Meningioma de la vaina del nervio óptico y tratamiento con radioterapia conformacional: reporte de un caso clínico tratado con largo seguimiento / Optic nerve sheath meningioma treated with radiation conformal therapy: clinical case report with long follow up

Introducción: Los meningiomas de la vaina del nervio óptico (MVNO) son tumores inusuales de la vía visual anterior. Sin tratamiento, el crecimiento del tumor lleva a pérdida visual progresiva hasta la ceguera debido a la compresión que ejerce sobre el nervio óptico. Presentación del caso: Paciente, sexo femenino, 42 años, sin antecedentes mórbidos, que en 1992, inicia cuadro de disminución de la agudeza visual del ojo izquierdo. La resonancia magnética (RM) cerebral informa una lesión expansiva fusiforme en relación a la vaina del nervio óptico izquierdo que lo engloba, altamente sugerente de MVNO. En esa ocasión se realiza exploración de órbita la cual resulta frustra, por lo que se decide observación con controles clínicos e imagenológicos anuales, permaneciendo estable. Aproximadamente diez años más tarde, en el lapso de un año, inicia agravación progresiva de la agudeza y campo visual, ptosis palpebral y alteraciones de la oculo-motilidad del ojo izquierdo, objetivadas por examen neuro-oftalmológico, por lo que se sospecha progresión de MVNO. Se solicita nueva RM que confirma crecimiento significativo del tumor. Se descarta nuevo abordaje quirúrgico por riesgo de mayor deterioro visual y se efectúa radioterapia conformacional con una dosis de 54 Gy. Actualmente, a la edad de 65 años, se cumplen 24 años de evolución, 13 post radioterapia, confirmándose estabilidad clínica y radiológica de MVNO. Discusión: La radioterapia, cuando se observa progresión de la enfermedad, ha demostrado ser una terapia eficaz para los MVNO, con menos complicaciones y con mejores resultados en la preservación de la función visual a largo plazo.

Introduction: Optic nerve sheath meningiomas (ONSM) are rare tumors of the anterior visual pathway. Without treatment, tumor growth leads to progressive loss of visual acuity and blindness due to optic nerve compression. Case report: Patient, female, 42 years without other morbility , begins in 1992 with decreased visual acuity of the left eye, magnetic resonance imaging (MRI) showed enlargement of the left optic nerve sheath, suggestive of ONSM. On that occasion, orbit exploration failed, so it was decided to follow up with annual clinical and imaging controls. About ten years later, begins with progressive deterioration of visual acuity and visual field , with ptosis and ocular motor palsy of the left eye, confirmed with neuro-ophtalmological examinations. MRI shows tumor progression. A new surgical approach was discarded by the risk of visual worsening. A conformal radiotherapy was performed with a fractionated 54 Gy dose. Today, at age 65, after 24 years of follow up,13 post radiation therapy. clinical and radiological stability of ONSM is confirmed. Discussion: Conformal radiotherapy has been shown as an effective therapy, with fewer complications and better outcomes in the preservation of visual function in the long term follow up.

Evaluation of contributive factors on recurrence of intracranial meningioma

Meningiomas are common benign tumors of the central nervous system. Patients with meningiomas achieve postoperative optimal functional recovery, but there is a probability of tumor recurrence months or years after surgical resection. This study aims to evaluate the prevalence of recurrent meningioma and the correlation between tumor recurrence and certain factors. We performed a retrospective descriptive-analytical study of patients with meningiomas who underwent surgical treatment in hospitals affiliated with Shiraz University of Medical Sciences during a 20-year period [1988 to 2008]. Factors including sex, age, bone changes, peritumoral edema, histological subtypes, tumor size, shape, location and resection degree, and recurrence time were evaluated in each patient. The recurrence rate of intracranial meningioma in a total of 644 patients included in the study was 10%. Statistical analysis of data showed a correlation between edema, bone changes, tumor size and shape, and histological subtypes. No relationship was found between age, sex and tumor location. This study has shown a statistical correlation between radiotherapy and a reduced probability of tumor recurrence or growth after surgical resection. Although the majority of meningiomas are benign, they can have malignant presentations. Recurrence occurs after a shorter period of time in patients with malignant and atypical meningiomas than in patients with benign meningiomas. Edema, bone changes, large size, special tumor shape and malignant histological subtypes are important prognostic factors that predict the probability of tumor recurrence or growth. Findings show a statistical correlation between the degree of tumor resection and its recurrence. This study recommends a more complete tumor resection along with adjuvant therapy and closer follow-up to decrease the risk of tumor recurrence

