Meningiomas In Locations Research Articles

Voxel-based lesion mapping of meningioma: a comprehensive lesion location mapping of 260 lesions.

OBJECTIVE In the present study the authors aimed to determine preferred locations of meningiomas by avoiding descriptive analysis and instead using voxel-based lesion mapping and 3D image-rendering techniques. METHODS Magnetic resonance images obtained in 248 treatment-naïve meningioma patients with 260 lesions were retrospectively and consecutively collected. All images were registered to a 1-mm isotropic, high-resolution, T1-weighted brain atlas provided by the Montreal Neurological Institute (the MNI152), and a lesion frequency map was created, followed by 3D volume rendering to visualize the preferred locations of meningiomas in 3D. RESULTS The 3D lesion frequency map clearly showed that skull base structures such as parasellar, sphenoid wing, and petroclival regions were commonly affected by the tumor. The middle one-third of the superior sagittal sinus was most commonly affected in parasagittal tumors. Substantial lesion accumulation was observed around the leptomeninges covering the central sulcus and the sylvian fissure, with very few lesions observed at the frontal, parietal, and occipital convexities. CONCLUSIONS Using an objective visualization method, meningiomas were shown to be located around the middle third of the superior sagittal sinus, the perisylvian convexity, and the skull base. These observations, which are in line with previous descriptive analyses, justify further use of voxel-based lesion mapping techniques to help understand the biological nature of this disease.

The Role of Adjuvant Treatment in Patients with High-Grade Meningioma.

ObjectiveTo investigate the efficacy of adjuvant treatment in patients with high-grade meningioma.MethodsA retrospective analysis was performed for patients with high-grade meningioma, World Health Organization grade 2 or 3, in a single center between 2003 and 2014. The patients were reviewed according to age at diagnosis, sex, the location of meningioma, degree of tumor resection, histological features, and type of adjuvant treatment. These factors were analyzed by Firth logistic regression analyses.ResultsFifty-three patients with high-grade meningioma were enrolled. Thirty-four patients received adjuvant treatment; conventional radiotherapy or radiosurgery. Clinical follow-up ranged from 13–113 months with a median follow-up of 35.5 months. Gross total removal (GTR), Simpson grade 1 or 2, was achieved in 29 patients and, among them, 13 patients received adjuvant treatment. In the other 24 patients with non-GTR, conventional adjuvant radiotherapy and radiosurgery were performed in 11 and 10 patients, respectively. The other 3 patients did not receive any adjuvant treatment. Radiation-related complications did not occur. Of the 53 patients, 19 patients had suffered from recurrence. The recurrence rate in the adjuvant treatment group was 23.5% (8 out of 34). On the other hand, the rate for the non-adjuvant treatment group was 57.9% (11 out of 19) (odds ratio [OR]=0.208, p=0.017). In the GTR group, the recurrence rate was 7.5% (1 out of 13) for patients with adjuvant treatment and 50% (8 out of 16) for patients without adjuvant treatment (OR=0.121, p=0.04).ConclusionAdjuvant treatment appears to be safe and effective, and could lead to a lower recurrence rate in high-grade meningioma, regardless of the extent of removal. Our results might be used as a reference for making decisions when planning adjuvant treatments for patients with high-grade meningioma after surgery.

Neurocognition in individuals with incidentally-identified meningioma.

Meningiomas are primary intracranial tumors that are often asymptomatic. To our knowledge, no study has attempted to describe neurocognitive function in patients with incidentally-discovered meningioma. We utilized the Mayo Clinic Study of Aging (MCSA), which is a population-based sample of Olmsted County, Minnesota residents that includes neuropsychological testing and brain MRI approximately every 15 months. Using a text search of radiologists' notes of 2402 MCSA individuals (mean age 77 years, scanned between 2004 and 2014) we identified 48 eligible subjects (2%) who had at least one meningioma. Most meningiomas were small (90% <3cm). We matched each of the 48 subjects to 5 non-demented MCSA controls (n = 240) on age, sex, and education. Cognitive domains assessed included memory, attention-executive function, language, and visuospatial. More women (67%) had a meningioma than men (33%). Groups did not differ on prevalence of Mild Cognitive Impairment (Meningioma = 19%, Controls = 13%). Across cognitive domains, we observed similar performance for the two groups (p's ≥ 0.21). Subtle differences emerged in memory and language domains (p = 0.05 and p = 0.11) when we divided the Meningioma group by tumor location, wherein the small group with an infratentorial tumor performed more poorly than controls globally as well as on select memory and language measures. Our findings suggest that small meningiomas are generally cognitively benign, but that may change as the tumor evolves, and might be impacted by other factors such as meningioma location.

