Resection Of Convexity Meningioma Research Articles

Postoperative diffusion-weighted imaging and neurological outcome after convexity meningioma resection.

Convexity meningiomas are commonly managed with resection. Motor outcomes and predictors of new deficits after surgery are poorly studied. The objective of this study was to determine whether postoperative diffusion-weighted imaging (DWI) was associated with neurological deficits after convexity meningioma resection and to identify the risk factors for postoperative DWI restriction. A retrospective review of patients who had undergone convexity meningioma resection from 2014 to 2018 was performed. Univariate and multivariate logistic regressions were performed to identify variables associated with postoperative neurological deficits and a DWI signal. The amount of postoperative DWI signal was measured and was correlated with low apparent diffusion coefficient maps to confirm ischemic injury. The authors identified 122 patients who had undergone a total of 125 operations for convexity meningiomas. The median age at surgery was 57 years, and 70% of the patients were female. The median follow-up was 26 months. The WHO grade was I in 62% of cases, II in 36%, and III in 2%. The most common preoperative deficits were seizures (24%), extremity weakness/paralysis (16%), cognitive/language/memory impairment (16%), and focal neurological deficit (16%). Following resection, 89% of cases had no residual deficit. Postoperative DWI showed punctate or no diffusion restriction in 78% of cases and restriction > 1 cm in 22% of cases. An immediate postoperative neurological deficit was present in 14 patients (11%), but only 8 patients (7%) had a deficit at 3 months postoperatively. Univariate analysis identified DWI signal > 1 cm (p < 0.0001), tumor diameter (p < 0.0001), preoperative motor deficit (p = 0.0043), older age (p = 0.0113), and preoperative embolization (p = 0.0171) as risk factors for an immediate postoperative deficit, whereas DWI signal > 1 cm (p < 0.0001), tumor size (p < 0.0001), and older age (p = 0.0181) were risk factors for deficits lasting more than 3 months postoperatively. Multivariate analysis revealed a DWI signal > 1 cm to be the only significant risk factor for deficits at 3 months postoperatively (OR 32.42, 95% CI 3.3-320.1, p = 0.0002). Further, estimated blood loss (OR 1.4 per 100 ml increase, 95% CI 1.1-1.7, p < 0.0001), older age (OR 1.1 per year older, 95% CI 1.0-1.1, p = 0.0009), middle third location in the sagittal plane (OR 16.9, 95% CI 1.3-216.9, p = 0.0026), and preoperative peritumoral edema (OR 4.6, 95% CI 1.2-17.7, p = 0.0249) were significantly associated with a postoperative DWI signal > 1 cm. A DWI signal > 1 cm is significantly associated with postoperative neurological deficits, both immediate and long-lasting. Greater estimated blood loss, older age, tumor location over the motor strip, and preoperative peritumoral edema increase the risk of having a postoperative DWI signal > 1 cm, reflective of perilesional ischemia. Most immediate postoperative deficits will improve over time. These data are valuable when preoperatively communicating with patients about the risks of surgery and when postoperatively discussing prognosis after a deficit occurs.

Evaluation of Resection Margin after Image-Guided Dural Tail Resection in Convexity Meningiomas.

Infiltration of adjacent dura with meningioma cells is a common phenomenon. Wide resection of the dural tail (DT) to achieve a gross total resection is a general recommendation. We aimed to investigate a tumor cell infiltration of the DT after image-guided resection of convexity meningiomas. The study’s inclusion criteria were the diagnosis of convexity meningioma, planned Simpson I° resection, and an identifiable DT. Intraoperative image-guidance was applied to identify the outer edge of the DT and to guide resection. After resection, en-bloc specimen or four samples of outermost pieces of DT in case of piecemeal resection were sent for histological analysis. In addition to resection margin infiltration, the radiological extent of DT, radiomic characteristics (109 in total), histology, and demographic data were assessed. Hierarchical clustering was used to generate patient clusters for radiomic analysis. Twenty-two patients were included in the study, while 20 (91%) were female. The mean age was 54.2 (Standard deviation (SD) 13.9, range 30–85) years. En-bloc resection could be achieved in 4 patients. The remaining patients received piecemeal resection. 2 DT samples were omitted due to tumor infiltration of the superior sagittal sinus. None of the en-bloc resection samples demonstrated dural infiltration on the resection margin. Tumor cells were detected in 4 of 70 (5.7%) dural tail samples and could not be excluded in another 5 of 70 (7.1%). No tumor recurrences were detected at follow-up MRI examinations after a mean follow-up of 27.5 (SD 13.2, range 0 to 50.0) months. There was no significant association between DT infiltration and histological subtype or patient characteristics and between DT extent and tumor infiltration. Clustering according to radiomic characteristics was not associated with tumor infiltration (p = 0.89). The radiological dural tail does not reliably outline the extent of tumor cell infiltration in convexity meningiomas. Hence, the extent of dural tail resection should not exclusively be guided by preoperative radiological appearance.

