Calcified Meningioma Research Articles

Calcified Meningiomas Demonstrate Equivocal Grade, Proliferation, and Immediate Surgical Outcomes

Meningioma calcification is thought to predict reduced growth potential and aggression. However, historical studies have primarily focused on correlating calcification in small meningiomas (diameter less than 2.5 cm) rather than analyzing characteristics of calcified meningiomas across all sizes. In this study, we investigate the pathologic and clinical implications of meningioma calcification. We utilized a historical database of 342 consecutive newly diagnosed intracranial meningiomas with preoperative computed tomography and magnetic resonance imaging scans treated at a single institution from 2005 to 2019. We correlated the presence of calcification with patient demographics, grade, Mindbomb Homolog-1 index, location, volume, Simpson grade, and recurrence using both univariate and multivariate generalized linear models. On univariate analysis, no single variable correlated with tumor calcification. Notably, neither tumor 2021 World Health Organization grade (P = 0.91) nor Mindbomb Homolog-1 index (P = 0.62) predicted calcification. After accounting for demographic characteristics and tumor volume and location, there was no significant association between 2021 World Health Organization grade (P = 0.52) and Mindbomb Homolog-1 index (P = 0.54) and calcification. Calcification had no influence on resection grade (P = 0.59) or recurrence (P = 0.80). In this series, calcified meningiomas exhibited similar 2021 World Health Organization tumor grading distribution, proliferation indexes, and immediate surgical outcomes compared to their noncalcified counterparts. These findings question the historical role of using meningioma calcification as an independent guide to their management.

A Comprehensive Study of Meningioma Biomineralization: Morphological, Crystallographic, and Immunohistochemical Aspects.

Biomineralization of brain tissues occurs both in normal and pathological conditions. Dura mater biomineralization is widespread and occurs in 1-72% of cases, depending on the patient's age and research method. The amount of biomineral deposits under the conditions of tumor growth in the meninges only increases, reaching 100% in the case of psammomatous meningiomas. Since calcifications are often found in the meninges, the problem of differential diagnosis with calcified meningiomas arises. A total of 30 samples of meningiomas with signs of biomineralization-dense structure, characteristic crunch, psammoma bodies (group I) and 30 samples of meningiomas without any signs of biomineralization were examined as controls (group II). To detect pathological biomineralization, the meningioma tissue was studied using the methods of macroscopic description, histology, histochemistry, and immunohistochemistry, scanning electron microscopy with microanalysis, and transmission electron microscopy. A significantly higher level of caspase3 and features of the expression of osteoblastic markers (a lower level of OPG expression and a higher level of the presence of RANKL in group I, the absence of fluctuations in the expression of SPARC) may indicate a dystrophic type of development of biomineral deposits in meningiomas.

Clinical utility of intraoperative direct wave monitoring in patients with pre-operative motor deficits: Case series

Introduction and importanceD-wave (Direct waves) are Motor Evoked Potentials (MEPs) generated by a single transcranial stimulation and captured by attaching an epidural recording electrode caudal to the vulnerable area. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development. Case presentationCase 1: A 48-year-old female presented to the outpatient department with complaints of difficulty walking for the past six months, numbness and weakness in bilateral lower limbs with recurrent falls for the past 1 month. Case 2: A 12-year-old boy presented to the emergency room with a history of inability to use both upper and lower limbs on the right side with tremulousness. Clinical discussionMagnetic resonance imaging (MRI) Spine in the first case revealed a D9-D10 calcified meningioma with significant spinal cord compression. In the second case, MRI Spine showed C1-C2 Intramedullary Space Occupying Lesion (SOL) and was planned for C1-C2 laminectomy with midline myelotomy. The first case was planned for microsurgical excision of the lesion under IONM guidance. The procedure went smoothly. Microsurgical gross total resection (GTR) of the intramedullary SOL under IONM Guidance was done for the second case. Postoperatively, the first patient showed no neurological compromise or complications. In the second case, following surgery, the child recovered gradually from surgery. ConclusionThis case series demonstrates the successful surgical management of two cases of spinal cord tumors through an IONM-guided surgery and the effective use of D waves in such challenging cases.

Removal of Spinal Calcified Meningiomas With Piezosurgery: Technical Note on a New Application of a Known Device

BACKGROUND AND IMPORTANCE: Ossified spinal meningiomas are a rare form of spinal tumor. The removal in narrow surgical space is challenging because of their hard consistency and strong adhesion to the neural tissue. These meningiomas are often located in the upper thoracic spine, and sometimes, even the identification of the correct intraoperative level is difficult. CLINICAL PRESENTATION: We describe the clinical findings, surgical strategies, and histological findings of a patient with a thoracic ossified meningioma. DISCUSSION: We discuss the technical points, safety, and efficacy of the piezosurgery device in reducing the calcified mass. CONCLUSION: The device has the potential to reduce the operating time and enhance surgical safety when removing ossified meningiomas.

