Surgical Resection Of Meningioma Research Articles

Dramatic Hemorrhagic Papilledema After Surgical Resection of Meningioma

To date there is no consensus regarding ophthalmology follow-up of patients with papilledema after resection of an intracranial mass. We present a case of drastically worsening papilledema after resection of an intracranial meningioma and discuss the possible mechanisms behind this. This article aims to highlight the potential utility of routine ophthalmology follow-up for patients with papilledema after resection of an intracranial mass. Further works could quantify the incidence of post-operative worsening or recurring papilledema, their association with a pathological cause, and its effect on vision.

Fenestrated Anterior Cerebral Artery, Anterior Communicating Artery, with Accessory Middle Cerebral Artery—A Conglomeration of Embryologically Different Entities in a Single Individual

Cerebral arterial fenestrations are anatomic variants of undetermined significance where there is a division of a single vessel into at least 2 channels, each having endothelial and muscular layers, that coalesce to a single lumen in the distal course of the vessel. The basilar artery is the most common site, followed by the anterior communicating artery. The accessory middle cerebral artery is defined as the anomalous origin of the vessel from the anterior cerebral artery and its further course along the sylvian fissure parallel to the middle cerebral artery. The embryologic basis of all these has been explained by studies on human embryological development by Padget et al. However, simultaneous existence of all 3 anomalies in a single individual has never been reported. Here we present a case of medial sphenoid wing meningioma with these incidental findings during workup and further delineation of anatomy following surgical resection of meningioma.

Positive Progesterone Receptor Expression in Meningioma May Increase the Transverse Relaxation: First Prospective Clinical Trial Using Single-Shot Ultrafast T2 Mapping

Rationale and ObjectivesThis project aims to investigate the diagnostic performance of multiple overlapping-echo detachment imaging (MOLED) technique-derived transverse relaxation time (T2) maps in predicting progesterone receptor (PR) and S100 expression in meningiomas. Materials and Methods63 meningioma patients were enrolled from October 2021 to August 2022, who underwent a complete routine magnetic resonance imaging and T2 MOLED, which can characterize the whole brain transverse relaxation time within 32 seconds in a single scan. After the surgical resection of meningiomas, the expression levels of PR and S100 were determined by an experienced pathologist using immunohistochemistry techniques. Histogram analysis was performed in tumor parenchyma based on the parametric maps. Independent t test and Mann-Whitney U test were applied for the comparison of histogram parameters between different groups, with a significance level of P < .05. Logistic regression and receiver operating characteristic (ROC) analysis with 95% confidence interval were conducted for the diagnostic efficiency evaluation. ResultsPR-positive group had significantly elevated T2 histogram parameters (P = .001-.049) compared to the PR-negative group. The multivariate logistic regression model with T2 showed the highest area under the ROC curve (AUC) for predicting PR expression (AUC=0.818). Additionally, the multivariate model also had the best diagnostic performance for predicting meningioma S100 expression (AUC=0.768). ConclusionThe MOLED technique-derived T2 maps can distinguish PR and S100 status in meningiomas preoperatively.

404 Identification of Persistent Racial Inequities in Recommendations for Resection of Primary Brain Tumors Using a Harmonized Dual Registry Analysis

INTRODUCTION: Disparities in outcomes disproportionately affect minority populations in many surgical fields. In contrast, racial disparities in surgical decision-making remains an enigma due to the difficulty in capturing surgeon recommendations during initial patient workup. METHODS: The odds of recommendation against surgical resection at initial diagnosis of primary brain neoplasms was determined using multivariable logistic regression with clinical, demographic, and socioeconomic factors. A dual registry analysis was designed using two national databases (NCDB and SEER), with independent analyses that were harmonized to ensure robustness of conclusions. Adults with the six most common intracranial neoplasms were included in the analysis. RESULTS: Two registries were queried to identify adults with meningioma (n = 63674, n = 222673), glioblastoma (n = 35258, n = 104047), pituitary adenoma (n = 27506, n = 87772), vestibular schwannoma (n = 11525, n = 30745), astrocytoma (n = 5402, n = 10631), and oligodendroglioma (n = 3977, n = 9187) in SEER and NCDB databases, respectively. Multivariable analysis in SEER demonstrated that, independent of clinical, demographic, and socioeconomic factors, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.06-1.21, p &lt; 0.001), glioblastoma (OR 1.14, 95% CI 1.01-1.28, p = 0.038), pituitary adenoma (OR 1.13, 95% CI 1.05-1.22, p &lt; 0.001), and vestibular schwannoma (OR 1.48, 95% CI 1.19-1.84, p &lt; 0.001) when compared to White patients in the SEER dataset. Performing a parallel analysis in NCDB confirmed these results in meningioma (OR 1.26, 95% CI 1.22-1.30, p &lt; 0.001), glioblastoma (OR 1.20, 95% CI 1.13-1.29, p &lt; 0.001), pituitary adenoma (OR 1.26, 95% CI 1.22-1.31), p &lt; 0.001), and vestibular schwannoma (OR 1.30, 95% CI 1.15-1.48, p &lt; 0.001). These findings persisted independent of both patient comorbidities and potential overlap between the databases. CONCLUSIONS: Racial disparities in surgery recommendations for patients with primary brain tumors independent of multiple potential confounders including clinical, demographic, and socioeconomic factors.

