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INTRODUCTION: Spinal tumors (ST) often result in dire prognosis, carrying risks such as permanent paralysis, sensory loss, and sphincter dysfunction. Data on their incidence and etiology in pediatric populations are markedly scant. Our study investigates the etiology, clinical manifestation, treatment, and outcomes of pediatric ST. METHODS: We conducted a retrospective review of our institutional pediatric oncology and neurosurgery database, examining 14 patients under 18 years admitted with ST due to oncological diseases since 2005. We analyzed the clinical presentations, evaluations, molecular diagnostics and treatments for these patients. RESULTS: The study spanned 15 years and included 14 pediatric patients, each diagnosed with distinct spinal tumor entity. The mean patient age was approximately 19.6 ± 10.1 months. Severe axial pain along the vertebral column was observed in 13 patients, while acute neurological deterioration manifested in 7 patients. As a first-line intervention, 13 patients underwent decompressive surgery through laminectomy and tumor resection, and only one patient received chemotherapy solely. Before surgery, seven patients were unable to walk; post-surgery, six of them regained their ability to ambulate. The diagnosis encompassed a range of neoplasms: two instances of Ewing sarcoma, 3 instances of teratoma, one case presenting an atypical teratoid Rhabdoid tumor, two instances each of low-grade astrocytoma and neuroblastoma, and single instances of ependymoma, meningioma, rhabdomyosarcoma, and embryonal tumors with multilayered rosettes (ETMRs). Three patients succumbed two years after initiating therapy. CONCLUSION: Despite their rarity, intraspinal tumors in pediatric patients pose substantial therapeutic challenges. The intertwined complexities of the disease entity and the patient's neurological status demand swift initiation of an individualized therapeutic strategy. This crucial step helps optimize outcomes for this patient cohort, who frequently grapple with debilitating health conditions. Inclusion of these patients within a registry is mandatory to optimize treatment outcomes due to their rarity in pediatric population.
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Neoplasias de la Columna Vertebral , Humanos , Masculino , Femenino , Estudios Retrospectivos , Preescolar , Niño , Lactante , Adolescente , Resultado del Tratamiento , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/complicaciones , Sarcoma de Ewing/cirugía , Sarcoma de Ewing/terapia , Sarcoma de Ewing/complicaciones , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/complicaciones , Ependimoma/terapia , Ependimoma/cirugía , Ependimoma/diagnóstico , Laminectomía , Descompresión Quirúrgica/métodos , Teratoma/complicaciones , Teratoma/cirugía , Teratoma/diagnóstico , Teratoma/terapia , Procedimientos Neuroquirúrgicos/métodos , Neuroblastoma/cirugía , Neuroblastoma/complicaciones , Astrocitoma/complicaciones , Astrocitoma/cirugía , Astrocitoma/terapia , Tumor Rabdoide/terapia , Tumor Rabdoide/complicaciones , Meningioma/cirugía , Meningioma/terapia , Meningioma/complicaciones , Meningioma/diagnósticoAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Neoplasias de la Base del Cráneo/cirugía , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Imagenología Tridimensional/métodos , Hueso Petroso/cirugía , Hueso Petroso/diagnóstico por imagen , Femenino , Persona de Mediana EdadRESUMEN
The stiffness of human cancers may be correlated with their pathology, and can be used as a biomarker for diagnosis, malignancy prediction, molecular expression, and postoperative complications. Neurosurgeons perform tumor resection based on tactile sensations. However, it takes years of surgical experience to appropriately distinguish brain tumors from surrounding parenchymal tissue. Haptics is a technology related to the touch sensation. Haptic technology can amplify, transmit, record, and reproduce real sensations, and the physical properties (e.g., stiffness) of an object can be quantified. In the present study, glioblastoma (SF126-firefly luciferase-mCherry [FmC], U87-FmC, U251-FmC) and malignant meningioma (IOMM-Lee-FmC, HKBMM-FmC) cell lines were transplanted into nude mice, and the stiffness of tumors and normal brain tissues were measured using our newly developed surgical forceps equipped with haptic technology. We found that all five brain tumor tissues were stiffer than normal brain tissue (p < 0.001), and that brain tumor pathology (three types of glioblastomas, two types of malignant meningioma) was significantly stiffer than normal brain tissue (p < 0.001 for all). Our findings suggest that tissue stiffness may be a useful marker to distinguish brain tumors from surrounding parenchymal tissue during microsurgery, and that haptic forceps may help neurosurgeons to sense minute changes in tissue stiffness.
