the diagnosis. We present a case of extradural spinal meningiomas in a patient with human immunodeficiency virus (HIV). This is the first reported case of multiple extradural spinal meningiomas in 2 separate regions of the spine.

CASE DESCRIPTION:

A 40-year-old male with a past medical history of HIV and hepatitis B infection presented with a 2-month history of progressive back pain radiating to the left flank and thigh. Magnetic resonance imaging of the thoracic and lumbar spine with intravenous gadolinium contrast revealed 2 extramedullary masses in the left neural foramina of T6 and L1. The patient underwent laminectomy, which revealed that the 2 lesions were entirely extradural. Both lesions were resected, and the histological diagnosis for both lesions was meningioma, World Health Organization grade I.

CONCLUSIONS:

Our experience with this 40-year-old male with AIDS who presented with radicular symptoms due to multiple purely extradural meningiomas underscores the importance of considering meningioma as a possible diagnosis in patients with tumors of the neural foramina. In addition, a wide differential diagnosis should be made for patients with spinal lesions and history of HIV, including illnesses that are related to immunodeficiency and those that are not.

KEYWORDS:

Epidural; Extradural; Meningioma; Spine oncology

PMID:
29966786
DOI:
10.1016/j.wneu.2018.06.162
[Indexed for MEDLINE]
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5.
6.
World Neurosurg. 2018 Jul;115:483-484. doi: 10.1016/j.wneu.2018.03.106.

"Wounded Meningioma Syndrome": Postoperative Exacerbation of Brain Edema in Brain-Invasive Meningioma.

Author information

1
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
2
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: nima_med83@yahoo.com.
PMID:
29958375
DOI:
10.1016/j.wneu.2018.03.106
[Indexed for MEDLINE]
Icon for Elsevier Science
7.
World Neurosurg. 2018 Sep;117:e637-e644. doi: 10.1016/j.wneu.2018.06.103. Epub 2018 Jun 22.

Mini-Pterional Craniotomy for Resection of Parasellar Meningiomas.

Author information

1
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
2
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. Electronic address: michael-sughrue@ouhsc.edu.

Abstract

BACKGROUND:

Surgical resection of parasellar meningiomas is a challenging operation that traditionally has been performed with a large pterional or orbitozygomatic craniotomy. In this study, we report patient outcomes and detail our surgical approach when resecting these tumors with a smaller, less invasive "mini-pterional" craniotomy.

METHODS:

We performed a retrospective review on all patients undergoing a mini-pterional craniotomy for resection of parasellar meningiomas from 2012 to 2016. We describe the technical aspects of the mini-pterional craniotomy and provide the outcomes of patients who received an operation with this approach.

RESULTS:

Twenty-four patients were treated with a mini-pterional craniotomy for resection of parasellar meningiomas. Median tumor volume was 6.2 cm3. Twenty-two of 24 (92%) patients had a World Health Organization grade I meningioma, and 2 of 24 (8%) patients had a World Health Organization grade II meningioma. Tumors were located at the medial sphenoid wing (60%), anterior clinoid (24%) and spheno-cavernous junction (12%). Nineteen of 24 (79%) patients had a Simpson Grade I resection and 5 of 24 (21%) a Simpson Grade IV resection. Median length of the operations was 242 minutes. Neurosurgical complications occurred in 2 patients who had a surgical-site infection and cerebrospinal fluid leak; one of these patients also developed postoperative hydrocephalus. In this series, no deaths, parenchymal contusions, or repeat operations occurred.

CONCLUSIONS:

The mini-pterional craniotomy can be used to resect parasellar meningiomas with good results and a low complication profile. This approach provides an efficacious method of resecting these tumors without sacrificing Simpson grade or patient safety.

KEYWORDS:

Keyhole; Meningioma; Middle fossa; Mini-pterional; Parasellar

PMID:
29940385
DOI:
10.1016/j.wneu.2018.06.103
[Indexed for MEDLINE]
Icon for Elsevier Science
8.
Clin Nucl Med. 2018 Sep;43(9):e338-e340. doi: 10.1097/RLU.0000000000002183.