Clinical Profile and Outcome of Intracranial Meningioma in Apollo Hospitals Dhaka

Background: A meningioma is a tumor that arises from the meninges- the membranes that surround the brain and spinal cord.Objective: This is a retrospective analysis of the recorded data of patients managed for intracranial meningiomas between January 2007 and June 2015 at Apollo Hospital, Dhaka.Methodology: Demographic data was analyzed for all but only patients who had surgery and histological diagnosis were analyzed for outcome.Results: This study shows that meningiomas had female preponderance. Majority cases were above 50 years of age. Convexity is the most common anatomical location of meningioma. Most common symptoms were headache (70%) followed by seizure in 34.3% of patients. 90% of the cases were benign. Malignant meningioma was 1.4% and recurrence was found in 1.4% of cases. Six patients with histological grades I, II and III meningi- omas were sent for stereotactic radiotherapy after incomplete tumor resection or for residual tumour. Total removal was done in 80% cases and the mortality was 1.4%, in patient who had poor GCS score on admission.Pulse Vol.9 January-December 2016 p.22-26

Extent of T1+C Intensity Is a Predictor of Blood Loss in Resection of Meningioma.

Surgery for meningioma is associated with significant blood loss. Preoperative embolization has been associated with reduction of blood loss and has been noted to decrease intensity on T1+ contrast sequences. We investigate potential relationships between blood loss and the extent of T1+ contrast intensity. Forty-two patients who underwent surgical resection of intracranial meningioma were retrospectively reviewed from August 2009 to May 2016. Clinical data were extracted (age, gender, location of meningioma, grade of meningioma, need for blood transfusion during surgery, preoperative and postoperative hematocrit level, estimated blood loss [EBL], and duration of surgery). Using OsiriX MD, the tumor volume, sinus involvement, peritumoral edema, extent of resection, and T1 index (average T1+C intensity across the tumor normalized to value at basilar artery) were assessed. With EBL, univariate analysis for gender, tumor volume, and T1 index showed correlations with Pvalue <0.1. A logistic regression to predict EBL <300 mL and ≥300 mL using the 3 variables yielded T1 index (odds ratio [OR], 31.22; 95% confidence interval [CI], 1.14-855.65), gender (OR, 0.17; 95% CI, 0.03-0.96), and tumor volume (OR,1.05; 95% CI, 1.00-1.10) as significant predictors (all P< 0.05). With duration for surgery, gender, tumor volume, need for blood transfusion, and preoperative hematocrit exhibited P value <0.05; multivariate analysis did not show a significant model. Along with gender and tumor volume, extent of T1+C intensity is also an independent predictor of EBL. This finding may be helpful for surgical management of meningioma.

Surgical management of ventrally located spinal meningiomas via posterior approach.

Spinal meningioma is a relatively common tumor among intradural extramedullary spinal tumors. When the locus of the meningioma is located on the ventral side, tumor removal, dura mater resection, and reconstruction via a posterior approach safety become technically difficult. Twelve patients, who received surgical treatment for ventral spinal meningioma via a posterior approach, were included. There were three male and nine female patients, with an average age of 66.3years (47-88years). The average observation period was 55.4months (22-132months). In these cases, we analyzed the spinal level of tumor position, histopathological type (subtype), the grade of tumor resection (Simpson grade), pre- and post-operative walking state (Nurick grade), perioperative neurological complications, and the recurrence. Spinal meningioma occurred in the cervical spinal cord in three cases, with a further nine cases in the thoracic spinal cord. Histopathologically, all 12 tumors were assessed as grade I on the WHO classification system (eight cases of meningothelial type and four cases of psammomatous type). The level of tumor resection was Simpson grade I resection for two cases and Simpson grade II resection for the remaining ten cases. The average of Nurick grade improved from 3.3 preoperatively to 1.3 postoperatively. In all cases, we identified no neurological complications. One incident of tumor recurrence was identified 11years after an operation involving a Simpson grade II resection CONCLUSION: Posterior approaches provide adequate exposure to safely remove ventrally located meningioma. Posterior exposures with lateral bone resection, dentate ligament division, provide also adequate exposure for safe removal.

