Diagnosis Of Meningioma Research Articles

Ectopic meningioma presenting as a neck mass: case report and review of literature

BackgroundEctopic meningiomas are rare neoplasms that occur entirely outside the intracranial and intraspinal cavities and account for only 1–2% of all meningiomas. These tumors have been reported at various sites, however they are predominantly observed in the head and neck region. Here, we detail a case of an adult diagnosed with ectopic meningioma of the neck.Case presentationA 26-year-old woman underwent evaluation for a neck swelling associated with difficult in swallowing. Clinical examination revealed a firm, non-tender and non-pulsatile swelling in the right side of neck. On imaging, a soft tissue mass lesion was seen involving the right supra-hyoid neck, centered at the right carotid space/retro-styloid parapharyngeal space. She underwent maximal safe resection of the tumor and a consensus was reached regarding the diagnosis of ectopic meningioma based on the histopathological, clinical and radiological findings. Relevant literature is reviewed.ConclusionsThe diagnosis of ectopic meningioma may pose difficulties due to their occurrence in uncommon sites. The primary approach to treatment entails the surgical removal of the neoplasm, and a multidisciplinary strategy is pivotal for achieving the best possible clinical outcomes for patients with this rare entity.

Prediction of meningioma grade by constructing a clinical radiomics model nomogram based on magnetic resonance imaging

PurposeTo explore the clinical value of a clinical radiomics model nomogram based on magnetic resonance imaging (MRI) for preoperative meningioma grading. Materials and methodsWe collected retrospectively 544 patients with pathological diagnosis of meningiomas were categorized into training (n = 380) and validation (n = 164) groups at the ratio of 7∶ 3. There were 3,376 radiomics features extracted from T2WI and T1C by shukun technology platform after manual segmentation using an independent blind method by two radiologists. The Selectpercentile and Lasso are used to filter the most strongly correlated features. Random forest (RF) radiomics model and clinical radiomics model nomogram were constructed respectively. The calibration, discrimination, and clinical validity were evaluated by using the calibration curve and decision analysis curve (DCA). ResultsThe RF radiomics model based on T1C and T2WI was the most effective to predict meningioma grade before surgery among the six different classifiers. The predictive ability of clinical radiomics model was slightly higher than that of RF model alone. The AUC, SEN, SPE, and ACC of the training set were 0.949, 0.976, 0.785, and 0.826, and the AUC, SEN, SPE, and ACC of the validation set were 0.838, 0.829, 0.783, and 0.793, respectively. The calibration curve and Hosmer-Lemeshow test showed the predictive probability of the fusion model was similar to the actual differentiated LGM and HGM. The analysis of the decision curve showed that the clinical radiomics model could obtain the best clinical net profit. ConclusionsThe clinical radiomics model nomogram based on T1C and T2WI has high accuracy and sensitivity for predicting meningioma grade.

Differential diagnosis of atypical and anaplastic meningiomas based on conventional MRI features and ADC histogram parameters using a logistic regression model nomogram.

The purpose of the study was to determine the value of a logistic regression model nomogram based on conventional magnetic resonance imaging (MRI) features and apparent diffusion coefficient (ADC) histogram parameters in differentiating atypical meningioma (AtM) from anaplastic meningioma (AnM). Clinical and imaging data of 34 AtM and 21 AnM diagnosed by histopathology were retrospectively analyzed. The whole tumor delineation along the tumor edge on ADC images and ADC histogram parameters were automatically generated and comparisons between the two groups using the independent samples t test or Mann-Whitney U test. Univariate and multivariate logistic regression analyses were used to construct the nomogram of the AtM and AnM prediction model, and the model's predictive efficacy was evaluated using calibration and decision curves. Significant differences in the mean, enhancement, perc.01%, and edema were noted between the AtM and AnM groups (P < 0.05). Age, sex, location, necrosis, shape, max-D, variance, skewness, kurtosis, perc.10%, perc.50%, perc.90%, and perc.99% exhibited no significant differences (P > 0.05). The mean and enhancement were independent risk factors for distinguishing AtM from AnM. The area under the curve, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the nomogram were 0.871 (0.753-0.946), 80.0%, 81.0%, 79.4%, 70.8%, and 87.1%, respectively. The calibration curve demonstrated that the model's probability to predict AtM and AnM was in favorable agreement with the actual probability, and the decision curve revealed that the prediction model possessed satisfactory clinical availability. A logistic regression model nomogram based on conventional MRI features and ADC histogram parameters is potentially useful as an auxiliary tool for the preoperative differential diagnosis of AtM and AnM.

