Meningiomas intracraneales. Experiencia de dos años en el servicio Neurocirugía de Matanzas / Intracranial meningiomas. Two-year experience in the service Neurosurgery of Matanzas

RESUMEN Introducción: los meningiomas constituyen la segunda causa de tumores cerebrales primarios, en el adulto. Representan hasta el 32 % del total de los mismos. Objetivo: describir el comportamiento del meningioma intracraneal en los pacientes investigados. Materiales y métodos: se realizó un estudio analítico, descriptivo, retrospectivo a los pacientes neurointervenidos con meningioma intracraneal, en el Servicio de Neurocirugía del Hospital Docente Universitario "Comandante Faustino Pérez Hernández", de la provincia Matanzas. En el período comprendido entre el 1ero de enero de 2017 al 1ero de enero del 2019. Los 15 pacientes intervenidos conformaron el universo de estudio. Resultados: la media poblacional fue de 55 años. Predominó el sexo femenino en un 73,3 %. La cefalea fue la manifestación clínica más frecuente, igualmente, que los meningiomas de la convexidad cerebral. En cuanto a la topografía, la media del tamaño de la lesión fue de 4,4 cm. La variedad meningotelial (40 %) fue la que predominó. El grado II de resección fue el que más se empleó. El edema cerebral postquirúrgico predominó en un 26,6 %. La puntuación de la escala de Karnofsky al egreso fue superior que al ingreso. Conclusiones: cuanto más precoz se realice el diagnóstico clínico y tratamiento quirúrgico en los pacientes portadores de meningioma, mejor será su calidad de vida al egreso (AU).

ABSTRACT Introduction: meningiomas are the second cause of primary brain tumors in adults, representing up to 32 % of the total. Objective: to describe the behavior of intracranial meningioma in the studied patients. Materials and methods: a retrospective, descriptive, analytical study was conducted on neurosurgery patients with intracranial meningioma in the Neurosurgery service of the University Teaching Hospital "Comandante Faustino Pérez Hernández" of the province of Matanzas, in the period from January 1st 2017 to January 1st, 2019. The 15 patients undergoing neurosurgery were the study universe. Results: the population mean was 55 years; female sex prevailed (73.3 %). Headache was the most frequent clinical manifestation as well as meningiomas of cerebral convexity in terms of topography. The average lesion size was 4.4 cm; the meningothelial variety (40 %) was the most commonly found; grade II resection was the most used one. Post-surgical cerebral edema (26.6%) predominated. Karnofsky scale score at discharge was higher than at admission. Conclusions: the earlier the clinical diagnosis and surgical treatment are performed in patients with meningioma the better will be their quality of life at discharge (AU).

Cystic Meningiomas: Correlation between Radiologic and Histopathologic Features

BACKGROUND: Tumors with cysts often correlate with gliomas, metastatic tumors, or hemangioblastomas, which require differentiation. METHODS: Thirty-eight cases of cyst associated-meningioma based on preoperative radiologic studies and histologic confirmations were reviewed from November 1998 to July 2017. RESULTS: A total of 395 cases of meningioma were observed in the 20 years, and surgical treatment of intracranial meningioma was performed in 120 cases. Thirty-eight (9.6%) cases of cyst associated meningiomas were analyzed. Nauta type I was the most common type of cyst (39.5%) and the most frequent histopathological subtype was meningothelial type (36.8%). CONCLUSION: Statistically there were no significant associations between meningioma histopathological type and associated cysts; however, the rate of World Health Organization grade II was higher in cyst associated meningiomas than in unrelated meningiomas. This correlation was weak, in accordance with the meningioma grade.

Recurred Intracranial Meningioma: A Retrospective Analysis for Treatment Outcome and Prognostic Factor