Ossified Intracranial Meningiomas: Description of the First Series of Cases and Review of the Literature

Metaplastic meningiomas are characterized by mesenchymal differentiation with formation of bone, cartilage, fat, or xanthomatous elements. However the presence of extensive areas of ossification is rare in meningiomas. In addition, intracranial location of ossified meningiomas is uncommon. Surgical management represents the optimal treatment for ossified meningiomas, but ossification may interfere with surgery and condition outcome. By reviewing patient records and contacting patients, families, and referring physicians, the following information was gathered: age, sex, tumor location, clinical presentation, preoperative and postoperative functional status, and surgical data. Each surgical specimen had been formalin-fixed, paraffin-embedded, and cut into parallel 4-μm-thick sections for histological evaluation. Our literature search identified 8 cases, all of whom had undergone surgical treatment. Histopathological analysis revealed the presence of disorganized bone spicules with solitary oval osteocytic nuclei and lined by osteoblasts, with clear evidence of bone tissue in at least 50% of tumor tissue. Here we present the largest series, to our knowledge, of surgically treated intracranial ossified meningiomas reported to date. The mechanism of ossification in these meningiomas remains unclear, and various hypotheses have been formulated. Complete lesion removal, or subtotal debulking in those cases characterized by tenacious adherences to vascular structures and/or critical areas, may represent the optimal treatment.

Osteolytic and Osteoblastic Lesion of the Skull in a Patient with Known Cancer History: A Typical Location of Meningioma

Osteolytic and Osteoblastic Lesion of the Skull in a Patient with Known Cancer History: A Typical Location of Meningioma

Human epidermal growth factor receptor 2/neu protein expression in meningiomas: An immunohistochemical study.

Background:Meningiomas are common slow-growing primary central nervous system tumors that arise from the meningothelial cells of the arachnoid and spinal cord. Human epidermal growth factor receptor 2 (HER2) or HER2/neu (also known as c-erbB2) is a 185-kD transmembrane glycoprotein with tyrosine kinase activity expressed in meningiomas and various other tumors. It can be used in targeted therapy for HER2/neu positive meningiomas.Aim:To correlate the expression of HER2/neu protein in meningiomas with gender, location, histological subtypes, and grade.Materials and Methods:It was 3½ years prospective (March 2010–October 2011) and retrospective (May 2008–February 2010) study of histopathologically diagnosed intracranial and intraspinal meningiomas. Clinical details of all the cases were noted from the computerized hospital information system. Immunohistochemistry for HER2/neu protein was performed along with scoring. Statistical analysis was done using Chi-square test to look for any association of HER2/neu with gender, location, grade, and various histological subtypes of meningiomas at 5% level of significance.Results:A total of 100 cases of meningiomas were found during the study period. Of which, 80 were Grade I, 18 were Grade II, and 2 were Grade III meningiomas as per the World Health Organization 2007 criteria. The female-male ratio was 1.9:1 and the mean age was 47.8 years. HER2/neu protein was expressed in 75% of Grade I and 72.2% of Grade II and none of Grade III meningiomas. About 72.7% brain invasive meningiomas showed HER2/neu immunopositivity.Conclusion:HER2/neu protein was expressed in 73% of meningiomas. Statistically significant difference of HER2/neu expression was not seen between females and males of Grade I and Grade II/III meningiomas, intracranial and spinal tumors, Grade I and Grade II/III cases, and various histological subtypes of meningiomas.