SURG-11. AKT1 E17K AND NF2 MUTATIONS DOMINATE SPINAL MENINGIOMAS WHO GRADE 1 AND PRESENT DISTINCT TUMOR FEATURES

Abstract INTRODUCTION While the mutational landscape of intracranial meningiomas has been extensively studied, our understanding of the molecular profile of spinal meningiomas (SM) remains incomplete. In this study, we correlate the molecular status with tumor features in a clinically well-characterized cohort. METHODS Samples from 50 patients (38 females and 12 males) with WHO grade 1 SM were collected. We performed next-generation sequencing (NGS) using an assay covering frequently mutated genes in meningiomas including AKT1, KLF4, NF2, PIK3CA, POLR2A, SMARCB1, SMARCE1, SMO, SUFU, and TRAF7. We correlated clinical and imaging data with the molecular tumor status. RESULTS AKT1 E17K mutations were detected in 15 (30%) and NF2 mutations in 32 (64%) patients. Both mutations were mutually exclusive. In contrast to AKT1-mutant intracranial meningiomas, AKT1-mutant SM only harbored a TRAF7 co-mutation in a single case. NF2-mutant meningiomas had a significant female predominance (n= 30/32, 94%) when compared to the balanced incidence of AKT1-mutant tumors (n= 7/15, 46.7%, p= 0.0006). The two groups demonstrated stark differences in the location: a thoracic localization was significantly more common in NF2-mutant meningiomas (n= 25/32, 78.1%, p= 0.0012), while meningiomas harboring an AKT1 mutation were predominantly located in the cervical spine (n= 11/15, 73.3%). Moreover, while a substantial proportion of NF2-mutant meningiomas developed in the dorsal location (n= 19/32, 59.3%), the vast majority of AKT1-mutant meningiomas (n= 13/15, 87%) arose ventral to the spinal cord. The histologic subtype of NF2-mutant meningiomas was variable, while all but one AKT1-mutant meningioma showed meningothelial histology (93.3%, p= 0.0001). All calcified meningiomas (n= 17) were NF2-mutant (p= 0.0002), whereas none of the AKT1-mutant meningiomas showed intratumoral calcifications. CONCLUSIONS Our findings support the central role of AKT1 and NF2 mutations in the molecular pathogenesis of WHO grade 1 SM. These mutations are mutually exclusive and are associated with distinct tumor and clinical features.

The Expression of miR-155-5p and Local Matrix Gla Protein in Meningiomas

Abstract Meningiomas are classified by the World Health Organization (WHO) in three grades, based on morphological features. Independent of this grading, the presence of calcification in meningiomas influences their growth rate. The messenger RNA of matrix Gla protein (MGP), an extra-hepatic protein with different conformations involved in the homeostasis of ectopic calcification has been found in meningiomas and was shown to be regulated in breast cancer by miR-155-5p, a specific micro RNA. Therefore, we investigated the expression of miR-155-5p and its relationship with local MGP conformations in different grade meningiomas. According to the WHO classification, our 41 samples of meningiomas were stratified in groups WHO I and WHO II. Using real time polymerase chain reaction, we observed a higher miR-155-5p expression in group WHO I versus group WHO II [with a fold change (FC) of 3.83, p=0.027)]. Moreover, the expression of miR-155-5p was higher in calcified tumors compared to non-calcified tumors in all samples (FC=3.01, p=0.047) and in group WHO I (FC=3.65, p=0.048). Utilizing immunohistochemistry, we determined the concurrent presence of all MGP conformations in calcified meningiomas. This study was the first to establish higher miR-155-5p expression in grade WHO I and calcified meningiomas, which could improve molecular classification and targeted therapy and also the presence of all MGP conformations in calcified meningiomas, confirming the existence of an anti-calcification mechanism in meningiomas..

English

In cancer patients, syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of hyponatremia. 1 Hyponatremia is a serious disorder of dyselectrolytemia, linked with neurological symptoms that are life-threatening and it is the most common aetiology of tumour-related electrolyte imbalance.2 The tumours commonly causing hyponatremia of SIADH variety are lung, head-neck and breast tumours. SIADH has been documented in various malignancy types with numerous possible aetiologies apart from active malignancy.2,3 The aetiology distribution of SIADH in tumour patients are not completely known. Secondly, clinically, it is not clear which malignancy is most commonly associated with SIADH.3 Calcified meningioma presenting as SIADH had not been reported so far in the literature. Here a case of an elderly female with clinical features and brain imaging suggestive of meningioma associated with hyponatremia due to SIADH had been highlighted.