Multidisciplinary Approach and Therapeutic Advances in the Management of Meningioma: A Comprehensive Review

Meningioma, a predominantly benign intracranial neoplasm originating in the meninges, has been the subject of extensive study in the medical community due to its prevalence, clinical diversity, and associated therapeutic challenges. This article aims to provide a comprehensive review of current advances in the understanding, diagnosis and treatment of meningiomas, focusing on the application of multidisciplinary approaches and innovative therapies. Through a detailed exploration of the molecular pathogenesis, updated histopathologic classifications, and varied clinical presentations of meningiomas, an in-depth understanding of the inherent heterogeneity of these neoplasms is sought. The importance of advanced neuroimaging, including diffusion-weighted MRI and positron emission tomography, in the accurate assessment of tumor extent and precise surgical planning will be highlighted. In the therapeutic arena, conventional options, such as surgery and radiation therapy, will be examined in detail and the challenges and limitations associated with these modalities will be discussed. In addition, emerging pharmacologic therapies, such as angiogenesis inhibitors and therapies specifically targeting genetic mutations frequently found in meningiomas, will be reviewed, highlighting their potential to modify the clinical course of the disease. The multidisciplinary approach, involving close collaboration between neurosurgeons, neuroradiologists, pathologists and oncologists, will be explored in detail, highlighting its crucial role in informed clinical decision making and optimizing patient outcomes. Finally, future prospects and areas of ongoing research, such as immunotherapy and gene therapy, which promise to further revolutionize the therapeutic paradigm for meningiomas, will be outlined. This article will provide a comprehensive overview of meningiomas, from their molecular basis to state-of-the-art treatment strategies, with the purpose of enriching medical knowledge and fostering a holistic approach in the care of patients affected by this complex pathological entity.

Automated Detection and Diagnosis of Spinal Schwannomas and Meningiomas Using Deep Learning and Magnetic Resonance Imaging.

Spinal cord tumors are infrequently identified spinal diseases that are often difficult to diagnose even with magnetic resonance imaging (MRI) findings. To minimize the probability of overlooking these tumors and improve diagnostic accuracy, an automatic diagnostic system is needed. We aimed to develop an automated system for detecting and diagnosing spinal schwannomas and meningiomas based on deep learning using You Only Look Once (YOLO) version 4 and MRI. In this retrospective diagnostic accuracy study, the data of 50 patients with spinal schwannomas, 45 patients with meningiomas, and 100 control cases were reviewed, respectively. Sagittal T1-weighted (T1W) and T2-weighted (T2W) images were used for object detection, classification, training, and validation. The object detection and diagnosis system was developed using YOLO version 4. The accuracies of the proposed object detections based on T1W, T2W, and T1W + T2W images were 84.8%, 90.3%, and 93.8%, respectively. The accuracies of the object detection for two spine surgeons were 88.9% and 90.1%, respectively. The accuracies of the proposed diagnoses based on T1W, T2W, and T1W + T2W images were 76.4%, 83.3%, and 84.1%, respectively. The accuracies of the diagnosis for two spine surgeons were 77.4% and 76.1%, respectively. We demonstrated an accurate, automated detection and diagnosis of spinal schwannomas and meningiomas using the developed deep learning-based method based on MRI. This system could be valuable in supporting radiological diagnosis of spinal schwannomas and meningioma, with a potential of reducing the radiologist's overall workload.