Prophylactic use of anticoagulation and hemodilution for the prevention of venous thromboembolic events following meningioma surgery

ObjectivesBrain tumors may be associated with postoperative venous thromboembolic (VTE) events with possible devastating consequences. Meningioma has the highest incidence of postoperative VTE events among all brain tumors. Hemodilution and anticoagulation both proved efficacy in deep venous thrombosis (DVT) prophylaxis that is why we theorized that this regimen would be beneficial for VTE prophylaxis in operated intracranial meningioma patients without added risk to the patients. Patients and methodsA retrospective double-blinded study, where the records of consecutive intracranial meningioma patients were revised comparing the efficacy of two regimens of postoperative VTE prophylaxis. Patients were divided into 2 groups; group A was submitted to the use of compressive stockings, low-molecular weight heparin (LMWH) administration and hemodilution, while group B was submitted only to the use of compressive stockings. ResultsThe study included 194 patients. Mean age of patients was 55 years (range from 27 to 78 years). VTE events were diagnosed in 16 patients (8.2%) all of them belonged to group B. The median time for VTE events was 12 days. Older age (P=.0001), larger size tumor (p=0.0438), delayed ambulation postoperatively (p=0.0351) as well as skull base location of meningioma (p=0.0163) were associated with higher incidence of postoperative VTE. Overall, group A patients showed more favorable outcome as compared to group B. ConclusionIn addition to the use of elastic stockings, we recommend starting hemodilution at the outset of surgery, LMWH administration starting 12h postoperatively as well as refraining from the use of diuretics during and after intracranial meningioma surgery till the patient became fully ambulatory to reduce the incidence of postoperative VTE events.

Pre-operative and post-operative cognitive deficits in patients with supratentorial meningiomas

ObjectivesCognitive deficits caused by extra-axial benign brain tumors like meningiomas and the course of these deficits after surgery is not well known. The aim of the study is to assess the pre-operative and post-operative cognitive functions in patients with meningiomas in the supratentorial compartment. Materials and methodsIn this prospective study, patients with clinico-radiological diagnosis of supratentorial meningioma, operated upon and later confirmed by histopathological examination, were included. The patients were evaluated for cognitive deficits before and after surgery. The various clinical and radiological factors influencing the cognitive status were evaluated. ResultsA total of 57 patients were enrolled into the study. Out of 57, 22 were males and 35 were females. The frontal group had 22 patients, the parietal group had 10 patients, the temporal group had 10 patients, the occipital group had 6 patients, and the suprasellar group had 9 patients. Meningiomas, although extra-axial, caused significant cognitive deficits in 42 patients (73.7%). The highest frequency of cognitive deficits is seen in the frontal and temporal group of meningiomas (90% each). Frontal meningiomas with volume greater than 35cc and peritumoral edema greater than 40cc caused a higher frequency of cognitive deficits. Also, patients with raised ICP had significant cognitive deficits. Postoperatively there was a significant improvement in the cognitive functions in the frontal and temporal groups. ConclusionMeningiomas cause cognitive deficits in 73.7% of patients. Anatomical location of meningioma, elevated ICP, the volume of meningioma and extent of peritumoral edema significantly influence the incidence of cognitive deficits. Post-operatively, the cognitive deficits improve significantly in the frontal and temporal group.

WHO grade 1 meningioma recurrence: Are location and Simpson grade still relevant?

ObjectiveTo examine whether Simpson grade and pathology location are still predictors of recurrence/progression free survival (RPFS) in WHO grade 1 cranial meningiomas. MethodsA retrospective case series of all WHO grade 1 cranial meningiomas undergoing surgical resection at our institution between 2002 to 2007 was performed. Demographic and outcome data included: Simpson grade, extent of resection [gross total (Simpson 1–3) and sub total (Simpson 4–5)], tumour location, timing of post-operative imaging and outpatient review, time to recurrence and subsequent management. Statistical analysis was by Kaplan–Meier survival curves. Results145 cases were included of which 75% were female, with an overall median age of 55 years. 24% had parasagittal, 23% convexity and 53% skull base meningioma. 21% had a grade 1 Simpson resection, 43% grade 2, 35% grade 4 and 1% grade 5. The median follow up period was 60 months with a median 5.5 outpatient appointments and 5 post-operative imaging studies. 10 cases (6.9%) had recurrence/progression at a median period of 42 months. Of these, 4 remained under active surveillance, 3 received stereotactic radiosurgery and 3 were treated with fractionated radiotherapy. 5 year recurrence/progression free survival (RPFS) for Simpson grade 1 was 96.8%, 2: 100%, 4: 82.4% and 5: 0%. Simpson grade (p=0.01) and gross total/sub total resection (p=0.001) were significant predictors of RPFS. Meningioma location was not a significant predictor of RPFS (p-value 0.836). ConclusionSimpson grade remains a significant predictor of RPFS in WHO grade 1 meningioma surgery. However, tumour location was not significant in this series. We advocate different post-operative imaging surveillance protocols depending on gross total or sub total surgical resection.

