Common Benign Intracranial Tumors Research Articles

Plasma extracellular vesicles proteomics in meningioma patients

Tumor derived Extracellular vesicles (EVs) in circulating system may contain tumor-specific markers, and EV detection in body fluids could become an important tool for early tumor diagnosis, prognosis assessment. Meningiomas are the most common benign intracranial tumors, few studies have revealed specific protein markers for meningiomas from patients’ body fluids. In this study, using proximity labeling technology and non-tumor patient plasma as a control, we detected protein levels of EVs in plasma samples from meningioma patients before and after surgery. Through bioinformatics analysis, we discovered that the levels of EV count and protein count in meningioma patients were significantly higher than those in healthy controls, and were significantly decreased postoperatively. Among EV proteins in meningioma patients, the levels of MUC1, SIGLEC11, E-Cadherin, KIT, and TASCTD2 were found not only significantly elevated than those in healthy controls, but also significantly decreased after tumor resection. Moreover, using publicly available GEO databases, we verified that the mRNA level of MUC1, SIGLEC11, and CDH1 in meningiomas were significantly higher in comparison with normal dura mater tissues. Additionally, by analyzing human meningioma specimens collected in this study, we validated the protein levels of MUC1 and SIGLEC11 were significantly increased in WHO grade 2 meningiomas and were positively correlated with tumor proliferation levels. This study indicates that meningiomas secret EV proteins into circulating system, which may serve as specific markers for diagnosis, malignancy predicting and tumor recurrent assessment.

Intracranial meningioma: an unusual silent killer—about two cases report and a literature review

BackgroundMeningiomas are common benign intracranial tumors, accounting for 1/3 of all primary intracranial neoplasms, and hence, are not considered the chief cause of death when encountered incidentally during autopsy. These tumors are usually slow-growing, and the clinical course may be asymptomatic to the point of acute complications. Sudden unexpected deaths due to meningiomas are exceptional and rarely reported in the literature.In the present report, we describe two autopsy cases of sudden unexpected death due to meningiomas and we discuss the mechanism of death.Case presentationTwo apparently healthy men were discovered dead in their home. A judicial autopsy was ordered. At dissection, a pedunculated firm mass, attached to the dura was found in both cases. Tumors were located in the anterior and middle fossa. The remaining organs were congestive without any abnormality. A microscopic examination confirmed the diagnosis of meningiomas. Postmortem toxicology analysis was negative. Forensic pathologists concluded to sudden unexpected death due to intracranial meningioma.ConclusionsThese cases illustrate the possibility of meningioma remaining silent till acute complication and fatal outcome. Therefore, clinicians must bear in mind the possibility, albeit extremely rare, of sudden unexpected death in cases of undiagnosed intracranial meningiomas, as documented in the present report. Thus, we emphasize the value of promptly and thoroughly investigating even seemingly minor neurological symptoms, such as headaches or acute epileptic seizures, in adults. We also stress the importance of the early detection and appropriate management of brain tumors in fatal outcome prevention, and we highlight the role of the post-mortem examination to detect such a fatal complication.

Radiation therapy outcomes of patients with pituitary macroadenoma.

Pituitary adenomas are one of the most common benign intracranial tumors, which are normally treated with surgery along with radiation therapy and medication such as dopamine agonist in prolactinoma. The aim of the present study was to evaluate the outcome of patients with pituitary macroadenoma who underwent radiation therapy. For the present retrospective study, a total of 75 patients with pituitary macroadenoma who received radiation therapy were included. Data was acquired from the electronic medical record system of the hospital. Mean ± standard deviation of the quantitative variables, such as age and sizes of the tumors, were reported. In addition, frequencies and percentages were presented for all categorical variables. To compare the frequency distribution in radiation therapy characteristics between functional and non-functional tumors, the χ2 test or Fisher's exact test was applied, where appropriate. Kaplan-Meier survival curve was drawn to assess the progression free survival proportion. P≤0.05 was considered to indicate a statistically significant difference. In the present study, all patients (n=75) with pituitary macroadenoma were treated with radiation therapy (RT). The mean age was 38.55±1.36 years and the majority of the patients were male (43; 57.3%). The mean tumor size was 3.84±1.43 cm. In total, 66.7% were non-functional tumors whereas 33.3% were functional tumors that produce hormones in excess [growth hormone (72%), prolactin (16%), both growth hormone and prolactin (8%) and adrenocorticotropic hormone (4%)]. The overall outcome was revealed to be 92% achieving local tumor control and 28% achieving biochemical control. Hypopituitarism (38.7%) and visual acuity deterioration (9.3%) were the most common complications observed following RT. The overall progression-free survival at 2 years was 92%. In conclusion, the data of the present study suggested that local tumor control in non-functional and functional pituitary macroadenoma can be well managed with RT. However, biochemical control to normalize hormones overproduction in functional pituitary macroadenoma was not as effective as local tumor control.