Ways to personalize the treatment of patients with relapse and continued growth of intracranial meningiomas

Purpose. According to the literature, to assess the state of the problem of diagnosis and treatment of meningiomas with recurrent course, to identify the causes of tumor progression, features of the clinical picture, radiology diagnostics, the specificity of pathomorphological and molecular genetic characteristics.Materials and methods. We searched for publications in the Pubmed, EMBASE, Cohrane Library and eLibrary databases published between January 2000 and January 2019 on the issue of recurrent intracranial meningiomas, in particular atypical and anaplastic.Results. The review systematizes data on the prognostic criteria for diagnosing meningiomas that affect survival, relapse-free period, and the progression of the neoplastic process. Particular attention is paid to the radicality of the operation and the assessment of the degree of anaplasia. The present day information on radiation therapy and drug treatment is presented, the results of studies on their effectiveness are discussed. The controversial issues of approaches to the assessment of morphological prognostic criteria are touched upon. The latest information on the most common genetic mutations in meningiomas, the prospects for their study and use for targeted therapy are presented. The authors come to the conclusion that the problem of managing patients with meningiomas is still far from its final solution; there are no optimal standards for the diagnosis and treatment of patients with meningiomas, taking into account biological characteristics, including growth characteristics, molecular genetic profile. There are no clear prognostic criteria for recurrence and continuity in further supervision after surgical treatment, which cannot but affect the mortality rate and quality of life of this category of patients.

Epidemiology of adult meningioma: Report from the Dutch Brain Tumour Registry (2000-2019).

Meningiomas are the most common primary tumours of the central nervous system. This study aimed to provide comprehensive nationwide estimates on the incidence, prevalence and prognostic impact of meningioma diagnosis in the Netherlands. Adult patients diagnosed with meningioma in 2000-2019 were selected from the Dutch Brain Tumour Registry (DBTR), part of the Netherlands Cancer Registry (NCR). Time trends in age-adjusted incidence and prevalence rates were evaluated using the estimated annual percentage change (EAPC). Relative survival rates were calculated using the Pohar Perme estimator. Case completeness of the DBTR/NCR was estimated through record linkage with one of the Dutch neuro-oncology centres. From a total of 23,454 cases of meningioma, 11,306 (48.2%) were histologically confirmed and 12,148 (51.8%) were radiological diagnoses. Over time, the incidence of diagnosis increased from 46.9 per 1,000,000 inhabitants (European Standardized Rate [ESR]) to 107.3 (EAPC 4.7%, p < 0.01), with an increase in the incidence of radiological diagnoses from 14.0 to 70.2 per 1,000,000 ESR (EAPC 9.1%, p < 0.01). The prevalence of meningioma was estimated at 1012/1,000,000 on 1 January 2020, with almost 17,800 individuals having had a diagnosis of meningioma. Relative survival rate at 10 years for grade 1 meningiomas was 91.0% (95% confidence interval [CI] 89.4%-92.3%), 71.3% (95% CI 66.8%-75.2%) for grade 2 meningiomas and 36.4% (95% CI 27.3%-45.6%) for grade 3 meningiomas. Local case completeness was estimated at 97.6% for histologically confirmed meningiomas and 84.5% for radiological diagnoses. With a near-complete registry, meningioma prevalence was estimated at over 1000 per 1,000,000 inhabitants.

DNA methylation meningioma biomarkers: attributes and limitations.