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Neoplasias Encefálicas , Glioblastoma , Meningioma , Ratones Desnudos , Microcirugia , Animales , Humanos , Microcirugia/métodos , Microcirugia/instrumentación , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/patología , Glioblastoma/cirugía , Glioblastoma/patología , Ratones , Meningioma/cirugía , Meningioma/patología , Línea Celular Tumoral , Instrumentos QuirúrgicosRESUMEN
INTRODUCTION: It is unclear how tranexamic acid (TXA) affects blood loss and seizures in meningioma resections. We performed a systematic review and meta-analysis and tried to evaluate the effectiveness and safety of TXA use for patients undergoing meningioma resections. METHODS: Regards to this systematic review and meta-analysis (registered with CRD42023416693), we searched PubMed, Embase (Ovid), EBSCO, and Cochrane central library up to and including Oct 2023. Patients undergoing meningioma resections treated with TXA and placebo or no treatment were eligible for this study. This would allow delineation of the impact of TXA on blood loss, postoperative seizure, and other complication incidences. RESULTS: Four prospective cohort studies with 781 patients (390 patients in the TXA group and 391 patients in the control group) were conducted via a systematic review and meta-analysis. The results suggested that the application of TXA for patients undergoing meningioma resections reduced mean blood loss of 252 mL with 95% confidence interval (CI) -469.26 to -34.67 (P = 0.02) and I2 of 94% but did not increase postoperative seizure (risk ratio: 1.08; 95%CI: 0.54 to 2.15; P = 0.84) and other complication rates. CONCLUSIONS: This systematic review and meta-analysis suggests that the administration of TXA could reduce blood loss in patients undergoing intracerebral meningioma resection. REGISTRY INFORMATION: The systematic review protocol has been registered at PROSPERO (Registration No. CRD42023416693) on April 23, 2023.
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Pérdida de Sangre Quirúrgica , Meningioma , Convulsiones , Ácido Tranexámico , Humanos , Meningioma/cirugía , Ácido Tranexámico/uso terapéutico , Ácido Tranexámico/efectos adversos , Convulsiones/tratamiento farmacológico , Convulsiones/prevención & control , Pérdida de Sangre Quirúrgica/prevención & control , Antifibrinolíticos/uso terapéutico , Antifibrinolíticos/efectos adversos , Neoplasias Meníngeas/cirugía , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Resultado del TratamientoRESUMEN
Preoperative identification of intracranial meningiomas with aggressive behaviour may help in choosing the optimal treatment strategy. Radiomics is emerging as a powerful diagnostic tool with potential applications in patient risk stratification. In this study, we aimed to compare the predictive value of conventional, semantic based and radiomic analyses to determine CNS WHO grade and early tumour relapse in intracranial meningiomas. We performed a single-centre retrospective analysis of intracranial meningiomas operated between 2007 and 2018. Recurrence within 5 years after Simpson Grade I-III resection was considered as early. Preoperative T1 CE MRI sequences were analysed conventionally by two radiologists. Additionally a semantic feature score based on systematic analysis of morphological characteristics was developed and a radiomic analysis were performed. For the radiomic model, tumour volume was extracted manually, 791 radiomic features were extracted. Eight feature selection algorithms and eight machine learning methods were used. Models were analysed using test and training datasets. In total, 226 patients were included. There were 21% CNS WHO grade 2 tumours, no CNS WHO grade 3 tumour, and 25 (11%) tumour recurrences were detected in total. In ROC analysis the best radiomic models demonstrated superior performance for determination of CNS WHO grade (AUC 0.930) and early recurrence (AUC 0.892) in comparison to the semantic feature score (AUC 0.74 and AUC 0.65) and conventional radiological analysis (AUC 0.65 and 0.54). The combination of human classifiers, semantic score and radiomic analysis did not markedly increase the model performance. Radiomic analysis is a promising tool for preoperative identification of aggressive and atypical intracranial meningiomas and could become a useful tool in the future.