Cervical lymph node metastases from meningioma: report of two cases and treatment outcome

Meningioma is usually a benign central nervous system [CNS] tumor. Metastasis is rare; however if it does occur the most metastatic sites are the liver and lungs. Here, two cases of CNS meningioma with metastasis to cervical lymph nodes are reported. The first case, a 48 year-old man developed cervical lymph node metastasis nine years after primary tumor diagnosis. The second case, a 23 year-old woman with parietal lobe meningioma, developed lymph node metastasis in the neck nine months after the diagnosis of meningioma

overview in stereotactic radiosurgery

Efficacy and utilization of radiation as a mode of management in neurosurgical lesions has increased radically as a consequence of improvements in appreciation of the concept of stereotaxis, progress in medical imaging, computer technology, and advanced delivery devises. [19.22] Primary management alternative in patients with cerebellopontine angle lesions, skull base tumours, meningiomas, paragangliomas, AVMs etc., is increasingly being used as also in secondary management of recurrent or planned residual disease patients where a part of the lesion is deliberately left behind to avoid loss of function and prevent iatrogenic injury. [22] Contemporary understanding with adequate and proper information of this resource along with understanding the controversies regarding the use of radiation of the management of several lesions in paramount. This article is intended to provide a concise basic introduction of the technology available and the pertinent applications in the management for several lesions with a basic understanding of the advantages and disadvantages of various available devices and the outcome in using various methods based on review of available literature

Secondary intracraneal meningiomas after high dose cranial radiation therapy: report of two cases and literature review

Introduction: Ionizing radiation is the only established risk factor today in the pathogenesis of meningioma. Radiation-induced meningiomas (RIMs)are an unusual complication of radiation therapy which often challenge skilled neurosurgeons. We report 2 RIM cases and discuss existing reports. Case Reports: A 55-year old woman presented with a RIM after adjuvant radiation therapy for low-grade astrocytoma. An 18-year old man presented a RIM after craniospinal radiation therapy for medulloblastoma. Both patients were treated and are alive and well. Discussion: RIMs have been associated with younger age at symptom onset, higher male-to-female ratio and more aggressive meningiomas. Our reports have several common points with existing RIM series. Prolonged radiological surveillance for RIMs has been suggested, but eurosurgeonsshould always remember this clinical entity when following patients who were submitted to radiation therapy in the past.

Intraoperative radiation therapy as an adjunctive therapy for huge and highly vascular parasagittal meningiomas

This case presents a 34-year-old man who had a huge parasagittal meningioma. Initial treatment consisted of preoperative external carotid artery embolization and partial tumor resection. During the resection, we found that the tumor invaded the adjacent calvarium, and due to massive hemorrhage, total removal of the tumor was impossible. The patient was treated with intraoperative radiation therapy (IORT) (25 Gy via 16 MeV) as an adjunctive therapy. Eight months after IORT, we were able to remove the tumor completely without surgical difficulties. IORT can be considered an useful adjunctive therapy for the superficially located, huge, and highly vascular meningioma.

Mengiomas / Mengiomas

Este artículo contempla una revisión de la literatura sobre la patogénesis e histopatología de los meningiomas y su comportamiento radiológico; las clasificaciones en tipos histológicos y de la Organización Mundial de la Salud que permite establecer las características tumorales para conocer su comportamiento y probabilidades de recurrencia. Dentro de los factores predisponentes está el antecedente de tratamientos con radioterapia, enfermedades genéticas como la Neurofibromatosis tipo 2 y defectos del Cromosoma 22. Las características radiológicas tales como lobulaciones, extensión del edema peritumoral, tamaño del tumor, la delimitación tumoral con respecto al parenquima subyacente entre otros son, importantes para tratar de establecer el comportamiento biológico de estos tumores y en algunos casos predecir el tipo histológico. Se presentan los casos ilustrados con su resumen clínico, imagenes radiológicas y su respectiva histopatología como primera etapa de este estudio prospectivo de un año. Palabras clave: Tumores cerebrales, meningioma, comportamiento biológico, edema peritumoral