409 Effect of Social Determinants of Health on Post-Discharge Adverse Outcomes After Surgical Resection of Meningioma

INTRODUCTION: Understanding the role of social determinants of health (SDoH) is critical in informing preoperative care and postoperative follow-up for meningioma patients undergoing surgery. METHODS: A retrospective cohort study of adults presenting for meningioma resection from 1999-2020 was conducted. Primary outcomes included recurrence, readmission, and LTF (6-month and total). The main exposure of interest was Area Deprivation Index (ADI), a composite score of socioeconomic disadvantages. Additional SDoH factors analyzed included drive time to the hospital, insurance, and race. Multivariable logistic regression analyses for LTF and Cox regression for recurrence- and readmission-free survival were conducted. Covariates included age, WHO grade, and extent of resection. RESULTS: In total, 736 patients were included. Recurrence was observed in 90 patients, and 99 patients were readmitted following discharge. 121 patients missed initial and 6-month follow-up, but 107 of those eventually followed-up after six months. Fourteen patients were entirely LTF. ADI (OR = 1.11 per 10-point increase, 95% CI 1.02-1.21, p = 0.017) and drive time (OR = 1.03 per 30-minute increase, 95% CI 1-1.06, p = 0.022) predicted 6-month LTF. Drive time predicted complete LTF (OR = 1.04 per 30-minute increase, 95% CI 1-1.07, p = 0.017). Medicare/Military insurance predicted lower recurrence risk (HR = 0.43, 95% CI 0.23-0.81, p = 0.009) and higher readmission risk (HR = 2.00, 95% CI 1.17-3.41, p = 0.011). Other SDoH factors were not associated with recurrence or readmission. Lower WHO grade predicted lower recurrence risk (HR = 0.5, 95% CI 0.33-0.78, p = 0.002), while age (HR = 0.75 per 10-year increase, 95% CI 0.62-0.89, p &lt; 0.001) and gross total resection (HR = 0.56, 95% CI 0.35-0.9, p = 0.016) predicted lower readmission risk. CONCLUSIONS: Socioeconomically disadvantaged neighborhoods and further distance from the hospital were barriers to follow-up after meningioma resection. Other SDoH associated with readmission and recurrence are reported. Individualized follow-up plans should consider these SDoH to ensure care continuity and improve outcomes.

Conditional Recurrence-Free Survival After Surgical Resection of Meningioma.

Recurrence after meningioma resection warrants serial surveillance imaging, but little evidence guides the optimal time interval between imaging studies/surveillance duration. To describe recurrence-free survival (RFS) after meningioma resection, conditioned to short-term RFS. A retrospective cohort study for adults presenting for meningioma resection from 2000 to 2018 was conducted. The primary outcome was postoperative follow-up RFS. Conditional RFS Kaplan-Meier analysis was performed at 1, 2, 3, 5, and 10 years, conditioned to 6-month and 12-month RFS. RFS probabilities conditioned to 6-month RFS were estimated in subgroups, stratified by World Health Organization grade, extent of resection, and need for postoperative radiation. In total, 723 patients were included. Median age at surgery was 57.4 years (IQR = 47.2-67.2). Median follow-up was 23.5 months (IQR = 12.3-47.8). Recurrence was observed in 90 patients (12%), with median time to recurrence of 14.4 months (IQR = 10.3-37.1). Conditioned to 6-month postoperative RFS, patients had 90.3% probability of remaining recurrence-free at 2 years and 69.4% at 10 years. Subgroup analysis conditioned to 6-month RFS demonstrated grade 1 meningiomas undergoing gross total resection (GTR) had 96.0% probability of RFS at 1 year and 82.8% at 5 years, whereas those undergoing non-GTR had 94.5% and 79.9% probability, respectively. RFS probability was 78.8% at 5 years for non-grade 1 meningiomas undergoing GTR, compared with 69.7% for non-grade 1 meningiomas undergoing non-GTR. Patients with non-grade 1 meningiomas undergoing upfront radiation had a 1-year RFS of 90.1% and 5-year RFS of 51.7%. Recurrence risk after meningioma resection after an initial recurrence-free period is reported, with high-risk subgroups identified. These results can inform objective shared decision-making for optimal follow-up.