Detection of Metastatic Meningioma to the Liver Using 68Ga-DOTA-Octreotate PET/CT.

Author information

1
From the Departments of Radiology and Biomedical Imaging.
2
Neurological Surgery, and.
3
Pathology, University of California San Francisco, San Francisco, CA.

Abstract

We present a case of metastatic meningioma detected on Ga-DOTA-octreotate PET. A 52-year-old woman presented with multiply recurrent multifocal meningioma. A staging Ga-DOTATATE PET/CT demonstrated focal radiotracer uptake within the known intracranial meningiomas. In addition, a DOTATATE-avid mass was found in the liver that was biopsied, confirming metastatic meningioma. This report suggests that Ga-DOTATATE PET/CT should be considered whenever screening meningioma patients for metastases.

PMID:
29939957
DOI:
10.1097/RLU.0000000000002183
[Indexed for MEDLINE]
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9.
Ophthalmic Plast Reconstr Surg. 2018 Sep/Oct;34(5):e147-e148. doi: 10.1097/IOP.0000000000001155.

Primary Extracranial Meningioma of the Lacrimal Sac Fossa.

Author information

1
Allure Laser Center & Medispa, Kirkland, Washington, U.S.A.
2
Department of Ophthalmology, University of Washington, Seattle, Washington, U.S.A.
3
Incyte Diagnostics Bellevue, Washington, U.S.A.

Abstract

Primary extracranial meningioma is a rare tumor, unlike its common intracranial counterpart. Infrequently found in the head and neck region, it can cause local or neurologic symptoms depending on its location and interaction with cranial nerves. While uncommon, it is an important diagnosis to have on the differential of periorbital lesions as surgical removal and prognosis are generally good. The authors present the first report of a patient with primary extracranial meningioma originating in the lacrimal sac fossa.

PMID:
29905637
DOI:
10.1097/IOP.0000000000001155
[Indexed for MEDLINE]
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10.
World Neurosurg. 2018 Sep;117:65. doi: 10.1016/j.wneu.2018.06.013. Epub 2018 Jun 12.

Arteries Paving the Way for Centrifugal Excision of Anterior Clinoidal Meningioma.

Author information

1
Department of Neurosurgery, PGIMER, Chandigarh, India. Electronic address: drpravin_salunke@yahoo.co.uk.
2
Department of Neurosurgery, PGIMER, Chandigarh, India.

Abstract

The anterior clinoidal meningiomas often engulf/encase or compress the internal carotid artery (ICA) and its branches, the optic nerve (ON), and structures passing through the superior orbital fissure (SOF). The transsylvian route of excising a tumor poses difficulty in exposing and safeguarding encased vessels. In addition, it may jeopardize the bulging brain and stretched veins, especially in large tumors. The objective is to present an operative video to demonstrate the technique of "centrifugal opening" and removal of anterior clinoidal meningiomas. The ICA, ON, and SOF are exposed after extradural anterior clinoidectomy. The dural base is devascularized and incised radially. Cuts start proximally from these neurovascular structures. The tumor is then debulked and removed by tracing these structures from proximal to distal. The arachnoid and veins are preserved. Early identification of the ICA, ON, and SOF provides better control and allows preservation of these structures despite their engulfment, encasement, or compression. The perforators and arteries are skeletonized in a stepwise manner to achieve maximal safe resection. Even with brain edema, the arachnoid and adjacent veins can be preserved. The technique was used by the authors in >15 cases with good outcome. Thus the discussed technique imparts better control of neurovascular structures with minimal handling of adjacent brain and veins, thereby allowing a more aggressive resection.

KEYWORDS:

Anterior clinoidal meningioma; Encased vessels; Extradural; Perforators; Surgical technique

PMID:
29902604
DOI:
10.1016/j.wneu.2018.06.013
[Indexed for MEDLINE]
Icon for Elsevier Science
11.
Medicine (Baltimore). 2018 Jun;97(24):e11123. doi: 10.1097/MD.0000000000011123.

Extracranial-intracranial bypass in medial sphenoid ridge meningioma associated with severe stenosis of the intracranial segments of the internal carotid artery: A case report.