Meningioma, one of the most common primary central nervous system tumors, are classified into three grades by the World Health Organization (WHO) based on histopathology. The gold-standard treatment, surgical resection, is hampered by issues such as incomplete resection in some cases and a high recurrence rate. Alongside genetic alterations, DNA methylation, plays a crucial role in progression of meningiomas in the occurrence and development of meningiomas. The epigenetic landscape of meningioma is instrumental in refining tumor classification, identifying robust molecular markers, determining prognosis, guiding treatment selection, and innovating new therapeutic strategies. Existing classifications lack comprehensive accuracy, and effective therapies are limited. Methylated DNA markers, exhibiting differential characteristics across varying meningioma grades, serve as invaluable diagnostic tools. Particularly, combinatorial methylated markers offer insights into meningioma pathogenesis, tissue origin, subtype classification, and clinical outcomes. This review integrates current research to highlight some of the most promising DNA and promoter methylation markers employed in meningioma diagnostics. Despite their promise, the development and application of DNA methylation biomarkers for meningioma diagnosis and treatment are still in their infancy, with only a handful of DNA methylation inhibitors currently clinically employed for meningioma treatment. Future studies are essential to validate these markers and ascertain their clinical utility. Combinatorial methylated DNA markers for meningiomas have broad implications for understanding tumor development and progression, signaling a paradigm shift in therapeutic strategies for meningiomas.

Optic Nerve Sheath Meningiomas: Solving Diagnostic Challenges with 68Ga-DOTATOC PET/CT.

68Ga-DOTATOC PET could be a noninvasive, highly sensitive, and specific technique for the challenging diagnosis of optic nerve sheath meningioma (ONSM). Our objective was to report the use and results of 68Ga-DOTATOC PET in suspected ONSM. Twelve subjects who underwent 68Ga-DOTATOC PET for suspected ONSM in our department were retrospectively included. Standardised clinical and radiological data were collected. The PET examination results were classified as positive or negative, and lesion standardised uptake values (SUVmax) were recorded. 68Ga-DOTATOC PET confirmed positive uptake in six cases (SUVmax > 5), leading to ONSM diagnoses followed by radiation therapy in patients with vision loss. Six 68Ga-DOTATOC PET scans were considered negative (SUVmax < 5); these comprised one case of neurosarcoidosis, one cavernous malformation, and four uncertain diagnoses, leading to further investigation. 68Ga-DOTATOC PET was helpful in tumour volume delineation before radiation therapy, leading to a decrease in dose exposure. Noninvasive 68Ga-DOTATOC PET should be performed before treating nonhistologically proven meningiomas with radiotherapy or stereotactic radiosurgery, particularly in cases of uncertain diagnosis with MRI, which characterises most ONSM cases. PET SUVmax thresholds to distinguish meningioma from nonspecific uptake in other lesions need to be adapted to ONSM. 68Ga-DOTATOC PET improves the intraorbital lesion diagnostic approach and therefore impacts therapeutic management.

Aplasia Cutis Congenita With Cutaneous Meningioma: A Rare Case.

Cutaneous meningioma, characterized by ectopic meningothelial cells in the dermis or subcutis, is a rare neoplasm. Generally, the most common location for cutaneous meningioma is the scalp. We report a case of cutaneous meningioma presenting as soft, light red, atrophic, and smooth patches with central blue spots. On histological examination, the tumor consisted largely of epithelioid cells, whorls, nests, and syncytial sheets of meningothelial cells. HMB-45, Melan-A, and S100 were negative; epithelial membrane antigen and somatostatin receptor 2 were positive. Ultimately, histopathologic examination and immunohistochemistry results supported a diagnosis of cutaneous meningioma. In addition, dermal dysplasia was observed above the tumor, manifested by thinning of the dermis and loss of appendages. No abnormalities were found on brain magnetic resonance imaging. Cutaneous meningioma is an extremely rare tumor, and its manifestation as an atrophic patch is even rarer. There have been mainly clinical reports of cutaneous meningioma. This was a rare case of focal aplasia cutis congenita with cutaneous meningioma. For cutaneous meningioma to be diagnosed earlier, there needs to be greater public awareness about the condition.