Using 68 Ga-DOTATATE PET for Postoperative Radiosurgery and Radiotherapy Planning in Patients With Meningioma: A Case Series.

For patients with either an incompletely resected meningioma or recurrence after surgery, stereotactic radiosurgery is frequently used. MRI is typically used for stereotactic radiosurgery targeting, but differentiating tumor growth from postoperative change can be challenging. 68 Ga-DOTATATE, a positron emission tomography (PET) radiotracer targeting the somatostatin receptor type 2, has been shown to be a reliable meningioma biomarker. To evaluate the impact of 68 Ga-DOTATATE on treatment planning in patients who had previously undergone meningioma resection. We present a consecutive case series of 12 patients with pathology-proven meningioma who received a 68 Ga-DOTATATE PET between April 2019 and April 2021. Treatment planning was performed first using MRI. DOTATATE-PET images were then used to assess accurate tumor identification. Ten patients had WHO Grade 2 meningioma, and 2 patients had Grade 1 tumor. Eight patients had recurrent meningiomas, and 4 patients had newly diagnosed disease. Overall, 68 Ga-DOTATATE PET scans altered previously formulated treatment plans in 5 of 12 patients. In addition, 9 of 12 patients had disease foci not appreciated on MRI. In this series, incorporating 68 Ga-DOTATATE PET imaging had clinical utility for most patients in whom it was used. It proved particularly adept in demonstrating intraosseous meningiomas, differentiating recurrence from postoperative changes, and identifying subcentimeter disease foci. It is an imaging modality that our center will continue to use as a means of improving postoperative treatment plans after the surgical resection of meningiomas.

Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis

Disparities in treatment and outcomes disproportionately affect minority ethnic and racial populations in many surgical fields. Although substantial research in racial disparities has focused on outcomes, little is known about how surgeon recommendations can be influenced by patient race. The aim of this study was to investigate racial and socioeconomic disparities in the surgical management of primary brain tumors. In this registry-based cohort study, we used data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) and the American College of Surgeons National Cancer Database (NCDB) in the USA for independent analysis. Adults (aged ≥20 years) with a new diagnosis of meningioma, glioblastoma, pituitary adenoma, vestibular schwannoma, astrocytoma, and oligodendroglioma, with information on tumour size and surgical recommendation were included in the analysis. The primary outcome of this study was the odds of a surgeon recommending against surgical resection at diagnosis of primary brain neoplasms. This outcome was determined using multivariable logistic regression with clinical, demographic, and socioeconomic factors. This study included US national data from the SEER (1975-2016) and NCDB (2004-17) databases of adults with a new diagnosis of meningioma (SEER n=63 674; NCDB n=222 673), glioblastoma (n=35 258; n=104 047), pituitary adenoma (n=27 506; n=87 772), vestibular schwannoma (n=11 525; n=30 745), astrocytoma (n=5402; n=10 631), and oligodendroglioma (n=3977; n=9187). Independent of clinical and demographic factors, including insurance status and rural-urban continuum code, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (adjusted odds ratio 1·13, 95% CI 1·06-1·21, p<0·0001), glioblastoma (1·14, 1·01-1·28, p=0·038), pituitary adenoma (1·13, 1·05-1·22, p<0·0001), and vestibular schwannoma (1·48, 1·19-1·84, p<0·0001) when compared with White patients in the SEER dataset. Additionally, patients of unknown race had significantly higher odds of recommendation against surgical resection for pituitary adenoma (1·80, 1·41-2·30, p<0·0001) and vestibular schwannoma (1·49, 1·10-2·04, p=0·011). Performing a validation analysis using the NCDB dataset confirmed these significant results for Black patients with meningioma (1·18, 1·14-1·22, p<0·0001), glioblastoma (1·19, 1·12-1·28, p<0·0001), pituitary adenoma (1·21, 1·16-1·25, p<0·0001), and vestibular schwannoma (1·19, 1·04-1·35, p=0·0085), and indicated and indicated that the findings are independent of patient comorbidities. When further restricted to the most recent decade in SEER, these inequities held true for Black patients, except those with glioblastoma (meningioma [1·18, 1·08-1·28, p<0·0001], pituitary adenoma [1·20, 1·09-1·31, p<0·0001], and vestibular schwannoma [1·54, 1·16-2·04, p=0·0031]). Racial disparities in surgery recommendations in the USA exist for patients with primary brain tumours, independent of potential confounders including clinical, demographic, and select socioeconomic factors. Further studies are needed to understand drivers of this bias and enhance equality in surgical care. None.