Preliminary experiences with intraoperative radiation therapy (IORT) for the treatment of brain tumors

Ten brain tumor patients underwent wide resection of the tumor followed by Intraoperative Radiation Therapy (IORT) at the first surgery or at the second salvage surgery after failure of conventional external beam irradiation. Two patients(1 meningioma, 1 glioblastoma multiforme) were treated at the first surgery and 8 patients(3 anaplastic astrocytoma, 3 glioblastoma multiforme, 1 meningioma, 1 gliosarcoma) were treated after salvage surgery. The IORT doses were ranged from 15-25 Gy depending on the tumor volume and previous radiation therapy. The neurological status(Karnofsky performance status) was improved in 4 cases, not changed in 6 cases after IORT. There were several complications after IORT; radiation necrosis, communicating hydrocephalus, wound infection, and abnormal CT findings such as diffuse low density area in an around operation site. The radiation necrosis was confirmed by operation in a recurrent meningioma patient 12 months after IORT. At follow-up, ranging from 1 to 16 months, there was no deaths. Based on our limited experiences, the IORT might be one of the adjuvant therapeutic modalities especially for the malignant brain tumors and unresectable huge meningioma.

Meningioma-like intracranial granulocytic sarcoma (chloroma): radiologic and surgical findings

Se presenta el caso de una paciente de 23 años de edad con leucemi granulocítica crónica en quien se identificaron dos lesiones tumorales con características típicas de meningiomas intracraneales. Durante la cirugía de la masa tumoral de mayor tamaño, que provocaba hipertensión intracraneana, se encontraron todas las características macroscópicas de un meningioma. El tratamiento fue exitoso y el estudio histopatológico reveló un sarcoma granulocítico. La otra masa tumoral fue radiada disminuyendo el volumen tumoral en el término de un mes y dejando a la paciente asintomática desde el punto de vista neurológico. Se propone tratamiento quirúrgico en casos futuros de grandes cloromas

Meningiomas intracraneales / Intracranial meningiomas

The author excised an intracranial meningioma from 28 patients, 17 women and 11 men, between 7 and 78 years of age, from 1974 to 1992. The tumor was located in the olfactory groove in 4 patients, in the cerebral convexity in another 4, in the falx in 8 (3 in the frontal and 5 in the parietal region). In 6 patients, the meningioma was found in the inner one third and in 1 in the middle third of sphenoid; in 1, in the clivus, in 1 in the petrous bone; in 2 patients the tumor was located in the tubercle of the sella turcica and in another patient it was in the cerebello-pontine angle. Total resection of the meningioma was accomplished in 16 patients (57.1%) because the tumor was in an accessible area. The tumor recurred in one patient, who died 5 years post operatively. In 8 (28.5%) of 12 patients in whom subtotal resection was done, post operative radiation was used, and in 3 of them recurrence occurred in less than 5 years after completion of treatment and in one, in less than 10. In 3 of the remain 4 patients, in whom subtotal resection was done but were not followed by radiation therapy, recurrence also occurred before 5 years post surgery, and in 1 patient at the end of 5 years

El Comportamiento Biológico del Meningioma y sus Perspectivas Terapéuticas

El estudio biológico de los meningiomas ha desarrollado múltiples espectativas terapéuticas que se encuentran en permanente renovación y perfeccionamiento. Se presenta una revisión actualizada de estos aspectos y se discuten las dos posibilidades más importantes que tienen los pacientes con este tipo de tumor en quienes el tratamiento quirúrgico no es el más favorable: manipulación hormonal y radiocirugía estereotáxica

El comportamiento biológico del meningioma y sus perspectivas terapeúticas

El meningioma ha sido, hasta el momento, la neoplasia cuyo estudio ha arrojado mejores perspectivas en el desarrollo de sistemas de tratamiento basados en las características biológicas de los tumores. Actualmente son escasas las aplicaciones clínico-terapéuticas, motivo por el cual, se deben implementar nuevas estrategias de investigación cuyos resultados se encaminen en beneficio de los pacientes que padecen de esta patologia. Este artículo presenta una revisión actualizada de los aspectos más importantes del meningioma, haciendo énfasis en su comportamiento biológico