Osteogenesis imperfecta and cerebrospinal fluid leak: a unique presentation and treatment challenge

Introduction: Osteogenesis imperfecta (OI) is a heritable disorder of the connective tissue that mainly manifests as bone fragility. Other signs and symptoms may be present, such as sensorineural hearing loss, cardiac malformations, and teeth alterations. Case description: 72-year-old female patient presented with left abundant spontaneous hyaline rhinorrhea, history of several bone fractures since early childhood, and a blue grayish sclera was noted. Cerebrospinal fluid (CSF) leak was diagnosed. Neuroimaging revealed lowering of the sella turcica floor, platybasia, basilar impression, left middle fossa calcified meningioma, syringobulbia, ventricular dilatation, and left ethmoidal fistula. Due to the patient’s age and clinical status, a medical approach was chosen, and treatment with acetazolamide and furosemide in low dosages, which resulted in a decrease of the rhinorrhea. Discussion: Clinical features and imaging study are often sufficient for diagnosis of OI. The neurological and cranial features in OI are varied. CSF leak is not commonly reported and might have been a consequence of bone softening and hydrocephalus. Conclusions: This case represents a treatment challenge, as the surgical results were uncertain, once bone fragility could result in the development of new leaks. Clinical treatment was chosen and resulted in a significant improvement of the symptoms.

Giant Intra-Ventricular Calcified Meningioma in Childhood Manifest as Movement Disorders : A Extremely Rare Presentation

Giant Intra-Ventricular Calcified Meningioma in Childhood Manifest as Movement Disorders : A Extremely Rare Presentation

Trap-door durotomy for ventral calcified thoracic meningioma

Abstract Ventral calcified meningiomas of the upper thoracic spine provide a unique challenge due to their location. The posterior approach has long been utilized for resection of ventral meningiomas with high success rates and low morbidity. There are a number of anatomical factors that can increase the difficulty in the case including patient body habitus, calcified tumors ventrally located can be adherent to the cord or anterior spinal artery, angle of the ribs and the vascularity in and around the tumor. We present a very challenging case of a large ventral calcified meningioma at T4 in a patient with body mass index of 50 (5′6, 337 lbs) who presented with progressive paraplegia.

Electroconvulsive therapy for medication-refractory depression in a patient with ruptured intracranial dermoid cyst, meningioma, and neurofibromatosis.

Electroconvulsive therapy (ECT) is considered relatively contraindicated in patients with intracranial space-occupying lesions. A 53-year-old male presented with a 5-year history of medication-refractory major depressive disorder. Brain imaging findings suggested the presence of a ruptured dermoid cyst in the transverse sinus and a calcified meningioma in the temporal lobe sulcal space. There was no evidence of mass effect. Neurofibromatosis was the only other clinical condition present. The patient had no clinical neurological deficits. Since the depression was severe and he was suicidal, ECT was advised. There was a substantial improvement after four bilateral and then eight right unilateral brief-pulse ECTs administered on alternate days, thrice weekly. There were no complications associated with ECT. The treatment gains were maintained with maintenance antidepressant medication at a 1-year follow-up. This is probably the first reported case of the use of ECT in a medication-refractory, severely depressed patient with a ruptured intracranial dermoid cyst and with a calcifying meningioma. The results testify to the safety of ECT even in high-risk patients.

Calcified intraventricular meningioma in 82-years-old woman: An unusual finding

Introduction: Primary Intraventricular meningiomas are rare and occur in much younger age group than other the intracranial meningiomas. Calcified intraventricular meningioma in elderly has never been reported before. Case Report: Here we report the unique case of an 82 year-old female who presented for headache and vomiting following a traffic accident. The neurological examination disclosed no abnormalities. The CT scan revealed a calcified Intraventricular meningioma. Conclusion: Since the patient was aged over 70 years and was asymptomatic, the lesion was not removed. Follow-up imaging showed no changes in the tumor.