MISLEADING PARAFALCINE MASS: A CASE REPORT

A parafalcine mass can be misdiagnosed with Giant intracranial aneurysm because of lack of specific radiological features. Giant aneurysm are rare comprising of 5 % of all intracranial aneurysm and commonly located on internal carotid artery and middle cerebral artery. A case which we describe, located on left distal anterior cerebral artery, is rare. A 53 old male presented with weakness in right lower limb associated with headache and dysarthria. On examination, Power of rt lower limb was 3/5 with normal vitals. On CT imaging, findings showed midline frontal parafalcine well defined mass with areas of hypodensity which conclude provisional diagnosis of parafalcine meningioma. MRI and CT Angiography was done for further confirmation where report was consistent with parafalcine meningioma. while operating following mid frontal craniotomy, findings are suggestive of thrombosed giant aneurysm arising from left distal anterior cerebral artery. Applying the clip at distal ACA prevented from possible unfortunate incidence and complete excision without complications. The postoperative period was uneventful with no new neurological deficit. This case is shared here as it is a rare kind of lesion which mislead surgeons during surgical intervention. So, clinician must be aware of the thrombosed aneurysm mimicking as intracranial neoplasms as differential diagnosis. It gives good result and patient satisfaction, without any neurological deficits.

Are there reliable multiparametric MRI criteria for differential diagnosis between intracranial meningiomas and solitary intracranial dural metastases?

Intracranial meningiomas are the most common tumors of the central nervous system (CNS). Meningiomas account for up to 36% of all brain tumors. The incidence of metastatic brain lesions has not been determined. Up to 30% of adult patients with cancer of one localization or another suffer from a secondary tumor lesion of the brain. The vast majority of meningiomas have meningeal localization; >90% are solitary. The incidence of intracranial dural metastases (IDM) is 8-9% of cases, while in 10% of cases, the brain is the only localization, and in 50% of cases the metastases are solitary. Typically, the task of distinguishing between meningioma and dural metastasis does not involve difficulties. Periodically, there is a situation when the differential diagnosis between these tumors is ambiguous, since meningiomas and solitary IDM may have similar characteristics, in particular, a cavity-less solid structure, limited diffusion of water molecules, the presence of extensive peritumoral edema, and an identical contrast pattern. The present study included 100 patients with newly diagnosed tumors of the CNS, who subsequently underwent examination and neurosurgical treatment at the Federal Center for Neurosurgery with histological verification between May 2019 and October 2022. Depending on the histological conclusion, two study groups of patients were distinguished: The first group consisted of patients diagnosed with intracranial meningiomas (n=50) and the second group of patients were diagnosed with IDM (n=50). The study was performed using a magnetic resonance imaging (MRI) General Electric Discovery W750 3T before and after contrast enhancement. The diagnostic value of this study was estimated using Receiver Operating Characteristic curve and area under the curve analysis. Based on the results of the study, it was found that the use of multiparametric MRI (mpMRI) in the differential diagnosis of intracranial meningiomas and IDM was limited by the similarity of the values of the measured diffusion coefficient. The assumption, previously put forward in the literature, regarding the presence of a statistically significant difference in the apparent diffusion coefficient values, which make it possible to differentiate tumors, was not confirmed. When analyzing perfusion data, IDM showed higher cerebral blood flow (CBF) values compared with intracranial meningiomas (P≤0.001). A threshold value of the CBF index was revealed, which was 217.9 ml/100 g/min, above which it is possible to predict IDM with a sensitivity and specificity of 80.0 and 86.0%, respectively. Diffusion-weighted images are not reliable criteria for differentiating intracranial meningiomas from IDM and should not influence the diagnosis suggested by imaging. The technique for assessing the perfusion of a meningeal lesion makes it possible to predict metastases with a sensitivity and specificity close to 80-90% and deserves attention when making a diagnosis. In the future, in order to reduce the number of false negative and false positive results, mpMRI would require additional criteria to be included in the protocol. Since IDM differs from intracranial meningiomas in the severity of neoangiogenesis and, accordingly, in greater vascular permeability, the technique for assessing vascular permeability (wash-in parameter with dynamic contrast enhancement) may serve as a refining criterion for distinguishing between dural lesions.

