RESUMEN
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.
Asunto(s)
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
OBJECTIVES: Cerebellopontine angle (CPA) tumors are a common cause of secondary trigeminal neuralgia (TN), characterized by their concealed location, slow progression, and difficulty in early detection. This study aims to explore the clinicopathological characteristics of patients with secondary TN due to CPA tumors to enhance understanding and management of secondary TN. METHODS: A retrospective analysis was conducted on clinical data and pathological results of 116 patients with CPA tumor-related TN treated at Xiangya Hospital of Central South University from January 1, 2017 to December 31, 2022. The study analyzed the relationship of tumor pathological types with clinical manifestations, tumor location, surgical methods, and treatment outcomes. RESULTS: Among the cases, 95.7% (111/116) were benign tumors, 3.4% (4/116) were malignant tumors, and 0.9% (1/116) were borderline tumors. Benign tumors were predominantly acoustic neuromas, meningiomas, and schwannomas. Among the patients, 46.6% (54/116) presented with isolated TN, while 53.4% (62/116) exhibited other associated symptoms depending on factors such as tumor growth location and rate. The complete resection rate in this group was over 90%, with 41.4% (48/116) of patients undergoing concurrent microvascular decompression after tumor resection, predominantly for schwannomas. The overall effective rate of surgical treatment reached 93.9%, with schwannomas showing higher efficacy rates compared with acoustic neuromas and meningiomas (P<0.05). The recurrence rate of acoustic neuromas was significantly higher than that of meningiomas and schwannomas (P<0.05). CONCLUSIONS: CPA tumors are a major cause of secondary TN, predominantly benign, with occasional underdiagnosed malignant tumors. Early diagnosis and treatment significantly impact prognosis. Different tumor types vary in clinical symptoms, surgical approaches, and treatment efficacy. Surgical strategies should balance tumor resection extent and neural function preservation, with microvascular decompression as necessary.
Asunto(s)
Neoplasias Cerebelosas , Ángulo Pontocerebeloso , Meningioma , Neuroma Acústico , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/cirugía , Estudios Retrospectivos , Ángulo Pontocerebeloso/patología , Neoplasias Cerebelosas/complicaciones , Neoplasias Cerebelosas/patología , Neoplasias Cerebelosas/cirugía , Meningioma/complicaciones , Meningioma/cirugía , Meningioma/patología , Neuroma Acústico/complicaciones , Neuroma Acústico/cirugía , Neuroma Acústico/patología , Neurilemoma/complicaciones , Neurilemoma/cirugía , Neurilemoma/patología , Femenino , Masculino , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Persona de Mediana Edad , Descompresión Quirúrgica/métodosRESUMEN
Central neurogenic hyperventilation (CNH) is a rare disease, caused by chemical or mechanical disturbance of respiratory centers. It is characterized by the absence of extracerebral respiratory stimuli. A woman developed severe respiratory alkalosis and lactatemia after resection of a posterior fossa meningioma despite lack of cardio-respiratory or metabolic alterations. Cerebral computed tomography (cCT) revealed edema of the pontomedullary area. Treatment with mannitol and dexamethasone reestablished normal breathing patterns. Lactatemia was likely due to reduced splanchnic lactate utilization. Intracranial pathologies should be suspected in case of hyperventilation without overt reasons. cCT to confirm edema or ischemia and prompt treatment is suggested.
Asunto(s)
Alcalosis Respiratoria , Neoplasias Meníngeas , Meningioma , Humanos , Femenino , Meningioma/cirugía , Meningioma/complicaciones , Alcalosis Respiratoria/etiología , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/complicaciones , Manitol/uso terapéutico , Manitol/administración & dosificación , Persona de Mediana Edad , Dexametasona/uso terapéutico , Dexametasona/administración & dosificación , Hiperlactatemia/etiología , Neoplasias Infratentoriales/cirugía , Neoplasias Infratentoriales/complicaciones , Tomografía Computarizada por Rayos X , Complicaciones Posoperatorias/etiologíaRESUMEN
Meningiomas are the most common intracranial tumors, predominantly affecting adults, with a higher incidence in female and elderly populations. Despite their prevalence, research on neurocognitive impairment in meningioma patients remains limited compared to intra-axial tumors such as gliomas. We conducted a comprehensive systematic review of the current literature on neurocognitive outcomes in meningioma patients pre- and post-surgery. Our review revealed significant disparities in reported neurocognitive outcomes, with prospective studies suggesting tumor-related factors as the primary contributors to postoperative deficits, while retrospective studies imply surgical intervention plays a significant role. Regardless of study design or specifics, most studies lack baseline preoperative neurocognitive assessments and standardized protocols for evaluating neurocognitive function. To address these gaps, we advocate for standardized neurocognitive assessment protocols, consensus on neurocognitive domains to be targeted in this population by tailored test batteries, and more prospective studies to elucidate correlations between tumor characteristics, patient attributes, surgical interventions, neurocognitive status, and planning for implementing tailored neurocognitive rehabilitation strategies early in the postoperative course which is crucial for achieving optimal long-term neurocognitive outcomes and enhancing patients' quality of life.