Chapter 8 - Convexity meningioma resection in the modern neurosurgical era

Convexity meningiomas are among the most common extra-axial tumors encountered in neurosurgery. Advances in diagnostic imaging, intraoperative technology, and nonsurgical treatment modalities have changed the face of neurosurgical oncology. In this chapter we describe the modern neurosurgeon's approach to convexity meningiomas in terms of diagnosis, treatment, and follow-up care.

Evaluation of prognosis of convexity meningioma by using MRI imaging parameters

Objectives To investigate the correlation of preoperative MRI imaging parameters and pathological grades and prognosis of convexity meningioma and to initially establish the imaging scoring method for predicting of the prognosis and biological behavior of meningiomas. Methods From January 2003 to December 2006, the preoperative imaging parameters of 246 patients underwent resection of convexity meningioma (Simpson gradeⅠ) at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University were analyzed retrospectively. The preoperative imaging parameters included the signal intensity of diffusion tensor imaging (DTI), T1 enhanced images, subarachnoid layer on T2-weighted images, peritumoral edema on T2-weighted images and tumor shape. The relationship between imaging features of tumors and clinical pathological grades was detected by the univariate analysis. Kaplan-Meier survival analysis and multivariate logistic regression analysis were used to evaluate whether the imaging parameters could predict the occurrence of high-grade meningiomas. According to preoperative imaging parameters, the patients were graded and grouped. Cox regression model was used to analyze the relationship between the imaging scores in patients with convexity meningioma and the overall survival (OS) and progression-free survival (PFS). The credibility of preoperative imaging scores was analyzed by the Kappa coefficient test. Results Univariate analysis results indicated that there were significant differences in diffusion tensor imaging (DWI) signal intensity, T1 enhancement images, arachnoid layer on T2 weighted imaging, peritumoral edema on T2-weighted images, and tumor shape in different grades of convexity meningiomas (all P<0.05). Multivariate logistic regression analysis indicated that DWI hyperintensity is the most important independent predictor of high-grade meningiomas (P<0.01, OR, 17, 95% CI 5.8-47.6), others were disruption of arachnoid layer (P<0.01, OR, 14, 95% CI 4.3-42.3), peritumoral edema (P<0.01, OR, 9, 95% CI 3.1-26.8), T1 heterogeneous enhancement (P<0.01, OR, 6.1, 95% CI 2.2-17.1), and tumor shape (P<0.01, OR, 6.1, 95% CI 2.1-17.5). Compared with WHO pathological grades (Ⅰ, Ⅱ, and Ⅲ), the imaging grades (1, 2, and 3) had a certain homogeneity (Kappa value, 0.511, P<0.01). Cox regression model analysis showed that age (P<0.001, OR, 1.039, 95% CI 1.017-0.062), WHO pathological grade (P=0.017, OR, 3.014, 95% CI 1.217-7.465), and preoperative imaging score groups (2-3 group, P<0.01, OR, 6.194, 95% CI 1.956-19.610; 4-5 group, P<0.01, OR, 21.658, 95% CI 5.701-82.273) could be used as the independent predictors of affecting the prognosis of patients. Conclusions Preoperative imaging grade has a certain degree of consistency with pathological grade, and can predict the prognosis in patients with convexity meningioma. For patients with pathology indicated WHO grade I, but the imaging score 2-3 may need more close follow-up and more radical resection in case of permission. Key words: Meningioma; Magnetic resonance imaging; Diffusion weighted imaging; Prognosis

Convexity meningioma associated with depression: a case report.