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Imagen por Resonancia Magnética , Neoplasias Meníngeas , Meningioma , Clasificación del Tumor , Humanos , Meningioma/diagnóstico por imagen , Meningioma/patología , Meningioma/cirugía , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Imagen por Resonancia Magnética/métodos , Anciano , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/patología , Adulto , Semántica , Aprendizaje Automático , RadiómicaRESUMEN
AIM: To compare T1-weighted contrast-enhanced (T1+C) with fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) sequences to protect healthy brain tissue during meningioma treatment with Gamma-Knife radiosurgery (GKRS). MATERIAL AND METHODS: After reviewing the data of 54 patients with solitary meningioma who underwent GKRS between January 2020 and June 2022, demographic characteristics were noted, tumor volumes on T1+C and FIESTA MRI sequences were measured, and sequences were compared. The patients were then divided into two groups according to the presence of invasion to intracranial venous sinuses (groups 1 and 2, respectively). SPSS 11.5 software was used for data analysis, with the level of significance set at 0.05. RESULTS: While no significant age and tumor size differences were observed between groups 1 and 2, sinus invasion was significantly higher among males. Tumor volumes measured in both groups were significantly smaller on FIESTA sequences than on T1+C sequences. CONCLUSION: The T1+C sequence has been the primary imaging method because of meningiomas' high contrast enhancement feature. However, the T1+C sequence during GKRS planning is an effective imaging method in treating meningiomas; FIESTA sequences can more precisely delineate the tumor border. In this study, we consider that using the FIESTA/CISS sequence MRI for planning meningioma therapy with Gamma-Knife can reduce target volume and prevent irradiation of healthy brain tissue.
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Imagen por Resonancia Magnética , Neoplasias Meníngeas , Meningioma , Radiocirugia , Humanos , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Meningioma/radioterapia , Radiocirugia/métodos , Masculino , Femenino , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/radioterapia , Anciano , Adulto , Estudios Retrospectivos , Carga TumoralRESUMEN
INTRODUCTION: Meningiomas located in the posterior fossa and involving the sinodural angle at the junction of the transverse and sigmoid sinuses are uncommon and present unique challenges due to their complex anatomical location. Despite their distinctive features, they are frequently categorized with tentorial meningiomas in the literature. MATERIALS AND METHODS: This retrospective study conducted at a tertiary care center involved 64 patients with sinodural meningiomas who underwent surgical treatment between 2010 and 2023. The analysis covered demographics, clinical presentation, radiological characteristics, surgical approaches, histopathological findings, and outcomes. RESULTS: The cohort predominantly comprised females (83 %) with a mean age of 47.64 years. Headache (92.2 %) and gait disturbances (62.5 %) were the most common presenting symptoms. Preoperative imaging showed sinus involvement in 57.8 % of cases, predominating Sindou's type 1 and type 6. Gross total resection (Simpson grades 1-2) was achieved in 40.6 % of cases. Postoperative complications included pseudomeningocele (9.4 %), especially in patients with hydrocephalus. CONCLUSION: Sinodural meningiomas represent a distinct subset of posterior fossa tumors, necessitating meticulous preoperative planning and intraoperative decision-making regarding sinus management. The study underscores the importance of individualized surgical strategies and highlights the role of radiosurgery in managing residual disease effectively.