Author information

1
Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China.

Abstract

RATIONALE:

Tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery (ICA) of intracranial segments has been rarely presented. Effective treatment as to the complex lesions may be complicated. Tumor resection and cerebrovascular protection should be both taken into consideration.

PATIENT CONCERNS:

We presented one case of medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments. The patient suffered hyperthyroidism, mirror-image dextrocardia and congenital heart disease atrial septal defect simultaneously.

DIAGNOSES:

Before the neurosurgical treatment , the colleagues of department of cardiac surgery, anesthesiology and respiratory medicine agreed on our plan of resecting the tumor following the comprehensive evaluation of basal clinical conditions in the patient. For reducing the bleeding intraoperatively, the interventional branch performed digital subtraction angiography(DSA) and found collateral anastomosis between the supplying vessels of left middle meningeal arteries and anterior choroid arteries. No preoperative interventional embolization was determined considering the risk of cerebral ischemia.

INTERVENTIONS:

The following subtotal resection of medial sphenoid ridge meningioma and left extracranial-intracranial bypass were carried out. Additionally, ipsilateral decompressive craniectomy was done. Post-operative imaging Computed tomography (CT), Computed tomography angiography (CTA) and Transcranial Doppler (TCD) indicated subtotal resection of tumor and bypass patency.

OUTCOMES:

The patient was discharged with the right limbs of muscle strength of grade IV. The muscle strength of the patient returned to grade V after 6 months of follow-up.

LESSONS:

Comprehensive treatment of tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments is effective.

PMID:
29901637
PMCID:
PMC6023708
DOI:
10.1097/MD.0000000000011123
[Indexed for MEDLINE]
Free PMC Article
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12.
Cutis. 2018 May;101(5):386-389.

Metastatic meningioma of the scalp.

Author information

1
Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Abstract

Meningiomas generally present as slow-growing, expanding intracranial lesions and are the most common benign intracranial tumor in adults. Rarely, meningiomas can exhibit malignant potential and present as extracranial soft-tissue masses through extension or as primary extracranial cutaneous neoplasms. Although they are uncommonly encountered by dermatologists, it is important to include meningioma in the differential diagnosis for scalp neoplasms. We present a rare case of a 68-year-old woman with scalp metastasis of meningioma 11 years after initial resection of the primary tumor.

PMID:
29894530
[Indexed for MEDLINE]
Icon for Frontline Medical Communications Inc
13.
World Neurosurg. 2018 Sep;117:20-24. doi: 10.1016/j.wneu.2018.05.243. Epub 2018 Jun 8.

A Unique Case of Recurrent Intracranial Extravascular Papillary Endothelial Hyperplasia After Gross Total Resection and Brachytherapy.

Author information

1
Division of Neurosurgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
2
Division of Pathology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
3
Division of Neurosurgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. Electronic address: Shabbar.Danish@rutgers.edu.

Abstract

BACKGROUND:

Extravascular papillary endothelial hyperplasia (EPEH) is an extremely uncommon form of papillary endothelial hyperplasia characterized by an exuberant reactive endothelial proliferation in areas of extravascular hemorrhage rather than within the vascular lumen. Intracranial EPEH is known to develop after radiosurgery in patients with intracranial neoplasms, suggesting a causative relationship between radiotherapy and the development of EPEH. Intracranial EPEH is typically treated with surgical resection; to date, there have been no reported cases of EPEH recurrence after gross total resection.

CASE DESCRIPTION:

A 75-year-old man with a history of atypical meningioma presented to our hospital with progressive right upper and lower extremity weakness. Eight and a half years before admission, he had undergone surgical resection and stereotactic radiosurgery for a World Health Organization grade II meningioma. Several years later, he experienced a mass in the prior resection cavity and was subsequently treated with gross total resection and cesium-131 brachytherapy seeds. Postoperative pathologic examination of the resected tissue at that time showed EPEH with no evidence of recurrent atypical meningioma. On this admission, magnetic resonance imaging showed a recurrent mass in the area of prior resection, at which time the patient underwent a third craniotomy and gross total resection. Postoperative histopathologic examination showed findings consistent with the diagnosis of recurrent EPEH.