Meningiomas are slow growing, extra-axial lesions, and can be neurologically silent for a long time and present only with depression. A 65-year-old woman developed major depression and was treated with antidepressants for two years. Depression failed to respond to drug treatment and there was no improvement. Two months before admission to hospital, due to the onset of epilepsy attack the patient underwent rein- vestigation, and a large temporal convexity meningioma, which corresponded in position to the original electroencephalography focus, was diagnosed using the computer topography of the brain. The patient underwent osteoplastic craniotomy, and a left fronto-temporal convexity meningioma of 5 cm in diameter was completely removed with its attachment to the dura. Histological examination confirmed a fibroblastic meningioma. Total resection of convexity meningioma and decompression of the brain tissue in the region of limbic pathways that are involved, may contribute to a complete remission of depression symptoms. This case also illustrates the need for a prompt neuroimaging of the brain when patients present any atypical psychiatric symptoms, with late onset (> 50 years old) of the first depressive episode or fast changes of the mental state.

Rolandic area meningioma resection controlled and guided by intraoperative cortical mapping

The resection of convexity meningiomas should harbour a low rate of morbidity. Functional preservation should be the main goal of surgery and have higher priority over radicality. Involvement of the primary motor cortex (PMC) increases surgical risk. The goal of this study was to evaluate the effect of cortical mapping on surgical morbidity after rolandic area meningioma treatment. From January 2005 to March 2011, 42 patients were operated on for rolandic meningioma involving or compressing the PMC. The cohort consisted of 25 (59.5%) convexity, 10 (23.8%) parasagittal and 7 (16.7%) falcine meningiomas. Four patients were treated for recurrent disease and 25 (59.5%). Intraoperative cortical mapping was used to identify location of PMC. The threshold stimulation current was set at every site of cortical monopolar anodal stimulation around the tumour and at the tumour-cortex junction repeatedly during the meningioma dissection. Radical resection (Simpson 1 and 2) was achieved in 30 patients (71.4%) and partial resection (Simpson 4) in 12 (28.6%). New permanent deficit occurred in three patients (7.1%). All patients had moderate preoperative deficit (muscle strength ≤ 3). WHO-I was in 28 cases (66.7%), WHO-II in 14 cases (33.3%). Average follow-up was 33.2 months. Five patients (11.9%) suffered from recurrence after an average of 23.8 months. Rolandic area meningiomas should be classified as a higher risk group. Intraoperative cortical mapping is in our experience useful in a situation when the cleavage plane at the PMC is lost. In such a scenario, resection outside the PMC is radical and only at the PMC is a thin remnant left without cortical damage, which helps to be safer with a better long-term prognosis.

Foreign Body Granuloma Associated With Dura-Cranioplasty After Resection of Convexity Meningioma With Extracranial Extension -Case Report-

A 72-year-old man presented with a space-occupying lesion at the site of the prior craniotomy one year after removal of a convexity meningioma with an extracranial extension. The lesion had grown outside the duraplasty with extracranial extension through the degenerative cranioplasty, and was removed. The histological diagnosis was granulation. The original dura-cranioplasty had been performed using Goretex dura substitute, hydroxyapatite cement, and fibrin glue-bonded autologous bone dust. This rare case of foreign body granuloma occurring after craniotomy with dura-cranioplasty indicates that detailed preoperative evaluation of tissue destruction based on neuroimaging is essential for construction of a suitable cranioplasty.

Pedicled Pericranial Flap for Dural Reconstruction Following Supratentorial Convexity Meningioma Resection: Initial 25 Cases

Introduction: Supratentorial convexity meningioma surgery involves resection of involved dura. Although CSF leak rates are low with even no repair, a variety of methods for dural reconstruction are performed. Such reconstruction allows an additional layer of coverage. We review a simple technique that provides a layer of vascularized reconstruction following such surgery.

Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated?

Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures. The authors identified 180 patients with no preoperative history of seizures who underwent resection of a convexity meningioma. Some patients received antiepileptic prophylaxis for 7 days postoperatively while others did not, based on the practice patterns of different attendings. The rates of clinically evident seizures in the first 3-4 weeks after surgery were compared. Patients who received antiepilepsy drugs (129 patients) did not significantly differ from those who did not (51 patients) in terms of age, sex, WHO tumor grade, extent of resection, rate of previous cranial surgery or radiation therapies, or use of preoperative embolization. There was a single new postoperative seizure in the entire cohort, yielding a new seizure rate of 1.9% in patients not on antiepileptic prophylaxis compared with 0% in patients on antiepileptics (p = not significant). While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.

Risk profile associated with convexity meningioma resection in the modern neurosurgical era

Although meningiomas are commonly found along the supratentorial convexity, the risk profile associated with this subset of lesions in the modern neurosurgical era is unknown. The authors retrospectively reviewed the clinical course of patients with supratentorial convexity meningiomas treated during the past 10 years. All patients had undergone MR imaging within 72 hours after surgery and at least 1 year of clinical follow-up. Patients with multiple meningiomas, hemangiopericytomas, malignant meningiomas, or tumor-prone syndromes were excluded from analysis. Between 1997 and 2007, 141 consecutive patients (median age 48 years, range 18-95 years) underwent resection of a supratentorial convexity meningioma. The most common signs or symptoms at presentation were headache (48%), seizures (34%), and weakness (21%). The mean tumor volume was 146.3 cm3 (range 1-512 cm3). There were no intraoperative complications or deaths. Medical or neurosurgical morbidity was noted in the postoperative course of 14 patients, equating to a 10% overall complication rate. Postoperative surgical complications included hematoma requiring evacuation, CSF leakage, and operative site infection. Medical complications included pulmonary embolus and deep vein thrombosis requiring treatment. A Simpson Grade 0 or 1 resection was achieved in 122 patients (87%). One hundred six tumors (75%) were WHO Grade I, whereas 35 (25%) were WHO Grade II. The median clinical follow-up was 2.9 years (range 1-10 years), and the median radiographic follow-up was 3.7 years (range 1-10 years). Six patients (4%) had radiographic evidence of tumor recurrence, with 3 (2%) undergoing repeat resection. With the conservative recommendations for surgery for asymptomatic meningiomas and the advent of radiosurgery during the past 10 years, microsurgically treated convexity meningiomas are now typically large in size. Nevertheless, the patient's clinical course following microsurgical removal of these lesions is expected to be uncomplicated. The authors' findings provide a defined risk profile associated with the resection of supratentorial convexity meningiomas in the modern neurosurgical era.

Effect of preoperative embolization on resection of intracranial meningioma: Local experience

Background/Aim: Preoperative devascularization of intracranial meningioma by endovascular embolization has been performed in many institutes over the past 30 years. Advancement in microsurgical techniques and endovascular technology during the period may have offset or magnified the benefit of the procedure. The aim of the present study was to evaluate the effect of preoperative embolization on surgical resection of intracranial meningiomas.Methods: The results of preoperative embolization followed by surgical resection of intrancranial meningiomas at a local neurosurgical unit in Kwong Wah Hospital (KWH) were compared to the results of surgical resection of intracranial meningiomas without preoperative embolization at another local neurosurgical unit in Princess Margaret Hospital (PMH) between 1 January 2000 and 30 June 2003.Results: For convexity meningioma, there was no statistically significant difference in intraoperative blood loss, units of blood transfused or operation time between the embolized group and the non‐embolized group. For parasagittal and sphenoid wing meningioma, although the mean tumour volume was larger in the embolized group, there was less intraoperative blood loss and units of blood transfused, and shorter operation time in the embolized group as compared with the non‐embolized group.Conclusion: There was no significant effect of preoperative embolization on surgical resection of convexity meningiomas. However, the procedure appeared to be a useful adjunct to surgical resection of parasagittal and sphenoid wing meningiomas.