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Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Meningioma/patología , Femenino , Persona de Mediana Edad , Masculino , Estudios Retrospectivos , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Adulto , Resultado del Tratamiento , Anciano , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Senos Craneales/cirugía , Senos Craneales/diagnóstico por imagen , Senos Craneales/patología , Adulto Joven , Neoplasias Infratentoriales/cirugía , Neoplasias Infratentoriales/diagnóstico por imagen , Neoplasias Infratentoriales/patologíaRESUMEN
BACKGROUND: Radiosurgery plays an important role as a treatment modality for intracranial meningiomas. Perfusion MR imaging can be performed by using arterial spin-labeling (ASL) which is a relatively new and advanced technique. OBJECTIVES: To assess the changes in perfusion parameters on ASL perfusion MRI in intracranial meningioma after radiosurgery and correlate with histopathological grade of meningioma. MATERIALS AND METHODS: In this Prospective study done at the our institute over a period of 20 months (Jan 2016-Aug 2017), patients with intracranial meningiomas had perfusion MRI with ASL sequence on GE Optima 450W®, 1.5T MRI (GE Medical Systems) prior to GKT and at 6 months after GKT were included in the study. RESULTS: Twenty-seven patients were included in this study. Mean cerebral blood flow (CBF) was higher in angiomatous meningiomas. Though mean values of average CBF, maximum, minimum, and SD derived from the ASL MR perfusion were relatively higher in post GKT group as compared to those obtained in pre-GKT but it was not clinically significant. Mean baseline volume of whole cohort was 5.71 cm3 and decreased significantly post GKT in a follow up of 6 months to 5.59 cm3 (P value 0.0018). On comparing volumes of primary and secondary group, volumes were not found be significantly decreased in primary group (P value = 0.1361), 0.1361), but significantly reduced in secondary group (7.13 vs 7.034 cm3) (P value of = 0.0038). CONCLUSION: Our preliminary observations support ASL as a sensitive MRI sequence for the evaluation of meningioma perfusion patterns.
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Circulación Cerebrovascular , Neoplasias Meníngeas , Meningioma , Radiocirugia , Humanos , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Radiocirugia/métodos , Estudios Prospectivos , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/patología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Circulación Cerebrovascular/fisiología , Anciano , Imagen por Resonancia Magnética , Angiografía por Resonancia Magnética , Marcadores de SpinRESUMEN
BACKGROUND: The Simpson grading scale assumes dural resection (grade I) is more effective against recurrence than coagulation (grade II). However, the results of recent studies have raised doubts about this effectiveness in spinal meningiomas. Therefore, we aimed to perform a meta-analysis comparing outcomes between Simpson grades I and II in spinal meningiomas. METHODS: According to the PRISMA statement, we systematically searched PubMed, EMBASE, and Web of Science for studies involving patients with spinal meningiomas who underwent Simpson grades I, II, III, or IV. Outcomes were radiological tumor recurrence, postoperative neurological deficits, and procedure-related complications. RESULTS: We included 54 studies with a total of 3334 patients. Simpson grades I, II, III, and IV were performed in 674 (20%), 2205 (66%), 254 (8%), and 201 (6%) patients, respectively. The follow-up ranged from 9 to 192 months, and 95.4% of all tumors were WHO grade 1. There was no difference in radiological tumor recurrence (OR 0.80, 95% CI: 0.46-1.36, P = 0.41; I2 = 0%), postoperative neurological deficits (OR 0.74, 95% CI: 0.32-1.75, P = 0.50; I2 = 0%) or procedure-related complications (OR 2.22, 95% CI: 0.80-6.13, P = 0.12; I2 = 3%) between Simpson grades I and II. Furthermore, no significant difference in postoperative neurological deficits or procedure-related complications was detected when comparing all Simpson's to each other. However, radiological tumor recurrences in Simpson I and II were significantly lower than in III and IV, with Simpson III outperforming IV (OR 0.19, 95% CI: 0.09-0.40, P < 0.01; I2 = 0%). CONCLUSION: Simpson grade I is not more effective than grade II in any outcome, although both are superior to III and IV in tumor recurrence. Our results might suggest that dural coagulation is preferable over resection when the latter carries a higher risk of complications.