Central nervous system tumours among users of vaginal oestradiol tablets: a nationwide population-based study.

It is currently unknown whether cumulative use of vaginal oestradiol is associated with development of meningioma and glioma. We conducted a nested case-control study within a nationwide cohort of Danish women followed from 2000 to 2018. The cohort consisted of 590,676 women aged 50-60 years at study start, without prior cancer diagnosis or use of systemic hormone therapy. Information on cumulative dose, duration, and intensity of vaginal oestradiol tablet use was assessed from filled prescriptions. Conditional logistic regression provided adjusted hazard ratios (HR) for the association between vaginal oestradiol use and diagnosis of meningioma or glioma. We identified 1,108 women with meningioma and 835 with glioma. Of these, 19.8% and 14.0% used vaginal oestradiol tablets, respectively. The HRs with ever use of vaginal oestradiol tablets was 1.14 (95% CI, 0.97-1.34) for meningioma and 0.90 (0.73-1.11) for glioma. The corresponding HRs for new users exclusively were 1.18 (0.99-1.40) for meningioma and 0.89 (0.71-1.13) for glioma. Intensity of vaginal oestradiol tablet use according to duration and user status yielded slightly elevated HRs for meningioma without an apparent dose-response pattern, while HRs of glioma were generally below unity. Among new users, the HR with high intensity of current or recent vaginal oestradiol tablet use for 2+ years was 1.66 (1.09-2.55) for meningioma and 0.77 (0.41-1.44) for glioma. Use of vaginal oestradiol tablets was associated with a slightly increased incidence of meningioma but not of glioma. Owing to the observational nature of the study, residual bias cannot be ruled out. This article is protected by copyright. All rights reserved.

Intraparenchymal Meningioma, A Challenging Diagnosis: Case Report

Background: Primary intraparenchymal meningiomas are extremely rare; their similarities to other intra-axial lesionsand thelack of dural adhesion make their presurgical diagnostic approach challenging. Case Description: A 27-year-old male, with no past medical history, presented to our emergency department for a first time grand mal seizure. Magnetic resonance imaging evidenced a 1,6×1,2 cm mass in the right temporo-parietal region. It was iso intense on T1WI, hyper intense on T2 WI, surrounded by large vasogenic edema and homogeneously enhanced on contrast magnetic resonance imaging with diffusion restriction. During surgery, the tumor was found to be located within the parenchyma with no dural attachment. It was removed en bloc. Histopathological examination confirmed the positive diagnosis of transitional meningioma (WHO Grade I). Conclusion: Intraparenchymal meningiomas are rarely reported in the literature. Their preoperative diagnosis is extremely difficult to make. Histopathological examination plays a key role for an accurate diagnosis.

Cost-Effectiveness Analysis of 68Ga-DOTATATE PET/MRI in Radiotherapy Planning in Patients with Intermediate-Risk Meningioma.

While contrast-enhanced MR imaging is the criterion standard in meningioma diagnosis and treatment response assessment, gallium 68Ga-DOTATATE PET/MR imaging has increasingly demonstrated utility in meningioma diagnosis and management. Integrating 68Ga-DOTATATE PET/MR imaging in postsurgical radiation planning reduces the planning target volume and organ-at-risk dose. However, 68Ga-DOTATATE PET/MR imaging is not widely implemented in clinical practice due to higher perceived costs. Our study analyzes the cost-effectiveness of 68Ga-DOTATATE PET/MR imaging for postresection radiation therapy planning in patients with intermediate-risk meningioma. We developed a decision-analytical model based on both recommended guidelines on meningioma management and our institutional experience. Markov models were implemented to estimate quality-adjusted life-years (QALY). Cost-effectiveness analyses with willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY were performed from a societal perspective. Sensitivity analyses were conducted to validate the results. Model input values were based on published literature. The cost-effectiveness results demonstrated that 68Ga-DOTATATE PET/MR imaging yields higher QALY (5.47 versus 5.05) at a higher cost ($404,260 versus $395,535) compared with MR imaging alone. The incremental cost-effectiveness ratio analysis determined that 68Ga-DOTATATE PET/MR imaging is cost-effective at a willingness to pay of $50,000/QALY and $100,000/QALY. Furthermore, sensitivity analyses showed that 68Ga-DOTATATE PET/MR imaging is cost-effective at $50,000/QALY ($100,000/QALY) for specificity and sensitivity values above 76% (58%) and 53% (44%), respectively. 68Ga-DOTATATE PET/MR imaging as an adjunct imaging technique is cost-effective in postoperative treatment planning in patients with meningiomas. Most important, the model results show that the sensitivity and specificity cost-effective thresholds of 68Ga-DOTATATE PET/MR imaging could be attained in clinical practice.

