Histopathological classification and location of consecutively operated meningiomas at a single institution in China from 2001 to 2010 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010.</p><p><b>METHODS</b>This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization (WHO) classification. The location of the meningiomas was also categorized.</p><p><b>RESULTS</b>The female:male ratio of the 7084 cases was 2.34:1. The mean age was 51.4 years (range, 11 months-86 years). The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas (P < 0.001, Fisher's Least Significant Digit test). There was a significantly higher female:male ratio in WHO grade I meningiomas than in grade II or grade III meningiomas (2.57, 1.03 and 0.76, respectively; P < 0.001, χ(2) test). Meningothelial (n = 2061) and fibrous meningiomas (n = 3556) were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site (38.33%, n = 2722). Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series.</p><p><b>CONCLUSIONS</b>Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade I meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common meningioma location.</p>

Preoperative surgical planning for intracranial meningioma resection by virtual reality / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The Dextroscope system by Volume Interactions (Singapore) had been applied to minimally invasive neurosurgery in many units. This system enables the neurosurgeon to interact intuitively with the three-dimensional graphics in a direct manner resembling the way one communicates with the real objects. In the paper, we explored its values in pre-operation surgical planning for intracranial meningiomas resection.</p><p><b>METHODS</b>Brain computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) were performed on 10 patients with parasagittal and falcine meningiomas located on central groove area; brain CT, MRI and magnetic resonance angiography (MRA) were performed on 10 patients with anterior skull base meningiomas and 10 patients with sphenoid ridge meningiomas. All these data were transferred to Dextroscope virtual reality system, and reconstructed. Then meningiomas, skull base, brain tissue, drainage vein and cerebral arteries were displayed within the system, and their anatomic relationships were evaluated. Also, the simulation operations were performed.</p><p><b>RESULTS</b>For parasagittal and falcine meningiomas, the relationships of tumor with drainage vein and superior sagittal sinus were clearly displayed in the Dextroscope system. For anterior skull base and sphenoid ridge meningiomas, the relationships of tumor with bilateral internal carotid arteries, anterior cerebral arteries, middle cerebral arteries and skull base were vividly displayed within the virtual reality system. Surgical planning and simulation operation of all cases were performed as well. The real operations of all patients were conducted according to the simulation with well outcomes.</p><p><b>CONCLUSIONS</b>According to the virtual reality planning, neurosurgeons could get more anatomic information about meningioma and its surrounding structures, especially important vessels, and choose the best approach for tumor resection, which would lead to better prognosis for patients.</p>

Microsurgical treatment for giant and irregular pituitary adenomas in a series of 54 consecutive patients.

The aim of this investigation was to evaluate the clinical significance of the various optional surgical approaches for giant and irregular pituitary adenomas and to summarize the optimal surgical protocols for the adenomas in terms of different growth morphologies. Fifty-four cases with giant and irregular pituitary adenomas were treated by studying their clinical features and image examinations, designing the specific surgical protocols, and choosing the optimal approaches according to the various growth morphologies. Neuro-endoscope and neuronavigation-assisted techniques were applied intraoperatively. Postoperative MRI and endocrine function were re-examined routinely to judge the therapeutic efficacy of various single approaches, combined approaches and staged operations. Application of the six protocols resulted in total removal of the tumours in 18 cases, subtotal removal in 28 cases, partial removal in five cases and three deaths. The most appropriate surgical approaches, which were adopted after comprehensive analyses of the morphological characteristics presented in image examinations, those involving anatomical spaces and the clinical symptoms, can achieve the improved therapeutic results and reduce injuries to the vital anatomic structures. The tumour removal rate can be increased with the help of neuro-endoscope, neuronavigation techniques and intraoperative MRI.