Two Case Reports of Calcified Spinal Meningioma and a Literature Review

Two Case Reports of Calcified Spinal Meningioma and a Literature Review

Intradural Tophaceous Gout of the Cavernous Sinus and Spine: Case Report and Review of Literature

Background: Purine-rich diets and improper metabolism of uric acid result in deposition of monosodium urate crystals in multiple organs throughout the body. Gout is typically characterized by recurrent attacks of inflammatory arthritis; however, deposition of uric acid crystals in the spinal canal may result in debilitating back pain, neural compression, and progressive myelopathy. While extradural gout is a widely reported source of spinal cord compression, we present a novel case of an individual with intradural tophaceous gout in the cranial and spinal cavities. Case history: A 61-year-old African-American male presented with diplopia, masticatory difficulty, and facial pain. Serial imaging revealed an enlarging, heterogeneously enhancing mass in the left cavernous sinus with extension into the superior orbital fissure and foramen ovale, raising suspicion for a meningioma. Successful surgical resection of the cavernous lesion was undertaken to eliminate the risk of permanent ophthalmoplegia and blindness. The pathological findings were felt to be compatible with chondroma. Nine years later, after stable yearly imaging follow-up of the cranial lesion, the patient presented with progressive myelopathy. Imaging of the spine revealed enhancing, intradural lesions suggestive of calcified meningiomas. Surgical resection was undertaken to preserve motor function. Histopathologic diagnosis after spinal decompression was tophaceous gout. Retrospective review of the cranial pathology indicated that this lesion, too, was consistent with tophaceous gout. Conclusion: The pathophysiology of spinal tophaceous gout is well known and extradural lesions are not uncommon. However, multifocal intradural tophi involving intracranial and intraspinal compartments have not been previously reported. This case represents the first reported case of both intracranial and intraspinal intradural tophaceous gout causing neurological deficits.

Utility of MRIs in Adult Cochlear Implant Evaluations

To determine the prevalence of MRI abnormalities in adults undergoing cochlear implantation and to correlate abnormalities to audiology data. Case series. Academic medical center. Adult patients (>18 yr old) undergoing cochlear implant evaluation from January 2008 to December 2012 were identified based on CPT code search. Demographics, preoperative MRI findings, operative findings, and audiometric data were collected. The study included 188 patients. Seventeen (9%) patients had significant otic capsule or vestibulocochlear nerve pathologies: 5 vestibular schwannomas, 4 enlarged vestibular aqueducts, 2 hypoplastic cochlear nerves, 2 labyrinthitis ossificans, 1 cochlear aplasia, 1 posterior semicircular canal malformation, 1 calcified meningioma, and 1 cholesterol granuloma. MRI results were normal (65%) or with findings not directly related to hearing loss (incidental findings, 25%) in the remaining patients. Mean pure tone average (PTA) differences (between the implanted and contralateral ear) did not significantly vary between normal-incidental and abnormal MRI scans (-6.6 dB versus -6.7 dB, p = 0.99) nor did speech discrimination scores (SDS) scores (8.5% versus 8.4%, p = 0.99). No significant difference was found in HINT scores for patients with a normal versus an abnormal MRI (19% versus 16,%, p = 0.62). Although the majority of precochlear implantation MRIs were normal or demonstrated incidental findings, such as white matter changes, significant MRI findings affecting implantation site and patient counseling were found in almost 10% of patients. Audiogram findings did not correlate with abnormal findings on MRIs. Routine use of MRI in adult cochlear implant candidates may be warranted.

An unusual cause for chronic right-sided abdominal pain: answer

MRI of the spine (Fig. 1 of Images in Neuroscience: Question) demonstrated a calcified lesion at T6/T7 causing marked cord compression, consistent with a large disc prolapse. The disc extrusion was eccentric to the right with the compressed cord displaced to the left. Localised cord signal abnormality was present on T2-weighted images. CT scan of the thoracic spine (Fig. 1 of Images in Neuroscience: Question) demonstrated calcification with a broad dural base anteriorly, extending superiorly behind the T6 vertebral body and intradurally. There were moderate degenerative changes within the T6/T7 intervertebral disc. The major differential diagnosis was considered to be a calcified meningioma. Surgery was subsequently performed through a T6/T7 laminectomy, wider on the right than the left. The calcified mass was confirmed to be intradural, and the dura was opened just right of the midline. An ultrasonic bone curette was used to resect the mass. Histopathology revealed mature hyaline cartilage, without evidence of atypia or malignancy. Thoracic disc prolapse is uncommon, with reported incidences between 0.15% to 4% of all symptomatic disc prolapses [1,2]. The most common level of prolapse is T11/T12, and calcification occurs in 65% of patients [2]. Presentations are varied, ranging from chronic pain to an acute myelopathy in 4% of patients [3]. The most common complaint is that of back pain, with or without a radicular component. Abdominal and groin pain are a rare but recognised entity and diagnosis of a thoracic disc prolapse in these patients usually follows multiple non-invasive and invasive procedures such as endoscopy and laparoscopy [1,3–7].The mechanism of abdominal pain is unclear. Visceral and somatic afferent fibres are attributed to different spinal locations and there is no relationship between visceral afferents and dermatome level, although the lower thoracic nerves (T8–T12) appear to be most commonly involved with patients who present with abdominal pain [1,4–6]. Surgery remains themainstay of treatment for symptomatic thoracic disc prolapse with rapid surgical decompression of patients with acute myelopathy frequently leading to neurological recovery