CONCLUSIONS:

This case report is the first known recurrence of intracranial EPEH occurring after gross total resection and brachytherapy.

KEYWORDS:

Extravascular papillary endothelial hyperplasia; Masson hemangioma; Radiotherapy; Stereotactic radiosurgery

PMID:
29890275
DOI:
10.1016/j.wneu.2018.05.243
[Indexed for MEDLINE]
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14.
Medicine (Baltimore). 2018 Jun;97(23):e11019. doi: 10.1097/MD.0000000000011019.

A rare subtype of meningioma: Case series of anaplastic meningioma and review of the literature.

Author information

1
Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences of China Medical University.
2
Department of Hepatobiliary and Spleenary Surgery, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China.

Abstract

RATIONALE:

Anaplastic meningioma, a rare subtype of meningioma, has malignant morphological characteristics and a World Health Organization (WHO) grade of III.

PATIENT CONCERNS:

In this report, we present findings from 6 cases of anaplastic meningioma.

DIAGNOSES:

Pathological examination of the tumors, including hematoxylin and eosin staining and immunohistochemical staining, was performed. Of the six cases of anaplastic meningioma, two were recurrent tumors from original seminoma with a WHO grade of I. Histologically, three cases had carcinoma-like morphology, one case had sarcoma-like morphology, and two had two kinds of tissue structures: carcinoma-like tumor cell nests and areas with spindle tumor cells. Necrosis was detected in most cases (5/6). Ki67 index was high and varied from 20% to 70%.

INTERVENTIONS:

All the patients received surgery. 3 patients received adjuvant radiotherapy. 1 patient received chemotherapy.

OUTCOMES:

4 patients had no recurrence at follow-up of 19, 30, 46 and 54 months after the last surgery. 1 patient had recurrence 3 months after the last surgery. 1 patient died 12 days after the last surgery.

LESSONS:

This malignant subtype can be secondary to a WHO grade I meningioma after a long quiescent period. Necrosis was common in the tumor tissues, and Ki67 index was usually high. For patients with a history of meningioma, including benign cases, regular physical examination is important for early detection of tumor recurrence and malignant transformation.

PMID:
29879067
PMCID:
PMC5999497
DOI:
10.1097/MD.0000000000011019
[Indexed for MEDLINE]
Free PMC Article
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15.
Malawi Med J. 2017 Sep;29(3):265-267. doi: 10.4314/mmj.v29i3.7.

A 42-year-old woman with subacute reversible dementia: A cautionary tale.

Author information

1
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
2
Liverpool Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
3
Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi.
4
Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi.
5
Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
6
Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
7
Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi.

Abstract

A 42-year-old woman presented with a 6-month history of diffuse headache of moderate intensity and gradual onset of generalized weakness, imbalance, apathy, memory decline, hypophonia, dysphagia, constipation and urinary incontinence. Clinical examination revealed several elements of a frontal lobe dysfunction including apathy with motor impersistence, presence of primitive reflexes, generalized hyperreflexia with bilateral Hoffman sign and ankle clonus. The biological workup was unremarkable and a brain computed tomography scan identified a giant olfactory groove meningioma. A prompt neurosurgical intervention helped to reverse the symptoms. This case illustrates the benefits of actively looking for treatable conditions in young patients presenting with acute or subacute dementia and emphasizes the pivotal role of early brain imaging.

PMID:
29872518
PMCID:
PMC5812000
DOI:
10.4314/mmj.v29i3.7
[Indexed for MEDLINE]
Free PMC Article
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16.
World Neurosurg. 2018 Aug;116:e1066-e1074. doi: 10.1016/j.wneu.2018.05.166. Epub 2018 Jun 1.

Contralateral Transcranial Approach to Tuberculum Sellae Meningiomas: Long-Term Visual Outcomes and Recurrence Rates.