SURG-31. UTILITY OF TRANEXAMIC ACID (TXA) FOR RESECTION OF INTRACRANIAL MENINGIOMAS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Due to its anti-fibrinolytic action, tranexamic acid (TXA) can be utilized to help maintain hemostasis during surgical operations. With respect to surgery for intracranial tumors, we hypothesize that TXA could help mitigate blood loss during resection of highly vascular tumors such as meningiomas. We therefore conducted a systematic review of the literature and meta-analysis to analyze the effects of TXA administration in patients undergoing surgical resection of intracranial meningioma. Study inclusion criteria were (1) primary data articles describing use of TXA in surgical resection of meningioma. In this meta-analysis, which included four primary comparative studies, outcome measurements between TXA and non-TXA groups were compared. Primary outcomes included operative length, complications, transfusion requirements, estimated blood loss, and postoperative Hb for TXA versus non-TXA (control) groups. Pooled-comparative analysis was conducted for each of these perioperative variables and formal meta-analysis was applied toward statistically significant parameters. A total of 221 patients were analyzed (110 TXA, 111 non-TXA). Patient age (p = 0.1632), gender (p = 0.8317), and tumor location (p = -.8334) were similar for TXA and control groups. TXA was associated with decreased complication rate (logRR: -0.85; CI95% = -1.49 to -0.22; p = 0.0087), decreased transfusion requirement (logRR: -0.50; CI95% = -0.92 to -0.08; p = 0.0039), reduced blood loss (SMD: -1.76; CI95% = -3.21 to -0.31; p &amp;lt; 0.0001), and increased postoperative Hb (SMD: 0.46; CI95% = -0.15 to 1.07; p &amp;lt; 0.0001). In three trials, TXA was administered intravenously as a loading dose of 20 mg/kg for 20 minutes preoperatively with an intraoperative maintenance rate of 1mg/kg/hr; in one trial, administration design was identical except that infusion rate of the 20 mg/kg preoperative loading dose was unspecified. TXA may be associated with reduced complications, transfusion requirements, perioperative estimated blood loss, and increasedpostoperative Hb when administered perioperatively for surgical resection of intracranial meningiomas.

Risk factors influencing cerebral venous infarction after meningioma resection

BackgroundCerebral venous infarction (CVI) is a serious complication after meningioma resection. The risk factors of postoperative cerebral venous infarction after surgical resection of meningioma can be determined through large samples and this study can add evidence to the literature.MethodsThe clinical and imaging data of 1127 patients with intracranial meningiomas who underwent resection in our hospital were retrospectively collected and analyzed. CVI was evaluated by postoperative imaging and clinical manifestations. Univariate and multivariate analyses were performed to identify risk factors associated with CVI.ResultsOverall, 4.7% (53/1127) of patients experienced CVI after meningioma resection. Multivariate analysis revealed superficial meningioma, moderate to severe peritumoral edema, peritumoral critical vein and WHO grade II-III as independent predictors of a postoperative CVI. After timely intervention, the symptoms were clearly alleviated in one month, and the prognosis was good, but injury to key veins could cause irreversible neurological disorders.ConclusionsIntraoperative protection of veins is the primary way to prevent CVI. The present study identified several significant and independent risk factors for postoperative venous infarction, thereby enabling the identification of high-risk patients who require special attention during clinical and surgical management.