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Duramadre , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirugía , Meningioma/patología , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/patología , Duramadre/cirugía , Duramadre/patología , Recurrencia Local de Neoplasia/cirugía , Procedimientos Neuroquirúrgicos/métodos , Resultado del Tratamiento , Complicaciones Posoperatorias/etiologíaRESUMEN
According to the literature, cerebellopontine angle tumors cause secondary trigeminal neuralgia and other symptoms of neurovascular compression in 1-9.9% of cases. We present a 58-year-old patient with left-sided secondary trigeminal neuralgia caused by ipsilateral posterior petrous meningioma. Stereotactic irradiation was followed by effective tumor growth control. However, residual trigeminal pain paroxysms significantly reduced the quality of life and required subsequent microsurgery. Trigeminal facial pain regressed after total resection of tumor. Considering this clinical case, we would like to discuss several issues: follow-up of meningioma requiring radiosurgery, course of secondary trigeminal neuralgia in a patient with apical petrous meningioma, characteristics of pain before and after radiosurgery, the best treatment option for these patients. Stereotactic radiosurgery seems unreasonable for CPA tumors with secondary trigeminal neuralgia. Indeed, persistent pain is possible even after tumor shrinkage. Moreover, primary stereotactic irradiation significantly complicates subsequent resection of tumor.
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Meningioma , Radiocirugia , Neuralgia del Trigémino , Humanos , Persona de Mediana Edad , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/complicaciones , Meningioma/cirugía , Meningioma/radioterapia , Meningioma/complicaciones , Microcirugia/métodos , Radiocirugia/métodos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/etiologíaRESUMEN
PURPOSE: Meningeal solitary fibrous tumour (SFT) and haemangiopericytoma (HPC) are uncommon tumours that have been merged into a single entity in the last 2021 WHO Classification of Tumors of the Central Nervous System. To describe the epidemiology of SFT/HPC operated in France and, to assess their incidence. METHODS: We processed the French Brain Tumour Database (FBTDB) to conduct a nationwide population-based study of all histopathologically confirmed SFT/HPC between 2006 and 2015. RESULTS: Our study included 399 SFT/HPC patients, operated in France between 2006 and 2015, in one of the 46 participating neurosurgical centres. The incidence reached 0.062, 95%CI[0.056-0.068] for 100,000 person-years. SFT accounted for 35.8% and, HPC for 64.2%. The ratio of SFT/HPC over meningioma operated during the same period was 0.013. SFT/HPC are about equally distributed in women and men (55.9% vs. 44.1%). For the whole population, mean age at surgery was 53.9 (SD ± 15.8) years. The incidence of SFT/HPC surgery increases with the age and, is maximal for the 50-55 years category. Benign SFT/HPC accounted for 65.16%, SFT/HPC of uncertain behaviour for 11.53% and malignant ones for 23.31%. The number of resection progresses as the histopathological behaviour became more aggressive. 6.7% of the patients with a benign SFT/HPC had a second surgery vs.16.6% in case of uncertain behaviour and, 28.4% for malignant SFT/HPC patients. CONCLUSION: Meningeal SFT and HPC are rare CNS mesenchymal tumours which both share common epidemiological characteristics, asserting their merging under a common entity. SFT/HPC incidence is less that one case for 1 billion per year and, for around 100 meningiomas-like tumours removed, one SFT/HPC may be diagnosed. SFT/HPC are equally distributed in women and men and, are mainly diagnosed around 50-55 years. The more aggressive the tumour, the higher the probability of recurrence.