Author information

1
Department of Neurosurgery, CHU de Bordeaux, Bordeaux Cedex, France. Electronic address: julien.engelhardt@chu-bordeaux.fr.
2
Department of Neurosurgery, CHG de Perpignan, Perpignan, France.
3
Department of Neurosurgery, CHU de Bordeaux, Bordeaux Cedex, France.

Abstract

BACKGROUND:

One of the most challenging aspects of the surgical treatment of tuberculum sellae meningioma is to control the involvement of the inferomedial side of the optic nerve, which is not directly visualized by an ipsilateral approach and thus requires optic nerve mobilization.

METHODS:

Between 2003 and 2017, 21 consecutive patients were operated on using this approach. The surgical technique is described and the visual outcomes, resection and recurrence rates, and complications are analyzed.

RESULTS:

Twenty patients were included, with a median follow-up of 5.6 years. Regarding visual outcomes, among the 19 patients who had a visual impairment before surgery, 14 (74%) improved, 2 were stabilized (10%), and 2 (10%) showed a worsening of the most-compromised optic nerve and 1 (5%) of the less-compromised optic nerve. Gross total resection was achieved in 18 patients (90%) and 1 patient experienced recurrence 10 years after the initial surgery.

CONCLUSIONS:

This approach allowed lower mobilization of the compromised optic nerve, better preservation of the vascularization of the visual pathways, and direct access to the inferomedial side of the optic nerve.

KEYWORDS:

Contralateral approach; Craniotomy; Meningioma; Tuberculum sellae; Visual outcome

PMID:
29864568
DOI:
10.1016/j.wneu.2018.05.166
[Indexed for MEDLINE]
Icon for Elsevier Science
17.
World Neurosurg. 2018 Sep;117:e57-e66. doi: 10.1016/j.wneu.2018.04.226. Epub 2018 May 30.

Prognostic Factors, Survival, and Treatment for Intracranial World Health Organization Grade II Chordoid Meningiomas and Clear-Cell Meningiomas.

Author information

1
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Dong Cheng District, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Brain Tumor, Beijing, China.
2
China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Brain Tumor, Beijing, China; Brain Tumor Research Center, Beijing Neurosurgical Institute, Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing Laboratory of Biomedical Materials, Dongcheng District, Beijing, China.
3
China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Brain Tumor, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Dong Cheng District, Beijing, China.
4
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Dong Cheng District, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Brain Tumor, Beijing, China. Electronic address: lidaatlas@aliyun.com.
5
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Dong Cheng District, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Brain Tumor, Beijing, China. Electronic address: wuzhen1966@aliyun.com.
6
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Dong Cheng District, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Brain Tumor, Beijing, China. Electronic address: zhangjunting2003@aliyun.com.

Abstract

OBJECTIVE:

Chordoid meningioma (CM) and clear-cell meningioma (CCM) are rare World Health Organization grade II meningioma subtypes. This study aimed to evaluate favorable factors and appropriate therapeutic strategies for these lesions.

METHODS:

We retrospectively reviewed clinical data from 111 cases of grade II meningiomas, including 55 cases of CM and 56 cases of CCM, between January 2011 and December 2015.

RESULTS:

The mean follow-up time of the rare World Health Organization grade II meningiomas (n = 111) was 45.3 months. In the CM group, 8 patients (14.5%) experienced recurrence, and 2 patients (3.6%) died. In the CCM group, 22 patients (39.3%) experienced recurrence, and 9 patients (16.1%) died. Significant differences were observed between the CM and CCM groups in tumor size (P = 0.019), history of surgery (P = 0.038), and peritumoral edema (P = 0.004). In the CM group, gross total resection was associated with favorable progression-free survival (hazard ratio, 0.144; 95% confidence interval, 0.029-0.714; P = 0.018). In the CCM group, univariate analyses showed that preoperative Karnofsky Performance Status <80 (P < 0.001), tumor size ≥5 cm (P = 0.015), tumor size (per-centimeter increase) (P = 0.022), bone invasion (P = 0.004), a history of surgery (P < 0.001), and subtotal resection (P = 0.009) were associated with worse progression-free survival. Male gender (P = 0.039), tumor size (per-centimeter increase) (P = 0.043), bone invasion (P = 0.030), and a history of surgery (P = 0.007) were associated with poor overall survival.

