Survival and Recurrence Outcomes Following Adjuvant Radiotherapy for Grade 2 Intracranial Meningiomas: 13-Year Experience in a Tertiary-Care Center.

OBJECTIVE: We sought to evaluate overall survival (OS) and local recurrence (LR) in patients with grade 2 meningiomas treated with adjuvant radiotherapy compared to surgery alone at time of diagnosis. METHODS: All patients at the authors' institution between 2007 and 2020 were retrospectively reviewed. OS, LR, and treatment toxicities were assessed. Sensitivity analyses were performed for patients with initial gross total resection (GTR) and subtotal resection (STR). Kaplan-Meier analyses and log-rank test for significance were used to compare surgery alone and adjuvant radiotherapy groups. RESULTS: We included 189 patients with mean age 57.4 ± 14.6 years. Patients were 64% female, and median follow-up was 64 (interquartile range: 20-96) months. At initial treatment, 21 patients received adjuvant radiotherapy and 168 received surgery alone. There was no significant difference for OS (hazard ratio = 1.3 [95% confidence interval 0.4-4.5], P = 0.92) overall or when limited to GTR (P = 0.38) or STR (P = 0.85). There was no significant difference in LR overall (P = 0.75) or when restricted to GTR (P = 0.77) or STR (P = 0.20). No patient had radiotherapy stopped or altered because of side effects; however, 71.4% reported tolerable side effects during the treatment period and 14.3% reported chronic side effects persisting longer than 12 months post treatment. CONCLUSIONS: In a large retrospective cohort, we found no survival or local recurrence benefit to adjuvant radiotherapy in treatment of grade 2 meningiomas. Sensitivity analysis limited to initial GTR and STR also failed to demonstrate any OS or LR benefit with adjuvant radiotherapy. In our experience, there is limited utility to upfront adjuvant radiotherapy following initial surgical resection in the treatment of grade 2 meningiomas.

The impact of brain invasion criteria on the incidence and distribution of WHO grade 1, 2, and 3 meningiomas.

BACKGROUND: In 2016 brain invasion was added as a standalone diagnostic criterion for Grade 2 meningiomas in the WHO Classification of Brain Tumors. The aim of this study was to compare the incidence and distribution of meningiomas, and agreement, between the 2007 and 2016 WHO criteria. METHODS: All cases of intracranial meningiomas diagnosed between 2007 and 2020 at a tertiary care academic hospital were identified. The incidence of each meningioma grade in the WHO 2007 and WHO 2016 cohorts were compared. Additionally, each case in the 2007 cohort was re-graded according to the WHO 2016 criteria to determine the intra-class correlation (ICC) between criteria. RESULTS: Of 814 cases, 532 (65.4%) were in the 2007 WHO cohort and 282 (34.6%) were in the 2016 WHO cohort. There were no differences in the distribution of meningioma grades between cohorts (P = .11). Incidence rates were: 75.0% vs. 75.2% for Grade 1, 22.7% vs. 24.5% for Grade 2, and 2.3% vs. 0.4% for Grade 3, for the 2007 and 2016 cohorts, respectively. Upon re-grading, 21 cases (3.9%) were changed. ICC between original and revised grade was 0.92 (95% CI: 0.91-0.93). Amongst Grade 2 meningiomas with brain invasion, 75.8% had three or more atypical histologic features or an elevated mitotic index. CONCLUSIONS: Including brain invasion as a standalone diagnostic criterion for Grade 2 meningiomas had minimal impact on the incidence of specific meningioma grade tumors. There is strong agreement between the 2007 and 2016 WHO criteria, likely due to cosegregation of grade elevating features.

Large Subependymoma Inferior to the Cerebellopontine Angle With Significant Obstructive Hydrocephalus: A Case Report on an Extremely Rare Tumor.

Subependymomas are rare yet benign tumors that are commonly found within the ventricular system. We describe the case of a 51-year-old male presenting with hydrocephalus and progressive headaches found to have a right cerebellopontine angle (CPA) lesion encasing multiple blood vessels and cranial nerves (CN). The lesion was resected subtotally via a retrosigmoid approach and was found to be a subependymoma. CPA subependymomas are extremely rare lesions. The neuroimaging and histopathological findings as well as a comprehensive literature review of similar cases are discussed.

Age- and sex-dependent profiles of APP fragments and key secretases align with changes in despair-like behavior and cognition in young APPSwe/Ind mice.

Biological sex exerts distinct influences on brain levels of the ß-amyloid (Aß) peptide in both clinical depression and Alzheimer disease (AD), yet studies in animal models focus primarily on males. We examined behavioral 'despair'/depression (using the tail-suspension test) and memory (using the novel object recognition task) in J20 (hAPPSwe/Ind) mice. Three month-old male (but not female) J20 mice exhibited less despair-like behavior, but more evidence of cognitive deficits. In young J20 mice, only soluble Aß peptides -primarily Aß(1-40)- were detected. There was no evidence of an effect on despair-like behavior in the six month-old J20 mice, although cognitive deficits were now evident in both sexes, and coincided with a greater proportion of the neurotoxic Aß(1-42) species (in soluble as well as insoluble fractions). This age-dependent shift in Aß peptide profile coincided with reduced expression of glycosylated species of ADAM-10 (α-secretase) and BACE1 (ß-secretase), and an increased co-immunoprecipitation of presenilin-1 with nicastrin (components of the γ-secretase complex). Sex-dependent changes in depression-related monoaminergic, e.g. serotonin and dopamine (but not noradrenaline), systems were evident already in young J20 mice. It is critical to acknowledge that sex-dependent APP-related phenotypes might differentially influence modifiable depression-related monoaminergic signalling at some of the earliest pathological stages of clinical AD.

Matrix metalloproteinase-2 is activated during ischemia/reperfusion in a model of myocardial infarction.

BACKGROUND: The degradation of myosin light chain 1 (MLC1) by matrix metalloproteinase-2 (MMP-2) during ischemia/reperfusion has been implicated in the development of cardiac dysfunction. Our objective was to elucidate the role of MMP-2 and MLC1 in the development of cardiac injury and dysfunction in a model of left anterior descending (LAD) coronary artery occlusion. METHODS: Adult rats (300-350 g) were anaesthetized, and the isolated hearts were retrogradely perfused in a Langendorff apparatus. The LAD was stabilized for 25 minutes and occluded for either 45 or 90 minutes and then reperfused. Cardiac function (evaluated as rate-pressure product) was significantly decreased in the reperfused hearts subjected to 90 minutes of LAD occlusion in comparison with hearts subjected to either sham or 45 minutes of occlusion. Ninety minutes of occlusion resulted in 60% of infarct. RESULTS: MMP-2 activity, measured by gelatin zymography, was significantly increased following occlusion as well as reperfusion. An increased degradation of MLC1 was observed at the end of reperfusion, but not at the end of occlusion, which most likely was because of the compensatory increase in tissue inhibitor of matrix metalloproteinases-4 (TIMP-4) during occlusion, but not reperfusion. CONCLUSION: We demonstrate that MMP-2 activation is an ischemic event that extends into the reperfusion phase, while MLC1 degradation in response to ischemia/reperfusion is strictly a reperfusion event. MLC1 degradation during occlusion is prevented by a compensatory increase in the levels of TIMP-4.