BACKGROUND: In this study, we aimed to compare repeated resection and radiation treatment, such as Gamma knife radiosurgery (GKRS) or conventional radiotherapy (RT), and investigate the factors influencing treatment outcome, including overall survival (OS), progression-free survival (PFS), and complication rates. METHODS: We retrospectively reviewed 67 cases of recurred intracranial meningiomas (repeated resection: 36 cases, radiation treatment: 31 cases) with 56 months of the median follow-up duration (range, 13–294 months). RESULTS: The incidence of death rate was 29.9% over follow-up period after treatment for recurred meningiomas (20/67). As independent predictable factors for OS, benign pathology [hazard ratio (HR) 0.132, 95% confidence interval (CI) 0.048–0.362, p<0.001] and tumor size <3 cm (HR 0.167, 95% CI 0.061–0.452, p<0.001) were significantly associated with a longer OS. The incidence of progression rate was 23.9% (16/67). Only treatment modality was important for PFS as an independent predictable factor (GKRS/RT vs. open resection; HR 0.117, 95% CI 0.027–0.518, p<0.005). The complication rate was 14.9% in our study (10/67). Larger tumor size (≥3 cm, HR 0.060, 95% CI 0.007–0.509, p=0.010) was significant as an independent prognostic factor for development of complications. Although treatment modality was not included for multivariate analysis, it should be considered as a predictable factor for complications (p=0.001 in univariate analysis). CONCLUSION: The role of repeated resection is questionable for recurred intracranial meningiomas, considering high progression and complication rates. Frequent and regular imaging follow-up is required to detect recurred tumor sized as small as possible, and radiation treatment can be a preferred treatment.

Surgical Experience of Infratentorial Meningiomas : Clinical Series at a Single Institution during the 20-Year Period

OBJECTIVE: Based on surgical outcomes of patients with infratentorial meningiomas surgically treated at our institution, we analyzed the predictors for surgical resection, recurrence, complication, and survival. METHODS: Of surgically treated 782 patients with intracranial meningioma, 158 (20.2%) consecutive cases of infratentorial location operated on between April 1993 and May 2013 at out institute were reviewed retrospectively. The patients had a median age of 57.1 years (range, 16--77 years), a female predominance of 79.7%, and a mean follow-up duration of 48.4 months (range, 0.8--242.2 months). RESULTS: Gross total resection (Simpson's grade I & II) was achieved in 81.6% (129/158) of patients. Non-skull base location was an independent factor for complete resection. The recurrence rate was 13.3% (21/158) and the 5-, 10-, and 15-year recurrence rates were 8.2%, 12.0%, and 13.3%, respectively. Benign pathology, postoperative KPS over than 90, low peritumoral edema, and complete resection were significantly associated with longer recurrence-free survival rate. The 5-, 10-, and 15-year survival rates were 96.2%, 94.9%, and 94.9%, respectively. Benign pathology, postoperative KPS over than 90 and complete resection were significantly associated with a longer survival rate. The permanent complication rate was 13% (21/158). Skull base location and postoperative KPS less than 90 were independent factors for the occurrence of permanent complication. CONCLUSION: Our experience shows that infratentorial meningiomas represent a continuing challenge for contemporary neurosurgeons. Various factors are related with resection degree, complications, recurrence and survival.

Radiation-Induced Intratumoral Necrosis and Peritumoral Edema after Gamma Knife Radiosurgery for Intracranial Meningiomas

OBJECTIVE: To study the clinical significance and relevant factors of radiation-induced intratumoral necrosis (RIN) and peritumoral edema (PTE) after Gamma knife radiosurgery (GKRS) for intracranial meningiomas. METHODS: We retrospectively analyzed the data of 64 patients who underwent GKRS for intracranial meningioma. The mean lesion volume was 4.9 cc (range, 0.3-20), and the mean prescription dose of 13.4 Gy (range, 11-18) was delivered to the mean 49.9% (range, 45-50) isodose line. RIN was defined as newly developed or enlarged intratumoral necrosis after GKRS. RESULTS: RIN and new development or aggravation of PTE were observed in 21 (32.8%) and 18 (28.1%) cases of meningioma, respectively during the median follow-up duration of 19.9+/-1.0 months. Among various factors, maximum dose (>25 Gy) and target volume (>4.5 cc) were significantly related to RIN, and RIN and maximum dose (>24 Gy) were significantly related to the development or aggravation of PTE. In 21 meningiomas with development of RIN after GKRS, there was no significant change of the tumor volume itself between the times of GKRS and RIN. However, the PTE volume increased significantly compared to that at the time of GKRS (p=0.013). The median interval to RIN after GKRS was 6.5+/-0.4 months and the median interval to new or aggravated PTE was 7.0+/-0.7 months. CONCLUSION: A close observation is required for meningiomas treated with a maximum dose >24 Gy and showing RIN after GKRS, since following or accompanying PTE may deteriorate neurological conditions especially when the location involves adjacent critical structures.