Meningioma with purely intratumoral hemorrhage mimicked intracerebral hemorrhage: Case report and literature review

Meningiomas are the most common non-glial intracranial tumor with an incidence of 2.3-5.5/100,000 people, accounting for 20-30% of all primary adult brain tumor diagnoses. Meningiomas associated with hemorrhage are rare; the reported incidence is 0.5-2.4%. We share a case experience of meningioma with purely intratumoral hemorrhage. The initial image study of the intratumoral hemorrhage mimicked intracerebral hemorrhage. A 63-year-old woman with initial presentation of headache, dizziness, nausea, and vomiting has brought to the emergent department. The brain computed tomography showed a 5.3 cm hyperdense lesion over the left occipitotemporal area. Under the impression of intracerebral hemorrhage with unknown etiology, the brain magnetic resonance imaging was done for tumor survey and showed lobulated enhanced mass over left T-O area. Tumor with bleeding with skull bone invasion was first considered. The surgical pathology revealed atypical meningioma with focal clear cell change (World Health Organization Grade II), which is separated with the brain by pia meter. Meningiomas associated with hemorrhage are rare; the reported incidence is 0.5-2.4%. The clinical features about increasing bleeding tendency: (i) age >70 years old or <30 years old; (ii) the location of meningiomas locate at intraventricle or convexity; (iii) histopathalogical type: Meningotheliomatous, malignant, fibrous, and angioblastic type. Most reported intracranial hemorrhages associated with meningiomas are found in the subarachnoid and subdural spaces. There are several hypotheses for the possible mechanism of tumoral bleeding. The tumoral bleeding in meningioma is a rare event. The incidence depended on the location and the histopathological finding. There might be other indicators but still need more research.

NIMG-43DUAL VOLUME VISUALIZATION (3D-DSA AND CROSS-SECTIONAL IMAGING) FOR SURGICAL PLANNING OF INTRACRANIAL MENINGIOMAS

INTRODUCTION: Many techniques about planning for the surgery of intracranial brain tumors have been considered for getting more information about the relationship between tumors and adjacent vasculatures. Especially for the surgery of meningiomas, it is essential to distinguish passing arteries from feeders. It is also very important to preserve venous structures. Dual volume visualization is apt and powerful method to know about these vascular structures. METHODS: Between Feb. 2012 and Dec. 2014, a total of 20 patients underwent brain tumor surgery after undergoing dual volume visualization. The tumors comprised of 1 glioblastoma, 1 medulloblastoma, and 18 meningiomas. The locations of meningiomas were as follows : 6 parasagittal; 4 falx; 2 convexity; 1 tentorial; 1 foramen magnum; 2 sphenoid wing; 1 petroclival; and 1 olfactory groove. RESULTS: In cases involving glioblastoma and medulloblastoma, the boundary between the distinctive tumor mass of the intrinsic tumor and the normal brain is unclear, resulting in post-operative assessments showing greater direct damage done to the normal brain than that caused by vessel injury. Vascular supply and disfiguring observed in preoperative dual volume visualization images closely resembled the actual observations made during the surgery of meningiomas. Three out of eighteen meningioma cases demonstrated new deficits. One case exhibited tumor bed bleeding and perilesional edema leading to aggravation of motor weakness and deterioration. One exhibited venous infarction and a separate delayed hemorrhage leading to motor weakness and deterioration. One developed facial palsy. CONCLUSIONS: The advantages of this technique are as follows: 1. It enables the visualization of arteries and veins, individually; 2. the 3D rotation allows for convenient presurgical orientation; 3. it permits simulating craniotomies. This technique could reduce the incidence of newly developed neurological deficits as a result of identifying which veins to preserve during surgery and predicting the arteries that may shift.