148 - Relationship of anxiety and depression with surgical resection of meningiomas: a systematic review

RESUMO Objetivos Apesar da sua natureza indolente, os meningiomas estao associados a varias perturbacoes psiquiatricas. A incidencia e natureza dos sintomas psiquiatricos dependem da localizacao do tumor, do seu volume e edema adjacente. As comorbilidades neuropsicologicas sao comuns e os meningiomas, em comparacao com outros tipos de tumores cerebrais, causando elevados niveis de ansiedade e depressao. O tratamento preferencial consiste na resseccao cirurgica do tumor. Com esta revisao sistematica, pretende-se clarificar a variacao dos niveis de ansiedade e depressao antes e apos a resseccao cirurgica do meningioma, de modo a permitir melhorar os cuidados de saude em doentes com este tipo de tumor. Metodos Foi realizada uma revisao sistematica da literatura em tres bases de dados diferentes, MEDLINE, Web of Science e SCOPUS, seguindo as diretrizes das Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Todos os trabalhos incluidos contemplam a avaliacao pre-cirurgica e pos-cirurgica dos sintomas de ansiedade e depressao em doentes com meningioma. Series de casos, revisoes, metanalises e cartas ao editor foram excluidos. Resultados Da pesquisa resultaram 611 artigos, dos quais treze foram selecionados para analise qualitativa. No total, foram incluidos 1259 pacientes no estudo. Os artigos incluidos na revisao foram estudos observacionais, longitudinais e prospetivos. A avaliacao da ansiedade, no geral, revelou valores decrescentes durante todo o acompanhamento apos a recessao do tumor. Da mesma forma, os resultados mostraram menores scores de depressao na primeira avaliacao pos-cirurgica. No entanto, os estudos com duas avaliacoes pos-cirurgicas revelaram niveis crescentes de depressao na segunda avaliacao. Conclusao A ansiedade e a depressao parecem diminuir apos a resseccao do meningioma. No entanto, esta revisao revelou varias discrepâncias metodologicas nos estudos analisados e as conclusoes tem de ser ponderadas, sugerindo a necessidade de metodologias de investigacao mais rigorosas.

Impact of venous thromboembolism during admission for meningioma surgery on hospital charges and postoperative complications

Surgical resection of meningiomas has been associated with high rates of venous thromboembolic events (VTE) as compared with all other intracranial tumors. There is a paucity of data regarding the clinical complications and comorbidities associated with this cohort yet the underlying pathophysiological mechanism for this tumor-specific finding remains unclear. Our goal was to determine the various impacts of VTE on meningioma surgery in a large cohort of inpatient admissions. This retrospective analysis utilized discharge data from the National Inpatient Sample (NIS) from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were compared between patients with and without VTE. Of 20,259 patients, 426 (2.1%) experienced a VTE. Compared to the non-VTE cohort, patients that experienced a VTE were older (62.7 ± 13.7 vs. 57.2 ± 14.7; p < 0.001), were more commonly male (38.0% vs 30.1%; p = 0.001), had longer hospitalizations (18.8 vs 6.6 days; p < 0.001), and incurred significantly greater hospital charges ($195,837 vs $74,434; p < 0.001). VTE patients experienced significantly higher rates of acute postoperative complications including shock, hemorrhage, wound dehiscence, infection, intracerebral hemorrhage, hemiparesis/hemiplegia, stroke, and death during admission. Odds ratio of aforementioned postsurgical complications remained significantly higher both before and after adjusting for age and sex (all p < 0.01). Occurrence of VTE in patients undergoing meningioma resection portends greater hospital charges, most likely attributed to longer lengths of admission. Increased postoperative complications and mortality in the VTE group warrants further investigation and wariness of the surgeon when treating surgical candidates of meningioma.

Risk of post-operative venous thromboembolism in patients with meningioma.

The surgical resection of meningiomas can be complicated by venous thromboembolism (VTE) in the post-operative period, but the exact incidence of this event is not known. Aim of this study was to assess the occurrence of VTE in patients operated for meningioma who underwent a post-operative clinical and objective screening for VTE. Patients undergoing meningioma resection between 2000 and 2010 who accepted to be investigated for VTE in the post-operative period were included in the study. The screening included daily clinical assessment, pulmonary perfusion scintigraphy (Q-SCAN) on day 2 and venous compression ultrasonography (CUS) of the lower limbs within day 7. The univariate and multivariate statistical analysis of risk factors for VTE included sex, age, presence of comorbidities, pre- and post-operative Karnofsky Performance scale (KPS), post-operative neurological worsening and post-operative walking ability. Two-hundred and seventy-five patients were included in the study. VTE was diagnosed in 82 patients (29.8%). Univariate analysis revealed that age ≥ 65 years, cardiovascular comorbidities, pre- and post-operative KPS < 80/100, post-operative neurological worsening and impaired post-operative walking ability were significantly associated with VTE. Multivariate analysis confirmed only age ≥ 65years (p = 0.011) and post-operative KPS < 80/100 (p = 0.002) as independent risk factors for VTE. Patients operated for meningioma have a 30% risk of VTE. Age ≥ 65years and post-operative KPS < 80 were independent risk factors for VTE.