CONCLUSIONS:

This study showed that gross total resection should be achieved in grade II meningiomas. Patients with larger tumors and/or surgical histories had worse outcomes.

KEYWORDS:

Chordoid meningioma; Clear-cell meningioma; Survival; Treatment

PMID:
29859361
DOI:
10.1016/j.wneu.2018.04.226
[Indexed for MEDLINE]
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18.
World Neurosurg. 2018 Aug;116:e611-e623. doi: 10.1016/j.wneu.2018.05.052. Epub 2018 May 16.

Surgical Strategy for and Anatomic Locations of Petroapex and Petroclival Meningiomas Based on Evaluation of the Feeding Artery.

Author information

1
Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake City, Aichi, Japan. Electronic address: kazu-adachi@rio.odn.ne.jp.
2
Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake City, Aichi, Japan.

Abstract

BACKGROUND:

The anterior transpetrosal (ATP) approach is the most appropriate approach for petroclival meningiomas (PCMs), which are typically located from the dorsum sellae to the upper border of the internal auditory meatus (IAM). Although neurosurgeons can resect over this area if the tumor is detached from the dura, tumors within the indication area for PCMs are not appropriate for the ATP approach, because it can be difficult to evaluate whether the tumor is attached to or only touching the dura. In this study, we investigated the tumor extension area based on an evaluation of the feeding artery to achieve a more accurate assessment of the dural attachment area.

METHODS:

Using various angiography techniques, we studied 51 feeding arteries from 24 patients who had undergone surgical treatment of primary petroapex meningiomas and PCMs via the ATP approach. We measured the lower and posterior extension distances, the extension rate of the cavernous sinus and Meckel's cave, and the midline extension rate of the tumors.

RESULTS:

The ascending pharyngeal artery (AphA) was the predominant feeding artery for tumors with lower extension. We determined that tumors extending over the lower border of IAM in cases in which the feeding artery was not the AphA can be resected using the ATP approach.

CONCLUSIONS:

This study shows an association between the predominant feeding artery and tumor extension area and demonstrates that an evaluation of the dural attachment area based on the feeding artery can aid selection of the appropriate surgical approach.

KEYWORDS:

Angiography; Anterior transpetrosal approach; Dura; Feeding artery; Petroclival meningioma; Skull base meningioma

PMID:
29777891
DOI:
10.1016/j.wneu.2018.05.052
[Indexed for MEDLINE]
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19.
Cancer Radiother. 2018 May;22(3):264-286. doi: 10.1016/j.canrad.2017.09.010.

[Base of the skull meningioma: Efficacy, clinical tolerance and radiological evaluation after radiotherapy].

[Article in French]

Author information

1
Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France.
2
Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire de radiobiologie, UMR 7178 institut pluridisciplinaire Hubert-Curien (IPHC), université de Strasbourg, 67000 Strasbourg, France; CNRS, IPHC UMR 7178, 67000 Strasbourg, France.
3
Service de neurochirurgie, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France.
4
Service de neurochirurgie, hôpital universitaire de Strasbourg, 1, rue Molière, 67000 Strasbourg, France.
5
Service de radiologie, hôpital universitaire de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
6
Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire de radiobiologie, UMR 7178 institut pluridisciplinaire Hubert-Curien (IPHC), université de Strasbourg, 67000 Strasbourg, France; CNRS, IPHC UMR 7178, 67000 Strasbourg, France. Electronic address: gnoel@strasbourg.unicancer.fr.

Abstract

Skull base meningioma leads to functional disturbances, which can significantly alter the quality of life. The optimal management of these lesions, whose goals are neurological preservation and tumour local control, is not yet clearly established. It is widely recognized that the goal of a radical excision should be abandoned despite the advances in the field of microsurgery of skull base lesions. Although less morbid, partial tumour excision would be associated with increased risk of local tumour recurrence. Although discussed both exclusive and adjuvant have proven to be highly successful in terms of clinical improvement and local control. Various radiation techniques have demonstrated their efficacy in the management of this pathology. However, high rates of clinical improvement are in contrast with low rates of radiological improvement. The notion of clinical and radiological dissociation appeared. However, in most of these studies, the analysis of the radiological response could be subject of legitimate criticism. This work proposes to review the local control, the efficacy and the clinical tolerance and the radiological response of the various radiation techniques for the meningioma of the base of the skull and to demonstrate the interest of quantitative volumetric analyses in the follow-up of meningioma after radiotherapy.

