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2.
World Neurosurg ; 189: 203-208, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38901486

RESUMEN

BACKGROUND: World Health Organization grade II/III meningiomas frequently recur despite maximal safe surgical resection and adjuvant radiation. Notoriously resistant to medical therapy, no well-established guidelines for pharmacologic treatment currently exist. In recent years, a small number of clinical trials have investigated immune checkpoint inhibitors (ICIs) for patients with recurrent grade II/III meningiomas. We reviewed the existing literature to 1) summarize the clinical responses that have been observed and 2) identify tumor genomic characteristics that may predict a better response to ICI therapy. METHODS: PubMed was searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include studies reporting clinical data for recurrent grade II or grade III meningiomas treated with ICIs. Clinical features, available tumor genomics, and outcomes were analyzed. RESULTS: Four studies were included comprising 59 patients; 74.6% had World Health Organization grade II meningiomas and 25.4% had grade III meningiomas. Thirt-two patients (54%) received nivolumab, 26 (44%) received pembrolizumab, and 1 (2%) received an ICI not named. While tumor genomic data was not consistently reported across studies, favorable response was most associated with mismatch repair deficiency and high tumor mutational burden. Common adverse effects included liver/pancreas enzyme elevations (11.5%), fatigue (11.5%), and leukopenia/infection (9%). CONCLUSIONS: Checkpoint inhibitors represent a promising investigational therapy for patients with recurrent grade II/III meningiomas. These drugs may be more efficacious for tumors with mismatch repair deficiency or high tumor mutational burden. Future investigations would benefit from research consortia with prospective enrollments of patients, descriptive characterization of tumor genomics, and standardized assessment of radiographic response.


Asunto(s)
Inhibidores de Puntos de Control Inmunológico , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/tratamiento farmacológico , Meningioma/terapia , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Neoplasias Meníngeas/tratamiento farmacológico , Clasificación del Tumor , Recurrencia Local de Neoplasia , Anticuerpos Monoclonales Humanizados
3.
World Neurosurg ; 178: 52, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37422189

RESUMEN

Mesenchymal tumors of the head and neck can lead to tumor-induced osteopeni, necessitating a biochemical cure to alleviate associated symptoms. We present a case of a 40-year-old man who presented with diffuse pain and wheelchair dependency secondary to a skull base mesenchymal tumor producing tumor-induced osteopeni. The tumor involved the cavernous sinus, infratemporal fossa, and middle cranial fossa. The patient failed the balloon occlusion test. Additionally, the patient consented to the procedure. Cerebral revascularization was performed using a robotically harvested internal thoracic artery because of the patient's short radial arteries and history of chronic superficial and deep vein thrombosis. After the common carotid artery-internal thoracic artery-M2 bypass, the patient underwent endovascular embolization of the external carotid artery feeders and occlusion of the cavernous external carotid artery. Several days later, the patient underwent a gross total resection via endoscopic assisted microsurgery. The residual biochemical disease was then addressed via supplemental radiosurgery. The patient's clinical outcome was favorable, with regained ambulatory function and resolution of initial symptoms. Unfortunately, he developed left optic neuropathy due to the embolization of the external carotid artery feeders.


Asunto(s)
Oclusión con Balón , Revascularización Cerebral , Embolización Terapéutica , Arterias Mamarias , Neoplasias de la Base del Cráneo , Masculino , Humanos , Adulto , Arterias Mamarias/cirugía , Arteria Carótida Externa/cirugía , Neoplasias de la Base del Cráneo/cirugía , Revascularización Cerebral/métodos , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Arteria Cerebral Media/cirugía
4.
World Neurosurg ; 177: 16, 2023 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-37236311

RESUMEN

Spinal cord arteriovenous malformations (AVMs) are rare and usually present in younger patients. We present the case of a 76-year-old woman with a 2-year history of unsteady gait. She presented to us with sudden-onset thoracic pain, numbness, and weakness in both legs. She was found to have urinary retention, dissociative pain loss in the left leg, and weakness involving the right leg. Magnetic resonance imaging demonstrated an intramedullary spinal AVM with subarachnoid hemorrhage and cord edema. The spinal angiogram detailed the architecture of the AVM and revealed a flow-related aneurysm in the anterior spinal artery. The patient underwent T8-T11 laminoplasty with a T10 transpedicular approach to allow for ventral exposure of the cord. Initially, a microsurgical clipping of the aneurysm was performed, followed by a pial resection of the AVM. Postoperatively, the patient recovered her bladder control and motor function. She is now able to walk with a walker due to impaired proprioception. Videos 1-4 detail the key steps and techniques for safe clipping and resection.

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