Radiological classification of meningiomas with hemorrhagic onset and its clinical significance.

Meningiomas are the most common benign intracranial tumors and frequently present with a gradual onset of neurological deficits; conversely, their acute presentation with hemorrhagic onset appears to be a rare event. Nonetheless, as early surgical evacuation is the foundation of treatment, a timely diagnosis of this rare type of intracranial hemorrhage is necessary. The purpose of the present single-center study was to investigate the radiological characteristics and propose a new bleeding classification for guiding the diagnosis and treatment. A total of 19 patients consecutively diagnosed with hemorrhagic meningioma were enrolled in this retrospective study. Intracranial extra-axial mass, tumor-associated hemorrhage and peritumoral brain edema were the three main radiological features of the hemorrhagic meningiomas. The site of tumor-associated hemorrhage included the peritumoral space, subarachnoid space, subdural space, brain parenchyma and/or intratumor region. Based on the anatomical relationship between meningioma and hematoma, the spontaneous hemorrhage stemming from meningiomas was further summarized into three bleeding patterns involving purely intratumoral hemorrhage (type I), purely extratumoral hemorrhage (type II) and combined intra/extratumoral hemorrhage (type III); furthermore, the type III hemorrhage usually came from type I bleeding that extended into the surrounding regions. The symptoms in type I patients were generally mild and early surgery was performed following adequate preoperative evaluations. The symptoms in type II patients were mild in certain cases and moderate to severe in others, so early or emergency surgery was chosen according to the clinical status of the patient. Almost all type III patients had moderate to severe symptoms and these patients usually required emergency surgery. In addition, patients with different bleeding types may have different pathological mechanisms underlying the tumor bleeding. Apart from being convenient for diagnosis, this concise and practical bleeding classification may aid in the selection of the treatment strategy and facilitate the understanding of the associated mechanisms.

Are there predilection sites for intracranial meningioma? A population-based atlas

Meningioma is the most common benign intracranial tumor and is believed to arise from arachnoid cap cells of arachnoid granulations. We sought to develop a population-based atlas from pre-treatment MRIs to explore the distribution of intracranial meningiomas and to explore risk factors for development of intracranial meningiomas in different locations. All adults (≥ 18 years old) diagnosed with intracranial meningiomas and referred to the department of neurosurgery from a defined catchment region between 2006 and 2015 were eligible for inclusion. Pre-treatment T1 contrast-enhanced MRI-weighted brain scans were used for semi-automated tumor segmentation to develop the meningioma atlas. Patient variables used in the statistical analyses included age, gender, tumor locations, WHO grade and tumor volume. A total of 602 patients with intracranial meningiomas were identified for the development of the brain tumor atlas from a wide and defined catchment region. The spatial distribution of meningioma within the brain is not uniform, and there were more tumors in the frontal region, especially parasagittally, along the anterior part of the falx, and on the skull base of the frontal and middle cranial fossa. More than 2/3 meningioma patients were females (p < 0.001) who also were more likely to have multiple meningiomas (p < 0.01), while men more often have supratentorial meningiomas (p < 0.01). Tumor location was not associated with age or WHO grade. The distribution of meningioma exhibits an anterior to posterior gradient in the brain. Distribution of meningiomas in the general population is not dependent on histopathological WHO grade, but may be gender-related.