Subsequent meningiomas in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

10058 Background: Meningiomas are the most common subsequent central nervous system tumor among aging survivors of childhood cancer, yet incidence across the lifespan, occurrence of multiple meningiomas, and risk for mortality are not established. Methods: Meningiomas were identified by self-report and validated with pathology/medical records. Twenty-year cumulative incidence of meningioma (95% confidence interval) was estimated and multivariable models assessed demographic- and treatment-related meningioma risk factors. Results: Among 24,902 5-year survivors of childhood cancer diagnosed 1970-1999, we identified 472 survivors with 710 meningiomas, 145 (20.4%) of which were WHO grade 2/3. Among survivors with meningioma, 137 (28%) had ≥2 meningiomas, and 80 (16%) met criteria for meningiomatosis. The median latency from childhood cancer to first meningioma diagnosis was 26.2 years (range 5.6-48.2), and the median time from first to second meningioma (among those without meningiomatosis) was 1.4 years (range 0-30.2 years). The twenty-year cumulative incidence did not significantly decrease between survivors diagnosed in the 1970s (0.58, 95% CI 0.41-0.79) and the 1990s (0.42, 95% CI 0.32-0.55). In multivariable analysis, female sex (HR 1.52, 95% CI 1.21-1.91) and all cranial radiotherapy dose levels ( &gt; 0-30Gy, HR 57.0, 95% CI 7.93-419.60; 30.1-50 Gy, HR 228.90, 95% CI 30.89-1695.99; &gt; 50 Gy, HR 113.29, 95% CI 15.09-850.34) were associated with increased meningioma risk, while older age at diagnosis (10-14 years, HR 0.60, 95% CI 0.44-0.82; 15-20 years, HR 0.35, 95% CI 0.22-0.55) was associated with reduced meningioma risk. Among 71 deaths in survivors with meningioma, the most prevalent cause of death was meningioma (N = 25, 35.2%). The 5-year all-cause mortality from first meningioma diagnosis was 4.20% (95% CI: 2.44-5.96%). Conclusions: In conclusion, cranial radiation, younger diagnostic age and female sex were identified as independent meningioma risk factors in, to our knowledge, the largest study to date. The risk for meningioma-associated mortality argues for assertive meningioma surveillance and treatment in this population.

The experience of living with malignant meningioma.

Meningiomas are the most common, primary intracranial tumor and most are benign. Little is known of the rare patient group living with a malignant meningioma, comprising 1-3% of all meningiomas. Our aim was to explore how patients perceived quality of daily life after a malignant meningioma diagnosis. This qualitative explorative study was composed of individual semi-structured interviews. Eligible patients (n=12) were selected based on ability to participate in an interview, from a background population of 23 patients diagnosed with malignant meningioma at Rigshospitalet from 2000 to 2021. We performed an inductive thematic analysis following Braun and Clarke's guidelines. Eight patients were interviewed. The analysis revealed 4 overarching themes: (1) perceived illness and cause of symptoms, (2) identity, roles, and interaction, (3) threat and uncertainty of the future, and (4) belief in authority. The perceived quality of daily life is negatively impacted by the disease. Patients experience a shift in self-concept and close interactions, and some struggle with accepting a new everyday life. Patients have a high risk of discordant prognostic awareness in relation to health-care professionals. We provide a much-needed patient-centered perspective of living with malignant meningioma: quality of life was affected by perception of threat and an uncertainty of the future. Perception of illness and the interpretation of the cause of symptoms varied between subjects, but a common trait was that patients' identity, roles, and interactions were affected. Shared decision-making and a strengthened continuity during follow-up could aid this rare patient group.