Meningiomas in pregnancy: timing of surgery and clinical outcomes as observed in 104 cases and establishment of a best management strategy

There is a strong correlation between the level of circulating female sex hormones and the parturient growth of meningiomas. As a result, rapid changes in meningioma size occur during pregnancy, putting both the mother and fetus at risk. Large, symptomatic meningiomas require surgical resection, regardless of the status of pregnancy. However, the preferred timing of such complex intervention is a matter of debate. The rarity of this clinical scenario and the absence of prospective trials make it difficult to reach evidence-based conclusions. The aim of this study was to create evidence-based management guidelines for timing of surgery for pregnancy-related intracranial meningiomas. The English literature from 1990 to 2016 was systematically reviewed according to PRISMA guidelines for all surgical cases of pregnancy-related intracranial meningiomas. Cases were divided into two groups: patients who have had surgery during pregnancy and delivered thereafter (group A) and patients who delivered first (group B). Groups were compared for demographic, clinical and radiological features, as well as for neurosurgical, obstetrical and neonatological outcomes. Statistical analysis was performed to assess differences. A total of 104 surgical cases were identified and reviewed, of which 86 were suitable for comparison and statistical analysis. Thirty-five patients (40%) underwent craniotomy for resection during pregnancy or at delivery (group A) and 51 patients (60%) underwent surgery after delivery (group B). Groups showed no significant differences in characteristics such as age at diagnosis, number of gestations, presenting symptoms, tumor site and tumor size. Despite a comparable distribution over the gestational trimesters, group A had significantly more patients diagnosed prior to the 27th gestational week (46 vs 17.5%, p = 0.0075). Group A was also associated with a significantly higher rate of both emergent craniotomies (40 vs 19.6%, p = 0.0048) and emergent Caesarian deliveries (47 vs 17.8%, p = 0.00481). The time from diagnosis to surgery was significantly longer in group B (11weeks vs 1week in group A, p = 0.0013). The rate of premature delivery was high but similar in both groups (∼70%). Risks of maternal mortality or fetal mortality were associated with group A (odds ratio = 14.7), but did not reach statistical significance. While surgical resection of meningioma during pregnancy may be associated with increased maternal and fetal mortalities, the overall neurosurgical, obstetrical and neonatological outcomes, as well as many clinical characteristics, are similar to patients undergoing resection postpartum. We believe that fetal survival chances have a significant impact on decision-making, as patients diagnosed at a later stage in pregnancy (≥27th week of gestation) were more likely to undergo delivery first. This complicated clinical scenario requires the close cooperation of multiple disciplines. While the mother's health and well-being should always be paramount in guiding management, we hope that the overall good outcomes observed by this systematic review will encourage colleagues to aim for term pregnancies whenever possible in order to reduce prematurity-related problems.

Evaluation of Radiological Indicators of Surgical Plane of Meningiomas

The study was to objectively assess radiological indicators in conventional MR sequences with respect to operative findings and tumor interface during surgical resection of meningiomas. Signal intensity of meningioma on T1, T2, FLAIR, and contrast MR sequences were prospectively noted and analyzed in relation to intraoperative tumor consistency, vascularity, dissection plane, Simpson’s grade of excision, and histopathology. Appropriate univariate and multivariate analysis were performed. Of the total 70 patients (44 females, 26 males), 18 had skull base, 15 had convexity, 10 had parasagittal, 11 had falcine, and 7 had tentorial meningiomas. Majority (67) had tumors which were hypo to isointense in T1. While 14 had hypointense signal in T2, only 8 were hypointense in FLAIR. 21 had inhomogeneous enhancement. 28 had marked tumor interface in MRI, while 33 and 9 had regular and irregular border, respectively. 19 had no edema, while 33 and 18 had focal and lobar edema respectively. Inhomogeneous enhancement (p = 0.01) and FLAIR hypointensity (p = 0.03) had significant association with tumor hardness. FLAIR hypointensity (p = 0.01) had significant association with low vascularity. Skull base location (p = 0.04), FLAIR hypointensity (p = 0.02), irregular border (p = 0.01), and recurrence (p = 0.01) had significant association with subpial or mixed plane of cleavage. Only skull base location (p = 0.01) had significant impact on extent of excision. T2 hypointensity (p = 0.001) and FLAIR hypointensity (p = 0.01) had significant association with Fibroblastic or Psammomatous meningioma. In multivariate analysis, FLAIR hypointensity (p = 0.02) and skull base location (p = 0.04) had significant independent association with suboptimal surgical plane, while skull base location (p = 0.01) had significant association with extent of excision. Among MRI sequences, FLAIR hypointensity had the best performance characteristic with specificity of 94% to predict suboptimal surgical plane. In conclusion, FLAIR images correlate with suboptimal surgical plane during resection of meningioma with high specificity.