Asunto(s)
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirugía , Meningioma/complicaciones , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/psicología , Calidad de Vida , Disfunción Cognitiva/etiología , Pruebas Neuropsicológicas , Trastornos Neurocognitivos/etiología , Procedimientos Neuroquirúrgicos/métodosRESUMEN
BACKGROUND: Patients with spinal meningioma may present preoperatively with paralysis and sensory deficits. However, there is a paucity of detailed evaluations and a lack of consensus regarding imaging findings that are predictive of neurological symptoms in patients with spinal meningioma. METHODS: Herein, a total of 55 patients who underwent surgical resection of spinal meningiomas in eight hospitals between 2011 and 2021 were enrolled. Patient characteristics, degree of muscle weakness, sensory disturbances, and the presence of bowel/bladder dysfunction (BBD) before surgical treatment were evaluated using medical records. Patients with American Spinal Injury Impairment Scale grades A-C and the presence of BBD were classified into the paralysis (+) group. Patients with sensory disturbances were assigned to the sensory disturbance (+) group. Based on magnetic resonance (MR) and computed tomography images, the tumor location was classified according to the spinal level and its attachment to the dura mater. To evaluate tumor size, the tumor occupation ratio (OR) was calculated using the area and distance measurement method in horizontal MR images, and the maximum length and area of the tumor in the sagittal plane were measured. RESULTS: Of all patients, 85 % were women. The mean age of patients at surgery was 69.7 years. Twenty-eight (51 %) and 41 (75 %) patients were classified into the paralysis (+) and sensory disturbance (+) groups, respectively. The average tumor length and area in the sagittal plane were 19.6 mm and 203 mm2, respectively; OR-area and diameters were 70.3 % and 72.3 %, respectively. In univariate analyses, tumor length and area in the sagittal plane were significant risk factors for paralysis. OR-diameter, symptom duration, and a low MIB-1 index correlated with sensory disturbances. Multivariate logistic regression analysis demonstrated that the area and length of the tumor in the sagittal plane were significantly correlated with paralysis, whereas the OR-diameter and symptom duration significantly correlated with sensory disturbances. The cut-off values for the area and length of the tumor in the sagittal plane to predict paralysis were 243 mm2 and 20.1 mm, respectively. CONCLUSIONS: Preoperative paralysis in patients with spinal meningiomas was significantly associated with sagittal tumor size than with high tumor occupancy in the horizontal plane. Sensory disturbances were associated with high occupancy in the horizontal plane. Patients with spinal meningiomas > 20 mm in length or 243 mm2 in area in the sagittal plane are at risk of developing paralysis and could be considered for surgery even in the absence of paralysis.
Asunto(s)
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Meningioma/complicaciones , Femenino , Masculino , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Factores de Riesgo , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/complicaciones , Imagen por Resonancia Magnética , Anciano de 80 o más Años , Adulto , Parálisis/etiología , Trastornos de la Sensación/etiologíaRESUMEN
Acromegaly is a rare endocrine disorder caused by hypersecretion of growth hormone (GH) from a pituitary adenoma. Elevated GH levels stimulate excess production of insulin-like growth factor 1 (IGF-1) which leads to the insidious onset of clinical manifestations. The most common primary central nervous system (CNS) tumors, meningiomas originate from the arachnoid layer of the meninges and are typically benign and slow-growing. Meningiomas are over twice as common in women as in men, with age-adjusted incidence (per 100,000 individuals) of 10.66 and 4.75, respectively. Several reports describe co-occurrence of meningiomas and acromegaly. We aimed to determine whether patients with acromegaly are at elevated risk for meningioma. Investigation of the literature showed that co-occurrence of a pituitary adenoma and a meningioma is a rare phenomenon, and the majority of cases involve GH-secreting adenomas. To the best of our knowledge, a systematic review examining the association between meningiomas and elevated GH levels (due to GH-secreting adenomas in acromegaly or exposure to exogenous GH) has never been conducted. The nature of the observed coexistence between acromegaly and meningioma -whether it reflects causation or mere co-association -is unclear, as is the pathophysiologic etiology. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022376998.