NCO-01NEUROPSYCHOLOGICAL PROFILES IN INDIVIDUALS WITH INCIDENTAL MENINGIOMA

Meningioma is a primary brain tumor that is thought to be most often asymptomatic. To our knowledge, no study has attempted to describe neurocognitive function in patients with incidental meningiomas. We hypothesized that relative to controls, individuals with incidental meningioma will have subtle neurocognitive deficits affecting efficiency and attention. To investigate this hypothesis, we utilized the Mayo Clinic Study of Aging (MCSA), which is a population-based sample of Olmsted County, Minnesota residents used to study prevalence, incidence, and risk-factors for Mild Cognitive Impairment and dementia and includes neuropsychological testing and brain MRI every 15 months. Using a text search of radiologist's notes of 2,402 MCSA individuals, mean age 77 ± 8 years and scanned between 2004-2014, we identified 52 subjects (2%) who had at least one meningioma. Most meningiomas were small (94% < 3cm). Each of the 52 subjects was matched to five non-demented MCSA controls (n = 260) on age, sex, and education. Cognitive domains assessed included memory, attention-executive function, language, and visuospatial. Groups did not differ on prevalence of Mild Cognitive Impairment (Meningioma = 13%, Controls = 12%). Across cognitive domains, very similar performance was observed for the two groups (p's ≥ 0.30). Subtle differences in memory performance (0.3 z-scores units; 95% CI - 0.6 to 0.0; p = 0.10) emerged for the evaluation that occurred when the meningioma was at its largest measurement during the study, and may be related to location. Our findings suggest that small meningiomas are clinically benign, but that may change as the tumor evolves, and might be impacted by other factors, such as meningioma location.

Analysis of prognostic factors and treatment of anaplastic meningioma in China

Meningioma is the most frequently reported primary brain and central nervous system tumor. However, malignant meningioma is rare with the anaplastic subtype the most common. This subtype of meningioma is fatal with a high recurrence rate and poor survival. A retrospective review of anaplastic meningioma patients treated in one of the largest neurosurgical centers in China between 2003 and 2008 was conducted. From 70 identified patients, seven were lost to follow-up, but the remaining 63 patients were studied for prognostic factors. The mean follow-up time was 84.9±standard deviation (SD) of 19.7months. Tumor recurred in 35 out of 63 (55.6%) patients. Thirty-three (52.4%) patients had died by the most recent follow-up, and the median overall survival (OS) was 70.0±9.7months. The 3year and 5year survival rates were 68.3% and 54.7%, respectively. The median progression-free survival (PFS) was 52.0±9.9months, whereas the 3year and 5year PFS rates were 60.2% and 43.9%, respectively. We found that preoperative KPS, extent of tumor resection, radiotherapy, tumor location and previous history of meningioma were factors related to PFS. In the non-recurrent group, the preoperative Karnofsky Performance Scale (KPS), extent of tumor resection and radiotherapy correlated with PFS. However, multivariate analysis identified radiotherapy as the only independent factor affecting PFS (p=0.007). Additionally, MIB-1 proliferation index failed to identify a cut-off point to predict the prognosis for anaplastic meningioma. This study provides an overview of the epidemiology and treatment of anaplastic meningioma in China using a large population.

Meningiomas: A Clinicopathological study

cells. Most of these tumors are intracranial; some are intraspinal and few extra cranial. There are many histological variants classified into three grades depending on clinical behavior. Classification is important for determining the modality of treatment. Objectives: To study the incidence, location, sex and age predilection, histological variants and grading of meningiomas based on WHO 2007 classification and recurrence if present. Materials and methods: All128 cases of meningiomas. Based on Histological features, typing and grading of meningiomas was done as per the WHO 2007 classification of Meningiomas. Age, Sex incidence, Location of meningiomas were studied. Results: Meningiomas comprised 25.25% of all CNS tumors during the study period. Of 507 CNS tumors, 128 were meningiomas. Most of them were intracranial, predominantly involving the convexities of brain, females and the 41 – 50 age group. Of these, 116 were benign grade I tumors, 9 were grade II and 3 were grade III. The most common histological variant was fibroblastic and meningothelial. Intraspinal meningiomas were 16 (12.5%) cases with the psammomatous variant being more common. Grade II and Grade III tumors located in parafalcine or parasagittal area commonly recurred. Conclusion: Meningiomas are slow growing tumors arising from the meningothelial cells accounting for 25.25% of all CNS neoplasms showing a variety of histological patterns, more common in women, predominantly Grade I tumors. Recurrence of tumors depends on histological grade and extent of surgery.