Surgical Management of Meningiomas 6 Months Fellow Up of 85 Cases in a Sub-Saharian Countrie

Objective: To evaluate the surgical management of intracranial meningiomas and the 6 months postoperative course. Method: Prospective study was conducted between January 2002 and May 2012. Were included patients for whom surgical resection of meningioma was made ??and whose follow-up was at least 6 months. The quality of resection was evaluated according to the criteria of Simpson. Karnofsky index was used to assess the pre-and postoperative morbidity. Results: 85 cases of intracranial meningiomas were included. The sex ratio was 0.88/1. The average age was 54.41 years. The mean disease duration was 7.17 months. It was supra tentorial meningiomas in 70.57% of cases, infra-tentorial meningiomas for 11.76% of cases and skull base meningiomas for 17.64% of cases. Karnofski average score at admission was 48.53 with 57% of patients with a score between 10 and 40. 95.29% of patients were operated according to Simpson I, II and 4.710 / 0 according to Simpson IV. It was benign meningiomas in 97.65% of cases. At 6 months theKarnofskipostoperative average score was 83.7. The postoperative mortality was 1.17%. Conclusion: The surgical treatment of meningiomas improves the clinical status of patients with low morbidity and mortality.

Post-operative Herpes Simplex Virus Encephalitis after Surgical Resection of Meningioma: A Case Report and Review of the Literature

Background: Herpes Simplex Virus (HSV) encephalitis is a rare but life threatening complication in neurosurgical patients. Diagnosis of Herpes Simplex Encephalitis (HSVE) is based on the detection of the herpes simplex virus (HSV) DNA in patient`s CSF samples. A low threshold for both investigations with CSF PCR and empirical treatment with intravenous acyclovir is warranted. Methods and materials: In this case we discussed a 55- year-old man with HSVE after surgical resection of meningioma. We represent a rare case of HSV encephalitis. The appearance of a high grade fever (40°C) and altered consciousness and spastic quadriparesia complicated the post-operative course in a 55-year-old man who underwent surgical removal of a meningioma on the second postoperative day. Brain MRI detected brain abnormalities on the fourth day after onset of symptoms, and polymerase chain reaction (PCR) identification of HSV 1 DNA confirmed the diagnosis. Result: A positive prognosis was achieved due to the decision to start specific, high-dose antiviral therapy based on clinical suspicion, before a firm diagnosis was established. . Treatment with acyclovir was maintained for 8 weeks and patient die after severe sepsis. Conclusion: There are only few case reports of postoperative HSV1 encephalitis. These reports suggest that this rare postoperative complication is associated with a poor prognosis, with high mortality and morbidity. Neurosurgical interventions involving peripheral nerve root or ganglia have been reported to cause re-activation of cutaneous herpes simplex infection. Factors compromising the immune system may also increase susceptibility to herpes simplex infection.

EPID-20SKULL BASE MENINGIOMAS ARE BIOLOGICALLY MORE BENIGN AND HAVE A LONG-TERM DIVERGING POSTOPERATIVE RECURRENCE PATTERN COMPARED WITH SUPERFICIAL MENINGIOMAS