Asunto(s)
Acromegalia , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/complicaciones , Meningioma/etiología , Meningioma/patología , Meningioma/epidemiología , Acromegalia/complicaciones , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/epidemiología , Neoplasias Meníngeas/patología , Hormona de Crecimiento Humana/metabolismo , Hormona de Crecimiento Humana/sangre , Factores de Riesgo , Adenoma/complicaciones , Adenoma/metabolismo , Adenoma/patología , Adenoma/epidemiologíaAsunto(s)
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirugía , Meningioma/patología , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/complicaciones , Femenino , Persona de Mediana Edad , Masculino , Lóbulo Frontal/diagnóstico por imagenRESUMEN
We describe a rare occurrence of bilateral acute severe sensorineural hearing loss in a middle-aged man that heralded the diagnosis of metastatic gastric cancer.
Asunto(s)
Pérdida Auditiva Sensorineural , Neoplasias Meníngeas , Humanos , Pérdida Auditiva Sensorineural/etiología , Masculino , Persona de Mediana Edad , Neoplasias Meníngeas/secundario , Neoplasias Meníngeas/complicaciones , Neoplasias Gástricas/secundario , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Pérdida Auditiva Bilateral/etiologíaRESUMEN
OBJECTIVE: This study aimed to identify factors affecting proptosis recovery in spheno-orbital meningioma (SOM) surgery and assess functional and oncological outcomes. METHODS: Data from 32 consecutive SOM surgery cases (2002-2021) were analyzed. Clinical, radiological, operative, and oncological parameters were examined. Proptosis was assessed using the exophthalmos index (EI) on MRI or CT scans. Statistical analyses were performed to identify predictive factors for proptosis recovery. RESULTS: Proptosis improved in 75% of patients post-surgery (EI decreased from 1.28 ± 0.16 to 1.20 ± 0.13, p = 0.048). Patients with stable or worsened EI had higher body mass index (28.5 ± 7.9 vs. 24.1 ± 4.7, p = 0.18), Simpson grade (IV 75% vs. 65%, p = 0.24), and middle sphenoid wing epicenter involvement (63% vs. 38%, p = 0.12), but no significant factors were associated with unfavorable exophthalmos outcomes. The improvement group had higher en plaque morphology, infratemporal fossa invasion, and radiation treatment for cavernous sinus residual tumor (88% vs. 75%, p = 0.25; 51% vs. 25%, p = 0.42; 41% vs. 25%, p = 0.42, respectively), but without statistical significance. Visual acuity remained stable in 78%, improved in 13%, and worsened in 9% during follow-up. Surgery had a positive impact on preoperative oculomotor nerve dysfunction in 3 of 4 patients (75%). Postoperative oculomotor nerve dysfunction was observed in 25%, of which 75% fully recovered. This occurrence was significantly associated with irradiation of an orbital tumor residue (p = 0.04). New postoperative trigeminal hypoesthesia was observed in 47%, of which 73% recovered. All SOMs were classified as WHO grade 1, and complementary treatments achieved oncological control, requiring gamma-knife radiosurgery in 53% and standard radiotherapy in 6%. CONCLUSIONS: Surgery effectively improves proptosis in SOM, though complete resolution is rare. The absence of predictive factors suggests multifactorial causes, including body mass index and tumor resection grade. Postoperative oculomotor nerve dysfunction and trigeminal hypoesthesia are common but often recover. Gamma-knife radiosurgery maintains long-term oncological control for evolving tumor residue.