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Hemangiopericitoma , Neoplasias Meníngeas , Tumores Fibrosos Solitarios , Humanos , Francia/epidemiología , Hemangiopericitoma/epidemiología , Hemangiopericitoma/patología , Hemangiopericitoma/cirugía , Hemangiopericitoma/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Neoplasias Meníngeas/epidemiología , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico , Tumores Fibrosos Solitarios/epidemiología , Tumores Fibrosos Solitarios/patología , Tumores Fibrosos Solitarios/cirugía , Tumores Fibrosos Solitarios/diagnóstico , Adulto , Anciano , Incidencia , Adulto Joven , Meningioma/epidemiología , Meningioma/patología , Meningioma/cirugía , Meningioma/diagnóstico , Adolescente , Anciano de 80 o más Años , NiñoRESUMEN
BACKGROUND: A primary pulmonary meningioma is an extremely rare entity. Primary pulmonary meningiomas manifested with a ground glass nodule are a very rare occurrence in clinical practice. CASE PRESENTATION: In this study, we report a case of a primary pulmonary meningioma with atypical computed tomography features. A 59-year-old Han Chinese female came to our hospital for treatment and reported that her physical examination revealed a ground glass nodule in the right lung for over 3 months. The histologic result revealed a primary pulmonary meningioma. The patient underwent a thoracoscopic lung wedge resection of the right upper lobe for a ground glass nodule. After 1 year of follow-up, the patient is still alive without evidence of metastasis or recurrence. CONCLUSIONS: Primary pulmonary meningiomas could have a variety of radiological findings. As there are no specific radiologic features for the diagnosis of primary pulmonary meningiomas, complete resection of the lesion is required for both diagnosis and treatment. It is necessary to note the imaging features of primary pulmonary meningiomas, presenting as a ground glass nodule; this rare tumor should be considered in differential diagnoses.
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Neoplasias Pulmonares , Meningioma , Tomografía Computarizada por Rayos X , Humanos , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Meningioma/patología , Meningioma/diagnóstico , Femenino , Persona de Mediana Edad , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico , Diagnóstico Diferencial , Nódulo Pulmonar Solitario/cirugía , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/patología , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/diagnóstico , Resultado del TratamientoRESUMEN
BACKGROUND AND IMPORTANCE: Spheno-orbital meningiomas (SOMs) pose a challenge to the skull base neurosurgeon because of their variable presentation and involvement of critical structures within the orbit. There is no consensus on optimal management of these patients and how to achieve maximal safe resection. The authors share an illustrative case with an accompanying video to demonstrate their aggressive approach to resect SOMs and their intraorbital components. CLINICAL PRESENTATION: A 75-year-old-woman presented with progressive vision loss and proptosis. Magnetic resonance imaging was consistent with a large, left-sided sphenoid wing meningioma with extension to the orbital wall and compression of the optic nerve medially. The patient elected to undergo surgical excision and optic nerve decompression. She did well postoperatively with resolution of proptosis and good resection margins on follow-up imaging. CONCLUSION: Aggressive resection of SOMs is possible with an understanding of the underlying anatomy. Familiarity with the orbit can facilitate a maximal safe resection with optic nerve decompression.
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Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Neoplasias Orbitales , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Femenino , Anciano , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Descompresión Quirúrgica/métodos , Órbita/cirugía , Órbita/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
This study reviews recent progress in the surgical treatment of Rathke's cleft cysts (RCCs) and Sellar region meningiomas, based on findings from three key studies. RCCs are benign, fluid-filled remnants from pituitary gland development that are usually asymptomatic and found by chance. However, surgical intervention is needed when they become symptomatic or increase in size. Research by Stefan Linsler et al. and others examines various surgical methods, including transcranial keyhole and transsphenoidal techniques for RCCs, and endoscopic endonasal and supraorbital keyhole approaches for Sellar meningiomas. The results show that both transcranial keyhole and transsphenoidal surgeries for RCCs have high success rates with no recurrences over 5.7 years, although the keyhole approach has fewer complications. For Sellar meningiomas, the choice between endoscopic endonasal and supraorbital keyhole techniques should be based on tumor characteristics, highlighting the importance of surgeon proficiency in both methods. These studies emphasize the need for personalized treatment strategies tailored to patient and tumor characteristics and highlight the importance of ongoing surgical skill development and further research to refine minimally invasive techniques. This study highlights the crucial role of personalized surgical approaches in improving outcomes for patients with RCCs and Sellar region meningiomas.