Integrated Analysis of Transcriptome and Differential Methylation of Neurofibromatosis Type 2 Vestibular Schwannomas

Vestibular schwannoma is the third most common benign intracranial tumor that can occur sporadically or be associated with neurofibromatosis type 2 (neurofibromatosis type 2 vestibular schwannoma [NF2-VS]). The aim of this study is to provide a comprehensive bioinformatic analysis of methylated-differentially expressed genes (MDEGs) in NF2-VS. Transcriptional sequencing datasets (GSE141801 and GSE108524) and gene methylation microarrays (GSE56598) from the Gene Expression Omnibus database were used to identify and analyze MDEGs in NF2-VS. A protein-protein interaction (PPI) network was built, and the hub genes and modules were identified. Finally, potential pharmacotherapy targeting MDEGs were extracted for NF2-VS. A total of 57 hypermethylation-low expression genes and 88 hypomethylation-high expression genes were identified. Pathways associated with aberrantly MDEGs included P13K-AKT, MAPK, and Ras, which were also involved in NF2-VS. Six hub genes (EGFR, CCND1, CD53, CSF1R, PLAU, and FGFR1) were identified from the PPI network. Modification of the aforementioned genes altered cell-to-cell communication, response to stimulus, cellular regulation, and membrane and protein bindings. Thirty drugs targeting these pathways were selected based on the hub genes. Analysis of MDEGs may enrich the understanding of the molecular mechanisms of NF2-VS pathogenesis and lay the groundwork for potential biomarkers and therapeutic targets for NF2-VS.

Hemorrhagic angiomatous meningioma: what we know. Case report and review of the literature

Meningiomas are the most common benign intracranial tumors and rarely present with spontaneous bleeding. We report on a case of hemorrhagic angiomatous meningioma that was treated surgically (the first case described in Brazil) and present a review of the literature. The patient wasa 38-year-old female with progressive headache and vomiting. She also had a previous history ofchronic headaches and refractory depression. Imaging studies showed a large left frontal extra-axialtumor, with intense contrast enhancement and hyperperfusion/hypervascularization. There was anextensive intratumoral and pericapsular hemorrhagic region, with dilation of the middle meningealarteries and falx cerebri vessels. The lesion was compatible with hemorrhagic meningioma. Thepatient underwent bifrontal craniotomy and tumor devascularization, followed by total resection.Histopathological and immunohistochemical analyses led us to conclude that this was a case of angiomatous meningioma. Subsequently, the patient’s headaches and depression improved. Noresidual or recurrent neoplastic lesion was observed during the follow-up.

P06.07 Germline mutation of SMARCE1 gene in a family with spinal meningiomas

Abstract BACKGROUND Meningioma is the most common benign primary intracranial tumor, arising from arachnoid cells of the meninges, but in 20% of cases displays aggressive behavior. Meningiomas are mainly sporadic and the familial forms are very rare. Meningioma account for a small subset (1–4%) of all pediatric brain tumors and may be associated with hereditary tumor predisposition syndrome caused by germline mutations of NF2, SMARCB1, SUFU, and SMARCE1 genes. MATERIAL AND METHODS We present a case of a 16-year-old girl with spinal clear cell meningiomas (CCMs) WHO II with a second spinal lesion identified during the follow-up. Considering the multiple lesions, we performed Whole Exome Sequencing (WES) on DNA from peripheral blood to search for an underlying CCMs tumor predisposition syndrome (#607174). RESULTS We identified a heterozygous frameshift variant c.439delA (p.Ser147fs) in SMARCE1, chromatin remodelling factor that acts as a tumor suppressor gene. Meningioma analysis by Sanger sequencing showed a loss of heterozygosity (LOH) of the wild-type allele. We identified the c.439delA in the constitutional DNA of the father and the sister but not in the mother. At the moment, the father is asymptomatic and the 14 years old sister showed two spinal lesions (meningiomas likely) at the first MRI. CONCLUSION We report a family study of hereditary tumor predisposition syndrome to CCMs with SMARCE1 mutation in which are present two asymptomatic carriers with different ages and gender. The asymptomatic carriers will undergo neurological examination and MRI of the brain and spine, according to a screening protocol. The incomplete penetrance phenomenon is known in SMARCE1-related families with CCMs and it is probably due to the interaction of SMARCE1 with yet unidentified genes.