OBJECTIVE: To identify differences in the recurrence pattern of surgically-resected skull base meningiomas compared with superficial intra-cranial meningiomas. METHODS: A retrospective hospital-based study of all patients referred to our institution from January 1990 to June 2014 for surgical resection of meningiomas was conducted. The database constituted both patients with a first time presentation and those with evidence of recurrence presenting for a surgical evaluation. Tumor proliferation index (based on the MIB-1 index) and the overall time to recurrence of the cohort of surgically-resected skull base and superficial meningiomas was documented. Kaplan-Meier curves and life tables were constructed for analysis of survival. SPSS v22.0 was used for statistical analysis. RESULTS: Overall, 398 intra-cranial meningiomas - 269 (68%) superficial and 129 (32%) skull base - were available for review. Follow up time ranged from 1 week to 250 months. Skull base lesions were found to have a significantly lower MIB-1 index compared with their superficial counterparts (0.0413 vs 0.0620, p 0.001). Meningiomas in all locations demonstrated a recurrence rate of 30% at an average of 100 months of follow-up. Subsequent to this point, however, the recurrence of skull base meningiomas demonstrated a plateau (250 months of follow-up) whereas superficial lesions were found to have a recurrence rate of 80% at 230 months of follow-up (P value: 0.038). CONCLUSIONS: As reflected by the difference in the MIB-1 index, skull base meningiomas demonstrated a less aggressive behavior compared with superficial lesions. This was reflected in the clinical recurrence rate of 80% for the latter. This suggests that while skull base lesions may not necessarily need to be followed beyond 100 months, superficial meningiomas would require a greater long-term follow-up given their higher propensity for recurrence.

5-Aminolevulinic Acid-Induced Protoporphyrin IX Fluorescence in Meningioma

The use of 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence has shown promise as a surgical adjunct for maximizing the extent of surgical resection in gliomas. To date, the clinical utility of 5-ALA in meningiomas is not fully understood, with most descriptive studies using qualitative approaches to 5-ALA-PpIX. To assess the diagnostic performance of 5-ALA-PpIX fluorescence during surgical resection of meningioma. ALA was administered to 15 patients with meningioma undergoing PpIX fluorescence-guided surgery at our institution. At various points during the procedure, the surgeon performed qualitative, visual assessments of fluorescence by using the surgical microscope, followed by a quantitative fluorescence measurement by using an intraoperative probe. Specimens were collected at each point for subsequent neuropathological analysis. Clustered data analysis of variance was used to ascertain a difference between groups, and receiver operating characteristic analyses were performed to assess diagnostic capabilities. Red-pink fluorescence was observed in 80% (12/15) of patients, with visible fluorescence generally demonstrating a strong, homogenous character. Quantitative fluorescence measured diagnostically significant PpIX concentrations (cPpIx) in both visibly and nonvisibly fluorescent tissues, with significantly higher cPpIx in both visibly fluorescent (P < .001) and tumor tissue (P = .002). Receiver operating characteristic analyses also showed diagnostic accuracies up to 90% for differentiating tumor from normal dura. ALA-induced PpIX fluorescence guidance is a potential and promising adjunct in accurately detecting neoplastic tissue during meningioma resective surgery. These results suggest a broader reach for PpIX as a biomarker for meningiomas than was previously noted in the literature.

Predictive factors related to symptomatic venous infarction after meningioma surgery

Introduction. The incidence of venous infarction after surgical resection of meningioma is low, but its occurrence can necessitate additional surgical procedures and long hospital stay. In this study, we evaluated variables associated with venous infarction after meningioma surgery. Methods. Among 825 patients with intracranial meningiomas who underwent microsurgical resection between January 1993 and March 2011, 27 (3.3%) presented with neurological deterioration due to postoperative venous infarction. The following factors were included in the statistical analysis to determine their association with venous infarction: sex, age, location, relation to venous sinus, peritumoural oedema, size and degree of resection. Results. Incidence of venous infarction was 6.8% with large meningiomas (size ≥ 4 cm), but with small (size < 4 cm) was reduced to 1.2% (p < 0.001). Meningiomas with perilesional edema elicited venous infarction more frequently than those without (5.1% vs. 2.3%, p = 0.030). Venous infarction was also determined to occur at 5.5% frequency in superficial meningiomas, such as parasagittal, falx and convexity, but only at 0.5% frequency in deep locations (p = 0.001). Venous infarction additionally occurred less often in meningiomas at a distance from the midline venous sinus than in those nearby, such as parasagittal and falx (2.2% vs. 6.6%, p = 0.004). Conclusions. To prevent venous infarction after meningioma surgery, it is essential to maintain the intervening arachnoid plane as much as possible; this is especially important in meningiomas larger than 4 cm, combined with peritumoural edema or positioned superficially around the midline venous sinus.