Peritumoral Brain Edema in Meningiomas : Correlation of Radiologic and Pathologic Features

OBJECTIVE: The primary objective of this study was to perform a retrospective evaluation of the radiological and pathological features influencing the formation of peritumoral brain edema (PTBE) in meningiomas. METHODS: The magnetic resonance imaging (MRI) and pathology data for 86 patients with meningiomas, who underwent surgery at our institution between September 2003 and March 2009, were examined. We evaluated predictive factors related to peritumoral edema including gender, tumor volume, shape of tumor margin, presence of arachnoid plane, the signal intensity (SI) of the tumor in T2-weighted image (T2WI), the WHO histological classification (GI, GII/GIII) and the Ki-67 antigen labeling index (LI). The edema-tumor volume ratio was calculated as the edema index (EI) and was used to evaluate peritumoral edema. RESULTS: Gender (p=0.809) and pathological finding (p=0.084) were not statistically significantly associated with peritumoral edema by univariate analysis. Tumor volume was not correlated with the volume of peritumoral edema. By univariate analysis, three radiological features, and one pathological finding, were associated with PTBE of statistical significance: shape of tumor margin (p=0.001), presence of arachnoid plane (p=0.001), high SI of tumor in T2WI (p=0.001), and Ki-67 antigen LI (p=0.049). These results suggest that irregular tumor margins, hyperintensity in T2WI, absence of arachnoid plane on the MRI, and high Ki-67 LI can be important predictive factors that influence the formation of peritumoral edema in meningiomas. By multivariate analysis, only SI of the tumor in T2WI was statistically significantly associated with peritumoral edema. CONCLUSION: Results of this study indicate that irregular tumor margin, hyperintensity in T2WI, absence of arachnoid plane on the MRI, and high Ki-67 LI may be important predictive factors influencing the formation of peritumoral edema in meningiomas.

Therapeutic Strategies of the Intracranial Meningioma in Elderly Patients

OBJECTIVE: The apparent increase in the incidence of the intracranial meningiomas in the elderly is due in part to improved diagnostic tools and improved span of life. The authors carried out a retrospective study to validate the use of the Clinical-Radiological Grading System (CRGS) as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival. METHODS: From January 1997 to January 2006, the authors consecutively recruited and surgically treated 20 patients older than 65 years of age with radiologic findings of intracranial meningiomas and a preoperative evaluation based on the CRGS. RESULTS: High CRGS score was associated with a higher probability of good outcome (p=0.004) and a lower probability of postoperative complications (p=0.049). Among the different subset items of the CRGS score, larger maximum tumor diameters (D> or =4cm) and the presence of a severe peritumoral edema were associated with incidence rate of postoperative poor outcome and complications (p<0.05). Additionally, the critical location of the tumor was also correlated with poor outcome (p<0.05). CONCLUSION: A CRGS score higher than 13 is a good prognostic indication of survival. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial meningiomas as surgical candidates.

Myoclonic Seizures Occurred during the Brain Tumor Resection in a Patient of the Recurred Malignant Meningioma of Cerebral Frontal Lobe : A case report / 대한마취과학회지

Several suspected etiologies can cause seizures during the resection of a brain tumor via a craniotomy: the tumor itself, intracranial hypertension or the anesthetic agents used, etc. Generalized myoclonic seizures, during general anesthesia in a 44 year old man, who underwent a resection for a relapsed frontal meningioma, were experienced. Anesthesia was induced and maintained using propofol and remifentanil. The myoclonic seizures began 30 minutes after the induction of anesthesia. The administration of rocuronium was unable to stop the involuntary movement. Midazolam was given to cease the seizures, but they continued for a further 105 minutes. After opening the dura mater, the seizures immediately disappeared and did not recur thereafter.

Resection the Huge Intracranial Meningioma Located in the Frontal Skull by Keyhole Operation / 医学研究杂志

Objective To study the surgical techniques with keyhole operation for treatment of the huge intracranial meningioma located in the frontal skull.Methods 39 cases of huge intracranial meningioma were removed by microsurgery with supra-eyebrow approach keyhole operation.Results 39 cases of meningioma were totally removed.There was no associated morbidity,mortality or exacebation in all cases.Conclusion It suggests that keyhole microsurgery may provide maximum efficiency to remove the huge intracranial tumor located in the frontal skull and minimum invasiveness.However,it is very important to choose indication properly,to prepare sufficienctly before operation,and to operate with proficient skill of microsurgery.