Recurrent Schowannoma With Extensive Xanthomatous Changes: A Case Report

Schwannoma is one of the most common benign intracranial tumors, which originates from the Schwann cells of neural structures in the upper part of the vestibular branch of the eighth cranial nerve. This report describes a 64-year-old woman with headache and vertigo who had a past surgical history of acoustic schwannoma about 10 years ago. The patient underwent excisional surgery. Histological examinations revealed schwannoma with extensive xanthomatous changes. Immunohistochemistry staining confirmed the diagnosis. Base on the diagnosis, the patient received no more treatment. After 6 months of close follow-up examinations, no recurrence and complication were observed. Schwannoma could be seen with a vast variety of histologic changes. Recurrence of Schownnoma is uncommon in patients without neurofibromatosis, but it should be considered in a proper clinical context.

Does the Timing of Radiosurgery after Grade 1 Meningioma Resection Affect Long-Term Outcomes?

Background: Meningiomas are the most common benign intracranial tumors. Gamma Knife® stereotactic radiosurgery (GKSRS) has become a preferred management for recurrent or residual meningiomas. This study focuses on the relationship between tumor control and the time interval between resection of a World Health Organization (WHO) grade 1 meningioma and GKSRS. Methods: This single institution retrospective analysis reviewed our experience in 238 patients who underwent GKSRS after a pathologically confirmed WHO grade 1 meningioma resection. The median follow-up was 7.4 years. The median aggregate tumor volume at GKSRS was 6 cm3 and a median margin dose of 13 Gy was utilized. Neurological symptoms were evident in 60% of patients at the time of procedure. Results: Overall actuarial tumor control rates achieved were 91.3% at 5 years, 83.4% at 10 years, and 76% at 15 years. There were 35 patients (15%) who developed tumor progression within or directly adjacent to the GKSRS treatment field. The median time until progression was 6.3 years. The duration between surgical intervention and GKSRS did not show statistical significance at 3 months (p = 0.9), 6 months (p = 0.8), 12 months (p = 0.5), or 24 months (p = 0.9). Fifteen patients (6%) had tumor progression at an anatomically distinct location outside the GKSRS target volume. Neurological symptomatic improvement was more likely with early radiosurgery intervention (p = 0.007). Conclusion: Postoperative GKSRS was associated with excellent long-term tumor control for WHO grade 1 meningiomas, regardless of the interval after initial surgery. In addition, earlier radiosurgery was associated with superior symptom improvement.

Massive intracranial hemorrhage caused by intraventricular meningioma: case report

BackgroundMeningiomas are the most common benign intracranial tumors, and commonly comprise high-vascularizing but slow-growing tumors. On the other hand, meningiomas arising from the ventricular system are of rare occurrence, and spontaneous hemorrhage is an infrequent event.Case presentationWe describe here the rare clinical manifestations of a 28-year-old female with acute intracranial hemorrhage located in the trigone of the lateral ventricle who was initially thought to have suffered an acute cerebrovascular accident, but was subsequently confirmed to have a benign intraventricular meningioma. To clarify the clinical features of such a rare course of meningioma, we also present a short literature review of acute intracranial hemorrhage caused by intraventricular meningioma.ConclusionsVentricular meningioma presenting with hemorrhage such as acute stroke is a rare event, but recognition of such a pathogenesis is important. Although further accumulation of clinical data is needed, we suggest that early surgery should be undertaken in patients with lateral ventricular meningioma, even if it is not so large or asymptomatic.

Prognostic Significance of Preoperative Neutrophil-to-Lymphocyte Ratio in Patients With Meningiomas.