Asunto(s)
Exoftalmia , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/complicaciones , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Hipoestesia , Exoftalmia/etiología , Exoftalmia/cirugía , Índice de Masa Corporal , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugíaRESUMEN
OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of transorbital neuroendoscopic surgery (TONES) in the management of sphenoid wing meningiomas (SWMs) with cavernous sinus and orbital invasion. METHODS: The authors conducted a retrospective review of 32 patients with SWMs treated at Gazi University using TONES from October 2019 to May 2023. The study includes clinical applications to elucidate the endoscopic transorbital approach. Surgical techniques focused on safe subtotal resection, aiming to minimize residual tumor volume for subsequent radiosurgery. Data were collected on patient demographics, tumor characteristics, surgical procedures, complications, and postoperative outcomes, including radiological imaging and ophthalmological evaluations. RESULTS: Surgical dissections delineated a three-phase endoscopic transorbital approach: extraorbital, intraorbital, and intracranial. In the clinical application, gross-total resection was not achieved in any patient because of planned postoperative Gamma Knife radiosurgery. The mean follow-up period was 16.3 months. Of 30 patients with preoperative proptosis, 25 experienced postoperative improvement. No new-onset extraocular muscle paresis or visual loss occurred postoperatively. The average hospital stay was 1.15 days, with minimal complications and no significant morbidity or mortality. CONCLUSIONS: Total resection of SWMs invading the cavernous sinus and orbit is associated with substantial risks, particularly cranial nerve deficits. TONES offers a minimally invasive alternative, reducing morbidity compared with transcranial approaches, and represents a significant advancement in the surgical management of SWMs, especially those extending into the cavernous sinus and orbit. The approach provides a safe, effective, and patient-centric approach, prioritizing subtotal resection to minimize neurological deficits while preparing patients for adjunctive radiosurgery. This study positions TONES as a transformative surgical technique, aligning therapeutic efficacy with neurovascular preservation and postoperative recovery.
Asunto(s)
Seno Cavernoso , Neoplasias Meníngeas , Meningioma , Neuroendoscopía , Humanos , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Meningioma/complicaciones , Seno Cavernoso/diagnóstico por imagen , Seno Cavernoso/cirugía , Seno Cavernoso/patología , Resultado del Tratamiento , Neuroendoscopía/métodos , Estudios Retrospectivos , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/complicacionesRESUMEN
BACKGROUND: Patients with intracranial meningiomas frequently suffer from tumor-related seizures prior to resection, impacting patients' quality of life. We aimed to elaborate on incidence and predictors for seizures in a patient cohort with meningiomas WHO grade 2 and 3. METHODS: We retrospectively searched for patients with meningioma WHO grade 2 and 3 according to the 2021 WHO classification undergoing tumor resection. Clinical, histopathological and imaging findings were collected and correlated with preoperative seizure development. Tumor and edema volumes were quantified. RESULTS: Ninety-five patients with a mean age of 59.5 ± 16.0 years were included. Most tumors (86/95, 90.5%) were classified as atypical meningioma WHO grade 2. Nine of 95 tumors (9.5%) corresponded to anaplastic meningiomas WHO grade 3, including six patients harboring TERT promoter mutations. Meningiomas were most frequently located at the convexity in 38/95 patients (40.0%). Twenty-eight of 95 patients (29.5%) experienced preoperative seizures. Peritumoral edema was detected in 62/95 patients (65.3%) with a median volume of 9 cm3 (IR: 0-54 cm3). Presence of peritumoral edema but not age, tumor localization, TERT promoter mutation, brain invasion or WHO grading was associated with incidence of preoperative seizures, as confirmed in multivariate analysis (OR: 6.61, 95% CI: 1.18, 58.12, p = *0.049). Postoperative freedom of seizures was achieved in 91/95 patients (95.8%). CONCLUSIONS: Preoperative seizures were frequently encountered in about every third patient with meningioma WHO grade 2 or 3. Patients presenting with peritumoral edema on preoperative imaging are at particular risk for developing tumor-related seizures. Tumor resection was highly effective in achieving seizure freedom.