Letter to the Editor: Calcified meningiomas

Letter to the Editor: Calcified meningiomas

Myelopathy due to calcified meningiomas of the thoracic spine: minimum 3-year follow-up after surgical treatment

Calcified meningiomas are an uncommon type of meningioma. This study details the clinical features, treatment, and follow-up of 11 calcified meningiomas treated from 2002 to 2009, for the purpose of providing general information, describing the skill required for the surgery, and detailing the imaging study of these tumors. Between 2002 and 2009, 11 patients underwent surgery for the treatment of calcified meningiomas. All were treated by the same group of doctors at the same institution, including surgery and rehabilitation after surgery. The minimum 3-year (> 36 months) follow-up data from the 11 patients were detailed. Neurological function was evaluated twice, based on the Frankel scale and Japanese Orthopaedic Association scoring system. The first evaluation occurred before surgery and the second 3 years after surgery. In 3 cases, the Frankel score decreased by 1 level. In a comparison of the duration of preoperative symptoms, age, degree of canal stenosis, and intraoperative blood loss, it was found that the greater the degree of canal stenosis, the poorer the outcome of the patient. Calcified meningiomas were more likely to adhere to the nerves and dura, a finding that might explain the high incidence of neurological dysfunction and CSF leakage after surgery. Calcified meningiomas are the most rare of all meningiomas. It appears that a greater degree of canal stenosis can lead to a poorer outcome. Computed tomography scans and MRI with contrast enhancement are recommended for intraspinal tumors before surgery to exclude the possibility of calcification. For calcified meningiomas, precise tumor resection, dura repair during surgery, and medical care after surgery are important for achieving an acceptable outcome.

Meningeal tumor: A rare extrahepatic association in patients with polycystic liver disease enrolled for liver transplantation

In the present study, we described a rare association of polycystic liver disease (PCLD) with intracranial meningiomas in patients included on a liver transplant list, focusing on the diagnosis, treatment and possible association with any genetic alterations. Two female patients, aged 39 and 49 years were included on a liver transplant list due to extensive PCLD, with symptoms related to an abdominal compartmental syndrome. Screening for extrahepatic manifestation revealed a right frontal meningioma in the first patient, and a parietal posterior calcified meningioma in the second patient, measuring 1 and 7×3×2 cm in diameter, respectively. Following tumor removal, the histological pattern was compatible with fibrous and transitional meningioma, respectively. Cytogenetic studies conducted following surgery did not reveal any changes in metaphase chromosomes. The postoperative follow-up for the two patients was uneventful, without complications, with the patients remaining on a liver transplant waiting list. We conclude that screening for extrahepatic manifestations of PCLD is mandatory, as certain lesions require treatment prior to liver transplantation. The lack of a genetic or familial association between these two cases show they are likely to have occurred by chance, rather than representing a previously unrecognized association between polycystic liver disease and cranial meningioma.

Intracranial subdural osteoma: A rare benign tumor that can be differentiated from other calcified intracranial lesions utilizing MR imaging

We report the magnetic resonance (MR) imaging characteristics of subdural osteoma and other benign calcified intracranial lesions to highlight imaging features that differentiate between these disease entities. A 63-year-old woman presented with progressively altered mental status. Non-contrast CT demonstrated a densely calcified right middle cranial fossa extra-axial mass. MR imaging of the lesion demonstrated T1 and T2 hypointensity without evidence of contrast enhancement, parenchymal abnormality, or connection to adjacent venous structures. Diffusion weighted imaging demonstrated markedly decreased signal intensity and artificially reduced diffusion on apparent diffusion coefficient map. Histologically, the tumor was predominantly composed of lamellar bone and small fragments of residual dura consistent with subdural osteoma. This case demonstrates that radiological examination can provide additional insight into the origin of intracranial osteomas (extradural versus subdural versus sinonasal) and help distinguish from other diagnostic considerations including benign meningeal ossification and calcified meningioma prior to surgical resection.