BackgroundMeningiomas are the most common benign intracranial tumors. However, even WHO grade I meningiomas occasionally show local tumor recurrence. Prognostic factors for meningiomas have not been fully established. Neutrophil-to-lymphocyte ratio (NLR) has been reported as a prognostic factor for several solid tumors. The prognostic value of NLR in meningiomas has been analyzed in few studies.Materials and MethodsThis retrospective study included 160 patients who underwent surgery for meningiomas between October 2010 and September 2017. We analyzed the associations between patients’ clinical data (sex, age, primary/recurrent, WHO grade, extent of removal, tumor location, peritumoral brain edema, and preoperative laboratory data) and clinical outcomes, including recurrence and progression-free survival (PFS).ResultsForty-four meningiomas recurred within the follow-up period of 3.8 years. WHO grade II, III, subtotal removal, history of recurrence, Ki-67 labeling index ≥3.0, and preoperative NLR value ≥2.6 were significantly associated with shorter PFS (P < 0.001, < 0.001, 0.002, < 0.001, and 0.015, respectively). Furthermore, NLR ≥ 2.6 was also significantly associated with shorter PFS in a subgroup analysis of WHO grade I meningiomas (P = 0.003). In univariate and multivariate analyses, NLR ≥2.6 remained as a significant predictive factor for shorter PFS in patients with meningioma (P = 0.014).ConclusionsNLR may be a cost-effective and novel preoperatively usable biomarker in patients with meningiomas.

Single Fraction Stereotactic Radiosurgery (SRS) versus Fractionated Stereotactic Radiotherapy (FSRT) for Vestibular Schwannoma (VS)

Vestibular schwannoma (VS), also referred to as acoustic neuroma, is one of the common benign intracranial tumors with rising incidence due to improved and more frequent neuroimaging.

Medial sphenoid wing parasellar meningioma masquerading as temporomandibular joint disorder: A case report

Orofacial pain may be multifactorial. Intracranial pathologic conditions can result in symptoms mimicking temporomandibular disorders (TMD) and orofacial pain (OFP). Meningioma is a common benign intracranial tumor. 1 American Association of Neurological SurgeonsNeurosurgical conditions and treatments. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Meningioma Google Scholar Approximately 11% through 20% of all meningiomas originate from the arachnoid cap cells and are attached to the meninges along the wing of the sphenoid bone, and approximately one-half arise from the medial aspect. 2 Cohen-Gadol A. Medial sphenoid wing meningioma:principles of resection. The neurosurgical atlas. https://www.neurosurgicalatlas.com/volumes/cranial-base-surgery/skull-base-meningioma/medial-sphenoid-wing-meningioma Google Scholar Sphenoid ridge meningiomas constitute approximately 20% of supratentorial meningiomas. 3 Basso A. Carrizo A.G. Duma C. Sphenoid ridge meningiomas. in: Roberts D.W. Schmidek H.H. Operative Neurosurgical Techniques: Indications, Methods, and Results 4th ed. W.B. Saunders, Philadelphia2000: 316-324 Google Scholar Meningiomas are most prevalent in patients aged 30 through 70 years. 1 American Association of Neurological SurgeonsNeurosurgical conditions and treatments. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Meningioma Google Scholar Although most meningiomas are benign, they have a tendency to slowly increase in size. When enlarged, depending on their location, they can be severely disabling or life-threatening. 4 American Association of Neurological Surgeons. Meningiomas. Available at: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Meningiomas. Accessed January 30, 2019. Google Scholar Because most meningiomas slowly increase in size, symptoms develop gradually. Common clinical initial symptoms include blurred vision, numbness, headaches, weakness of the arms or legs, and seizures. 5 al-Mefty O. Ayoubi S. Clinoidal meningiomas. Acta Neurochir Suppl (Wien). 1991; 53: 92-97 Crossref PubMed Scopus (46) Google Scholar If symptoms are suggestive of a tumor, magnetic resonance imaging (MRI), computed tomographic scanning, or both are indicated. 6 Bikmaz K. Mrak R. Al-Mefty O. Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg. 2007; 107: 905-912 Crossref PubMed Scopus (95) Google Scholar ,7 Maroon J.C. Kennerdell J.S. Vidovich D.V. Abla A. Sternau L. Recurrent spheno-orbital meningioma. J Neurosurg. 1994; 80: 202-208 Crossref PubMed Scopus (125) Google Scholar These studies can aid in locating the meningioma and determining its size. On occasion, a biopsy may be performed. 8 WebMD Meningioma. https://www.webmd.com/cancer/brain-cancer/meningioma-causes-symptoms-treatment#1 Google Scholar The tumor must be removed in part, or in some cases totally excised, to determine if it is benign or malignant. Radiation therapy can be used to treat malignant tumors 9 Malik I. Rowe J.G. Walton L. Radatz M.W. Kemeny A.A. The use of stereotactic radiosurgery in the management of meningiomas. Br J Neurosurg. 2005; 19: 13-20 Crossref PubMed Scopus (66) Google Scholar when directed at areas inaccessible to the surgeon. Surgical management of medial sphenoid wing meningiomas (SWMs) is challenging owing to the closely associated critical neurovascular structures along the parasellar region. 10 Puzzilli F. Ruggeri A. Mastronardi L. Agrillo A. Ferrante L. Anterior clinoidal meningiomas: report of a series of 33 patients operated on through the pterional approach. Neuro Oncol. 1999; 1: 188-195 Crossref Scopus (45) Google Scholar SWMs are associated with higher morbidity, mortality, and recurrence rates than meningioma in other locations. 5 al-Mefty O. Ayoubi S. Clinoidal meningiomas. Acta Neurochir Suppl (Wien). 1991; 53: 92-97 Crossref PubMed Scopus (46) Google Scholar ,11 Dufour H. Muracciole X. Métellus P. Régis J. Chinot O. Grisoli F. Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?. Neurosurgery. 2001; 48: 285-294 PubMed Google Scholar ,12 Al-Mefty O. Clinoidal meningiomas. J Neurosurg. 1990; 73: 840-849 Crossref PubMed Scopus (155) Google Scholar The rate of recurrence is one of the highest among all intracranial meningiomas. 13 Mathiesen T. Lindquist C. Kihlström L. Karlsson B. Recurrence of cranial base meningiomas. Neurosurgery. 1996; 39: 2-7 Crossref PubMed Scopus (267) Google Scholar Dr. Kalladka is an adjunct assistant professor, Orofacial Pain and Temporomandibular Disorders, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave, Rochester, NY 14620. Dr. Al Obaidi is a resident, Orofacial Pain and Temporomandibular Disorders, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY. Dr. Babu is a consultant, Oral and Maxillofacial Surgery. Columbia Asia Hospital, Bengaluru, Karnataka, India. Dr. Maloth is an associate professor, Department of Dentistry, Koppal Institute of Medical Sciences, Koppal, Karnataka, India. Dr. Khan is an associate professor and program director, Orofacial Pain and Temporomandibular Disorders, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY.