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Quistes del Sistema Nervioso Central , Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Silla Turca , Humanos , Meningioma/cirugía , Quistes del Sistema Nervioso Central/cirugía , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Meníngeas/cirugía , Silla Turca/cirugía , Neoplasias Hipofisarias/cirugía , Resultado del Tratamiento , Neuroendoscopía/métodosRESUMEN
BACKGROUND: Spinal intradural tumors are rare and heterogeneous in histological type, aggressiveness, and symptomatology, and there is a lack of data about them. This study investigated the epidemiological features of spinal intradural tumors. METHODS: This retrospective analysis included patients with spinal intradural tumors who underwent surgical treatment at the Myelopathy and Spondylosis Ward Beijing Jishuitan Hospital between January 2012 and December 2022. RESULTS: This study included 1321 patients [aged 47.19 ± 14.90 years, 603 (45.65%) males] with spinal intradural tumors. The most common histological subtype was schwannoma [n = 511 (38.68%)], followed by spinal meningioma [n = 184 (13.93%)] and ependymoma [n = 101 (7.65%)]. Fifteen (1.14%) patients were diagnosed with metastatic spinal intradural tumors as a presentation of another primary cancer type. The spinal intradural tumors were mostly found in the lumbar region [n = 436 (33.01%)], followed by the thoracic vertebrae [n = 390 (29.52%)], cervical vertebrae [n = 154 (11.66%)], and thoracolumbar region [n = 111 (8.40%)]. Schwannomas mostly affected the lumbar region [n = 256 (52.64%)], spinal meningiomas in the thoracic region [n = 153 (83.15)], and ependymomas in the lumbar region [56 (55.45%)]. The de novo metastases were mostly found in the lumbar region [n = 8 (53.33%)]. CONCLUSION: According to the results of our single-center study, the most common spinal intradural tumor in Northern China is schwannoma, followed by spinal meningioma and ependymoma.
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Ependimoma , Meningioma , Neurilemoma , Neoplasias de la Médula Espinal , Humanos , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Adulto , Neoplasias de la Médula Espinal/epidemiología , Neoplasias de la Médula Espinal/cirugía , Ependimoma/epidemiología , Ependimoma/cirugía , Ependimoma/patología , Anciano , Meningioma/epidemiología , Meningioma/cirugía , Meningioma/patología , Beijing/epidemiología , Neurilemoma/epidemiología , Neurilemoma/cirugía , Neurilemoma/patología , Adulto Joven , Vértebras Cervicales/cirugía , Vértebras Cervicales/patología , Neoplasias Meníngeas/epidemiología , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/patología , Adolescente , Anciano de 80 o más Años , Vértebras Torácicas/cirugía , Vértebras Torácicas/patologíaRESUMEN
OBJECTIVE: This study compared the effectiveness of the endoscopic endonasal approach (EEA) with the conventional transcranial approach (TCA) for treating tuberculum sellae meningiomas (TSMs), aiming to identify the superior surgical method and the risk factors affecting outcomes. METHODS: Patients treated for TSM from 1998 to 2023 at our institution were retrospectively analyzed, evaluating patient characteristics, tumor features, outcomes, and complications. A novel grading system for preoperative evaluation of TSMs was proposed. RESULTS: Among 49 patients, 26 underwent EEA and 23 underwent TCA. The maximum diameters were comparable between the groups (mean 22 mm vs. 23 mm). Gross total resection rates were 62% for EEA and 70% for TCA, showing no significant difference. However, postsurgical visual improvement was significantly higher in the EEA group compared with the TCA group (77% vs. 44%; P = 0.020), with fewer complications in the EEA group (8% vs. 35%; P = 0.032). CONCLUSIONS: EEA is a safe and effective treatment approach for small to medium TSMs, with outcomes comparable to TCA in terms of resection but superior in visual improvement and fewer complications. Selection of surgical approach should consider patient and tumor characteristics as well as surgeon experience.