Magnetic Resonance Imaging Patterns of Intracranial Meningiomas in Erbil City

Background and objectives: Meningiomas are the most common non-glial tumors of the central nervous system representing around one fifth of primary intracranial tumors with annual incidence of six per 100,000 populations. This study aimed to address the diagnostic precision of magnetic resonance imaging as a brain investigation tool to evaluate meningioma diagnosis and tumor staging before performing the operation. Methods: This study designed as a cross-sectional study and carried out between December 2019 and December 2020. A total number of 48 meningiomas resected and evaluated at three public hospitals in Erbil City. Pre-operative magnetic resonance imaging investigation and postoperative histopathological evaluation were done for all patients for their intracranial tumors and tissue sections. Results: Majority of patients showed isointense pattern on T1 (87.5%) and T2 (85.4%) signal intensity, homogenous in consistency (81.3%), the vast majority of the meningiomas were typical (93.8%) and of meningothelial type (81.3%). In most of the cases, there was no bone involvement (77.1%), no invasion of dural venous sinuses (83.3%), no calcifications (83.3%), no cystic changes (97.9%) but positive cerebral spinal fluid cleft (66.7%) and homogenous enhancement pattern (83.3%). Five out of eleven imaging patterns and configurations including T1 signal intensity, T2 signal intensity, consistency, calcification and vascularity of the meningioma were valid and reliable by calculating their sensitivity, specificity and running kappa test. Conclusions: Some magnetic resonance imaging patterns such as T1 signal intensity, T2 signal intensity, consistency, calcification, and vascularity of the meningioma are useful for predicting the stages of meningioma.

Optic nerve sheath meningioma mimicking optic perineuritis

Tram-track and doughnut-shaped enhancements of the optic nerve sheath in axial and coronal magnetic resonance imaging (MRI) views, respectively, play crucial roles in the diagnosis of optic nerve sheath meningioma (ONSM). However, this finding is not specific to ONSM since it can also be observed in optic perineuritis (OPN). Here we report a 42-year-old female with ONSM who presented with clinical and MRI findings similar to those of OPN.

Immunohistochemical study of CD147 and matrix metalloproteases in meningiomas

Background/Aim: Expression of extracellular matrix proteins and metalloproteases (MMPs) has been implicated in neoplasm recurrence. Some recent studies have suggested a correlation between matrix modifier proteins and recurrence or invasion of meningiomas. Based on previous data, the aim of this study was to find a correlation between the immunohistochemical (IHC) expression patterns of a group of matrix modifier proteins, including CD147, Matrix Metalloprotease 2 and 9 (MMP2 and 9, respectively), Epithelial Cadherin (ECAD), and Galectin-3 (GAL3) with World Health Organization (WHO)-defined grade, brain invasion, recurrence, and other clinicopathological features. Methods: This study was a cohort study. All patients with meningioma who underwent resection over a 10-year period were identified from the electronic pathology archives. Tissue microarrays (TMAs) were created for IHC studies, and IHC staining was performed using standard methodology. Results: A total of 231 cases fulfilled the study criteria. Histological review identified 198 grade 1 tumors (85.3%), 28 grade 2 tumors (12.6%), and five grade 3 tumors (2.2%). CD147 was determined to be positively correlated with WHO-defined grade (P=0.009). ECAD, MMP2, MMP9, GAL3 were not found to be correlated with brain invasion, recurrence, or WHO grade. Conclusion: The study results demonstrated that CD147 could be a target for diagnosis, prognosis, and treatment of meningiomas.