Meningioma Tumor Microenvironment.

The tumor microenvironment consists of noncancerous cells, such as immune cells and fibroblasts, and the proteins produced by these cells as well as the extracellular matrix components in the environment around a tumor. Tumor influences the behavior of the cells present in the surrounding environment, while the cells in the tumor microenvironment modulate the evolution of the tumor. Little is known about the microenvironment of meningioma, the most common benign intracranial tumor. Here, we review the current knowledge of the tumor microenvironment of meningioma and discusses its importance in meningioma tumorigenesis as well as in the designation of novel therapeutic approaches.

Stereotactic Radiosurgery after Subtotal Resection of Critically-Located Grade I Meningioma: A Single-Center Experience and Review of Literature.

To analyze the results of stereotactic radiosurgery in 295 patients with residual Grade I meningiomas located at parasellar region, petroclival region, cerebellopontine angle and parasagittal region. A total of 295 patients with Grade 1 residual Meningiomas (197 women, 98 men), who were treated by adjuvant radiosurgery in Gazi University Gamma Knife Center between 2004-2015 were analyzed. WHO Grade 2 and 3 meningiomas were not included in our study. Minimum radiological follow-up was 24 months. The median follow-up was 54 months. The tumor volume, location, treatment dose, morbidity, progression free survival and tumor control rate were analyzed. The median tumor volume was 5.2 cm3 (0.04-39.7), median age was 50 (20-80), median dose was 14 Gy and tumor control rate was 94.5% (stationary in 85.0%, volume reduction in 9.5%). Increase in tumor volume was seen in 16 patients (5.5%) and re-operation was performed in 5 of them (1.6%). Stereotactic radiosurgery was performed again for 8 patients (2.7%).The location of the tumors was as follows: 39.3% parasellar region, 20% cerebellopontine angle, 13.6% petroclival and 27.1% was parasagittal, falcine or convexity. Major morbidities were detected in 6 (2%) patients. Minor morbidities were detected in 18 (6.1%) patients. Stereotactic radiosurgery is an effective and safe treatment modality for residual Grade I meningiomas.