Asunto(s)
Neoplasias Meníngeas , Meningioma , Neuroendoscopía , Complicaciones Posoperatorias , Humanos , Meningioma/cirugía , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Meníngeas/cirugía , Anciano , Neuroendoscopía/métodos , Adulto , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Silla Turca/cirugía , Cirugía Endoscópica por Orificios Naturales/métodos , Cavidad Nasal/cirugía , Procedimientos Neuroquirúrgicos/métodosRESUMEN
BACKGROUND: Meningiomas involving the dural venous sinuses present unique therapeutic challenges. While gross total resection remains the mainstay of treatment for meningiomas, involvement of critical vascular structures may limit extent of resection and increase the risk of recurrence. Optimal management of meningiomas with venous sinus involvement has been discussed in the literature, with some advocating for subtotal resection with postoperative surveillance and radiation, if necessary, while others recommend total resection with reconstruction of resection of the involved sinus. METHODS: We performed a review of our series of 70 patients at a single institution who underwent resection of a meningioma involving the dural venous sinuses with reconstruction as needed, evaluating demographics, preoperative assessment of venous anatomy, surgical technique, and outcomes. RESULTS: In our series, we found successful maximal safe resection was achievable in patients with dural venous sinus involvement. We identified no venous infarctions and a low rate of recurrence. CONCLUSIONS: Maximal safe resection, including resection and reconstruction of involved sinuses, may be a safe and effective treatment for many patients. Careful preoperative assessment of venous anatomy and planning extent of resection and reconstruction are essential for safe and successful surgery in these patients.
Asunto(s)
Senos Craneales , Neoplasias Meníngeas , Meningioma , Microcirugia , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Femenino , Senos Craneales/cirugía , Masculino , Persona de Mediana Edad , Microcirugia/métodos , Anciano , Adulto , Resultado del Tratamiento , Procedimientos Neuroquirúrgicos/métodos , Estudios Retrospectivos , Anciano de 80 o más AñosRESUMEN
OBJECTIVE: The rhomboid lip is a neural tissue encountered during cerebellopontine angle surgery, with differing shape and extent among individuals. This study aimed to investigate the variation of rhomboid lips during posterior fossa surgery. METHODS: In this retrospective study, we examined posterior cranial fossa surgeries performed using a retrosigmoid approach. Rhomboid lips were classified according to thickness, extent, and appearance, with some subjected to histological analysis. T2-weighted magnetic resonance imaging of rhomboid lips was conducted. RESULTS: Among 304 surgeries, rhomboid lips were observed in 75 patients who underwent schwannoma or meningioma resection, facial spasm-related neurovascular decompression, and other surgeries (37, 2, 32, and 4 patients, respectively). Rhomboid lips were categorized based on apparent thickness: thin membranous type, resembling an arachnoid membrane, and thick parenchymal type. Rhomboid lip extension was classified by position relative to the choroid plexus: nonextension, lateral extension, and jugular foramen (41, 22, and 12 patients, respectively). Veins were observed on the rhomboid lip surface in 37 cases. The rhomboid lip was visible in only 1 case (parenchymal jugular foramen type) on magnetic resonance imaging. Histologically, the rhomboid lip comprised an ependymal cell layer, a glial layer, and connecting tissue. The glial layer thickness determined the rhomboid lip thickness, which was greater in the parenchymal type than in the membrane type. In 42 patients, the rhomboid lip was dissected with no complications observed. CONCLUSIONS: Morphological classification of the rhomboid lip and understanding of its anatomical details contribute to safe surgical field development for neurosurgeons.