KEYWORDS:

Analyse volumétrique; Base du crâne; Intensity-modulated radiation therapy; Meningioma; Méningiome; RCMI; Radiochirurgie; Radiothérapie stéréotaxique; Résultat thérapeutique; Skull base; Stereotactic radiation; Volumetric analyses

PMID:
29773473
DOI:
10.1016/j.canrad.2017.09.010
[Indexed for MEDLINE]
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20.
Br J Radiol. 2018 Jul;91(1088):20180088. doi: 10.1259/bjr.20180088. Epub 2018 May 31.

The diagnostic value of using combined MR diffusion tensor imaging parameters to differentiate between low- and high-grade meningioma.

Author information

1
1 ¹Department of Radiology, Ondokuz Mayis University Faculty of Medicine , Samsun , Turkey.
2
2 Department of Biostatistics, Ondokuz Mayis University Faculty of Medicine , Samsun , Turkey.

Abstract

OBJECTIVE:

The purpose of this study was to examine whether the combined use of MR diffusion tensor imaging (DTI) parameters [DTI-apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD)] could provide a more accurate diagnosis in differentiating between low-grade and atypical/anaplastic (high-grade) meningioma.

METHODS:

Pathologically proven 45 meningioma patients [32 low-grade, 13 high-grade (11 atypical and 2 anaplastic)] who had received DTI before surgery were assessed retrospectively by 2 independent observers. For each lesion, MR DTI parameters (ADCmin, ADCmax, ADCmean, FA, AD, and RD) and ratios (rADCmin, rADCmax, rADCmean, rFA, rAD, and rRD) were calculated. When differentiating between low- and high-grade meningioma, the optimum cutoff values of all MR DTI parameters were determined by using receiver operating characteristic (ROC) analysis. Area under the curve (AUC) was measured with combined ROC analysis for different combinations of MR DTI parameters in order to identify the model combination with the best diagnostic accuracy in differentiation between low and high-grade meningioma.

RESULTS:

Although the ADCmin, ADCmax, ADCmean, AD, RD, rADCmin, rADCmax, rADCmean, rAD, and rRD values of high-grade meningioma were significantly low (p = 0.007, p = 0.045, p = 0.035, p = 0.045, p = 0.003, p = 0.02, p = 0.03, p = 0.03, p = 0.045, and p = 0.01, respectively), when compared with low-grade meningioma, their FA and rFA values were significantly high (p = 0.007 and p = 0.01, respectively). For all MR DTI parameters, the highest individual distinctive power was RD with AUC of 0.778. The best diagnostic accuracy in differentiating between low- and high-grade meningioma was obtained by combining the ADCmin, RD, and FA parameters with 0.962 AUC.

CONCLUSION:

This study shows that combined MR DTI parameters consisting of ADCmin, RD, and FA can differentiate high-grade from low-grade meningioma with a diagnostic accuracy of 96.2%. Advances in knowledge: To the best of our knowledge, this is the first study reporting that a combined use of all MR DTI parameters provides higher diagnostic accuracy for the differentiation of low- from high-grade meningioma. Our study shows that any of the model combinations was superior to use of any individual MR DTI parameters for differentiation between low and high-grade meningioma. A combination of ADCmin, RD, and FA was found to be the best model for differentiating low-grade from high-grade meningioma and sensitivity, specificity, and AUC values were found to be 92.3%, 100%, and 0.96, respectively. Thus, a combination of MR DTI parameters can provide more accurate diagnostic information when differentiation between low and high-grade meningioma.

PMID:
29770735
DOI:
10.1259/bjr.20180088
[Indexed for MEDLINE]
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