Schowannoma in an Uncommon Site, Upper Lip: A Case Report

Schwannoma is one of the most common benign intracranial tumors which originates from the Schwann cells of neural sheaths in the upper part of vestibular branch of the eighth nerve, especially in patients with neurofibromatosis type 2. Schwannoma in the other parts of head and neck region is, however, relatively uncommon.The present report describes a rare case of schwannoma that was accidentally discovered in the upper lip in asymptomatic patient lasting for more than 10 years with recently size enlargement. Schwannoma could be seen in a variety of anatomic sites. Thus, this diagnosis should be considered in the differential diagnosis of soft tissue tumor in any location.

Approach to the patient with pancytopenia secondary to panhypopituitarism after craniopharyngioma surgery

Craniopharyngioma is the most common benign intracranial tumor in children. The major post-operative complication is dysfunction of pituitary, which can result in many complicate clinical manifestations with hormonal deficiencies. Normochromic anemia has been reported as a common hematologic abnormality. However, pancytopenia is rarely reported so far. Here we described a 21-year-old inpatient with the main complaint of nasal bleeding, who received craniopharyngioma surgery 9 years ago. Laboratory tests showed pancytopenia secondary to panhypopituitarism. This paper aims to increase the awareness of this disease and accumulate clinical experiences for the clinicians. Key words: Craniopharyngioma; Hypopituitarism; Pancytopenia

Bundle Payment, Health Care Utilization, and Outcomes Following Surgery for Anterior, Middle, and Posterior Cranial Fossa Skull Base Meningioma: A Market Scan Analysis

Abstract INTRODUCTION Meningioma is the most common benign intracranial brain tumor accounting for approximately one-third of all primary brain tumors. The aim of our study was to compare the bundle payment, health care utilization, and outcomes following surgery for anterior (AFM), middle (MFM), and posterior cranial fossa meningioma (PFM) across the United States. METHODS We queried the Market Scan database using ICD-9 and CPT-4, from 2000 to 2016. We included adult patients who had at least 24 mo of enrollment following the surgical procedure. The outcome of interest was length of hospital stay, disposition, complications, and reoperation following the procedure. RESULTS A cohort of 1,188 patients was identified from the database. In all 43.86% of tumors were AFM, 32.32% were MFM, and only 23.8% were PFM. Patients who underwent surgery for PFM had significant longer hospital stay (P = .0013), higher complication rate (P = .0009), and less likely to be discharged home (P = .0013) during index hospitalization. Patients with MFM and PFM incurred higher outpatient services with no differences in corresponding payments compared to those with AFM at 12 mo (P &lt; .0001) and 24 mo follow-up (P &lt; .0001). There were no differences in overall payments at 12 mo (AFM: $19,702; MFM: $20,671; PFM: $20,922) and 24 mos (AFM: $37,142; MFM: $44,133; PFM: $36,601) among the cohorts. There was no significant difference in 90-d median bundle payments among the groups, $66,173 (AFM) vs $65,602 (MFM), and $71,837 (PFM), P = .1955. CONCLUSION Ninety-day bundle payment and overall payments (at 12 mo and 24 mo) were not significantly different among the cohorts. Patients with PFM had longer hospital stay, higher complication rate, and less likely to be discharged home with higher utilization of outpatient services at 12 mo and 24 mo.

Intracranial – extracranial meningioma: a case report of a rare entity

Abstract Meningiomas are common benign intracranial tumors. However, intracranial meningiomas with extracranial extension are exceedingly rare lesions with only a few reported cases in the literature. We report a case of an 86 years old female patient presented with enlarging mass over left parietal region for last 3 years. Besides cosmetic, she had no complaints. Head CT scan with bone window showed a large tumor consisting of intracranial and extracranial part, suggestive for meningioma. Patient was operated, and both parts of tumor were removed. Taking into account surgery indication and patient’s age, bone flap was returned. The postoperative course was uneventful and patient fully recovered. In the case of epicranial tumor attached to the underlying bone, meningioma should be excluded.