MS-15 * THE IMPACT OF HISTOPATHOLOGIC AND RADIOLOGIC CHARACTERISTICS IN CLINICAL OUTCOME OF PATIENTS WHO UNDERWENT SURGERY FOR INTRACRANIAL MENINGIOMAS

INTRODUCTION: Meningiomas are common intracranial neoplasms with variability in their clinical presentation, biological behavior and response to treatment. PURPOSE: The aim of this study was to identify factors that predict the biological behaviour of meningiomas and patients' postsurgical outcome. METHODOLOGY: We retrospectively reviewed 415 meningiomas cases who had undergone surgical resection at Toronto Western Hospital between January 2007 to June 2013. Our cohort consisted of 162 males and 253 females. We reviewed clinical, radiological, and pathological reports, and collected the following data for statistical analysis: patients' sex, age, tumor grade-location, presence of peritumoral edema prior to surgical resection, tumors' largest diameter as a clinical measure of tumor size and history of radiation. All analyses were performed using IBM SPSS 20.0. RESULTS: The incidence of peritumoral edema was significantly higher in males (75%) than in females patients (52%) (p = 0.007). Meningioma location was associated with presence of edema (p < 0.001): olfactory meningiomas showed the highest incidence of edema (71.4%) followed by convexity meningiomas (62%), and sphenoid wing meningiomas (72%) (p < 0.001). Tumors with larger diameters (4.3cm vs. 3.5cm) were likely to have peritumoral edema (p = 0.001). The history of radiation was significantly correlated with peritumoral brain edema (76.4%, p = 0.003). The presence of residual tumor after surgical resection was more likely in meningiomas with higher grades; residual tumor was most common in grade III meningioma (75%) followed by grade II (29.3%), and grade I (17.7%) (p = 0.008). In radiation induced meningiomas the incidence of residual was 41.1%. Also, the grade of tumor was significantly correlated with the incidence of recurrence; grade III meningiomas showed the highest incidence of recurrence (50%) followed by grade II (19.5%) and grade I (4.1%) (p < 0.001). CONCLUSION: The present study demonstrates that specific demographic, radiologic, and pathologic characteristics are significant predictors of tumor response to therapy, tumor recurrence and overall patient outcome.

The Association of Leprosy and Spinal Psammomatous Meningioma: A Case Report

Leprosy or Hansen’s disease (HS) caused by Mycobacterium leprae may involve all organ systems, especially skin and nervous system, and is an contagious disease. The responsible organism is M. leprae which is an acid-fast staining bacilli and similar to M. tuberculosis . Spinal masses are rarely seen tumoral lesions. Intradural spinal masses are generally extradural located meningiomas, nerve-sheath tumors and metastasis . A 68-year-old female patient followed up by a local leprosy center was admitted for new onset lower extremity motor deficits and urinary incontinence. Cervical MRI showed the mass in size of 3 × 1.5 cm. The case was operated under general anesthesia and the lesion was located in the intradural extramedullary space with smooth border and removed totally. The pathologic result was reported as psammomatous meningioma. The purpose of this study was to present the improvement of paraparesis in the case with rarely seen lepromatous type leprosy and a spinal mass which was histologically psammomatous meningioma after emergent surgical intervention . J Med Cases. 2014;5(2):62-65 doi: http://dx.doi.org/10.14740/jmc1389w

The Association of Leprosy and Spinal Psammomatous Meningioma: A Case Report

Leprosy or Hansen’s disease (HS) caused by Mycobacterium leprae may involve all organ systems, especially skin and nervous system, and is an contagious disease. The responsible organism is M. leprae which is an acid-fast staining bacilli and similar to M. tuberculosis . Spinal masses are rarely seen tumoral lesions. Intradural spinal masses are generally extradural located meningiomas, nerve-sheath tumors and metastasis. A 68-year-old female patient followed up by a local leprosy center was admitted for new onset lower extremity motor deficits and urinary incontinence. Cervical MRI showed the mass in size of 3 × 1.5 cm. The case was operated under general anesthesia and the lesion was located in the intradural extramedullary space with smooth border and removed totally. The pathologic result was reported as psammomatous meningioma. The purpose of this study was to present the improvement of paraparesis in the case with rarely seen lepromatous type leprosy and a spinal mass which was histologically psammomatous meningioma after emergent surgical intervention. J Med Cases. 2014;5(2):62-65 doi: https://doi.org/10.14740/jmc1389w