Enhanced expression of the c-myc protooncogene in human intracranial meningiomas

We examined the alteration and expression of c-myc protooncogene in 11 human intracranial meningiomas using Southern blot, Northern blot and immunohistochemical techniques. Southern blot showed neither amplification nor rearrangement but Northern blot and immunohistochemical study revealed enhanced expression of the c-myc gene. Immunohistochemically, c-myc product was found in all of the 11 cases and seven of these cases showed an above moderate degree of immunoreaction in semiquantitative analysis. Loss of heterozygosity at IGLC2 locus on chromosome 22 was detected in four of the 8 informative cases. But extent and intensity of immunoreactivity did not correlated with loss of heterozygosity on chromosome 22. These genetic changes may play important roles in the pathogenesis of human intracranial meningioma.

Clinical Analysis of Intracranial Meningiomas

Authors reviewed 92 cases of intracranial meningiomas which confirmed by operation at the Department of Neurosurgery, Seoul National University Hospital from September 1957 to July 1982. 45 cases out of 50 cases that had performed computerized tomographic(CT) scans preoperatively were analyzed. The results were as following ; 1) Meningiomas constituted 12.4% of all intracranial tumors. There were 51 women and 41 men(55.4%/44.6%). The average age at the time of diagnosis was 41.2 years. 2) The initial symptoms were headache(50.0%), visual disturbance(14.1%), and seizure(8.7%) in the order. 3) The most common location was parasagittal-falcial, and followed by convexity, sphenoid ridge, tuberculum sellae tentorial and olfactory groove. 4) 61 cases(76%) out of 80 cases showed abnormal findings in the plain skull X-ray examinations. The preenhanced CT scans(45 cases) showed hyperdense lesion in 57.8%(26 cases), isodense lesion in 35.6%(16 cases), and hypodense lesion in 6.6%(3 cases). The incidence of peritumoral low density was 68.9%. The detection rate of intratumoral calcification by CT scan was 22.2%, and by plain X-ray was 7.5%, 95.6%(43 cases) of meningiomas showed contrast enhancement. 5) The detection rate of tumors by CT scans was 98%, and 1 case(2%) couldn't be detected by CT scans because it was en plaque type. Preoperatively, 44 cases(88%) were diagnosed as meningiomas and other 6 cases were diagnosed as glioblastoma multiforme, cystic astrocytoma, glioma, and bone tumor by CT scans. 6) The postoperative pathological diagnosis were meningotheliomatous(55.4%), fibroblastic(13.0%), transitional(8.7%), angioblastic(3.3%), and sarcomatous(2.2%).

Clinical Analysis of Intracranial Meningiomas

Authors reviewed 92 cases of intracranial meningiomas which confirmed by operation at the Department of Neurosurgery, Seoul National University Hospital from September 1957 to July 1982. 45 cases out of 50 cases that had performed computerized tomographic(CT) scans preoperatively were analyzed. The results were as following ; 1) Meningiomas constituted 12.4% of all intracranial tumors. There were 51 women and 41 men(55.4%/44.6%). The average age at the time of diagnosis was 41.2 years. 2) The initial symptoms were headache(50.0%), visual disturbance(14.1%), and seizure(8.7%) in the order. 3) The most common location was parasagittal-falcial, and followed by convexity, sphenoid ridge, tuberculum sellae tentorial and olfactory groove. 4) 61 cases(76%) out of 80 cases showed abnormal findings in the plain skull X-ray examinations. The preenhanced CT scans(45 cases) showed hyperdense lesion in 57.8%(26 cases), isodense lesion in 35.6%(16 cases), and hypodense lesion in 6.6%(3 cases). The incidence of peritumoral low density was 68.9%. The detection rate of intratumoral calcification by CT scan was 22.2%, and by plain X-ray was 7.5%, 95.6%(43 cases) of meningiomas showed contrast enhancement. 5) The detection rate of tumors by CT scans was 98%, and 1 case(2%) couldn't be detected by CT scans because it was en plaque type. Preoperatively, 44 cases(88%) were diagnosed as meningiomas and other 6 cases were diagnosed as glioblastoma multiforme, cystic astrocytoma, glioma, and bone tumor by CT scans. 6) The postoperative pathological diagnosis were meningotheliomatous(55.4%), fibroblastic(13.0%), transitional(8.7%), angioblastic(3.3%), and sarcomatous(2.2%).