Asunto(s)
Edema Encefálico , Neoplasias Meníngeas , Meningioma , Humanos , Adulto , Persona de Mediana Edad , Anciano , Meningioma/complicaciones , Meningioma/cirugía , Meningioma/patología , Estudios Retrospectivos , Calidad de Vida , Convulsiones/etiología , Convulsiones/epidemiología , Factores de Riesgo , Edema , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/patología , Organización Mundial de la Salud , Edema Encefálico/etiología , Edema Encefálico/cirugíaRESUMEN
INTRODUCTION: To study the rare and unusual causes of monocular elevation deficit. METHODS: Five patients presenting to us with diplopia and elevation deficit were thoroughly examined and were found to have monocular elevation deficit due to rare causes. OBSERVATIONS: All five were found to have different underlying etiologies - iatrogenic, sphenoid wing meningioma, cysticercosis, sarcoidosis and mid brain infarct, and were managed appropriately. DISCUSSION: Monocular Elevation Deficit can occur due to a variety of causes. Having a high index of suspicion for the more serious etiologies is of utmost importance. Thorough clinical examination and imaging help clinch the diagnosis.
Asunto(s)
Diplopía , Meningioma , Humanos , Femenino , Meningioma/complicaciones , Masculino , Persona de Mediana Edad , Diplopía/etiología , Diplopía/fisiopatología , Diplopía/diagnóstico , Adulto , Neoplasias Meníngeas/complicaciones , Sarcoidosis/complicaciones , Sarcoidosis/diagnóstico , Sarcoidosis/fisiopatología , Cisticercosis/complicaciones , Cisticercosis/diagnóstico , Cisticercosis/fisiopatología , Enfermedad Iatrogénica , Infarto Encefálico/complicaciones , Infarto Encefálico/diagnóstico por imagen , Infarto Encefálico/fisiopatología , Anciano , Músculos Oculomotores/fisiopatología , Trastornos de la Motilidad Ocular/fisiopatología , Trastornos de la Motilidad Ocular/etiología , Trastornos de la Motilidad Ocular/diagnóstico , Imagen por Resonancia Magnética , Visión Monocular/fisiología , Hueso EsfenoidesRESUMEN
NF2-related schwannomatosis (NF2) is a rare autosomal-dominant genetic disorder characterized by bilateral vestibular schwannomas and multiple meningiomas. This case report presents the extremely rare occurrence of an anaplastic meningioma in a 12-year-old male with previously undiagnosed NF2. The patient presented with a history of abdominal pain and episodic emesis, gait unsteadiness, right upper and lower extremity weakness, and facial weakness. He had sensorineural hearing loss and wore bilateral hearing aids. MR imaging revealed a sizable left frontoparietal, dural-based meningioma with heterogeneous enhancement with mass effect on the brain and midline shift. Multiple additional CNS lesions were noted including a homogenous lesion at the level of T5 indicative of compression of the spinal cord. The patient underwent a frontotemporoparietal craniotomy for the removal of his large dural-based meningioma, utilizing neuronavigation and transdural ultrasonography for precise en bloc resection of the mass. Histopathology revealed an anaplastic meningioma, WHO grade 3, characterized by brisk mitotic activity, small-cell changes, high Ki-67 proliferation rate, and significant loss of P16. We report an anaplastic meningioma associated with an underlying diagnosis of NF2 for which we describe clinical and histopathological features.
Asunto(s)
Neoplasias Meníngeas , Meningioma , Neurofibromatosis , Humanos , Masculino , Meningioma/cirugía , Meningioma/complicaciones , Meningioma/diagnóstico por imagen , Meningioma/patología , Niño , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Neurofibromatosis/complicaciones , Neurofibromatosis/cirugía , Neurofibromatosis/diagnóstico por imagen , Neurofibromatosis 2/complicaciones , Neurofibromatosis 2/cirugía , Neurofibromatosis 2/diagnóstico por imagen , Neurilemoma/cirugía , Neurilemoma/complicaciones , Neurilemoma/diagnóstico por imagen , Neurilemoma/patología , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/complicaciones , Imagen por Resonancia MagnéticaRESUMEN
ABSTRACT: A 67-year-old woman complained of rest and postural tremors in her left upper extremity, associated with bradykinesia and gait disorder since 2 years ago, with no significant response to antiparkinsonism drugs. Dopamine transporter SPECT/CT revealed a remarkable area of 99m Tc-TRODAT-1 uptake in a huge tumoral lesion in the right frontotemporal region, compressing and dislocating the right striatum with evidence of significant midline shift. The patient underwent surgical resection with a diagnosis of meningioma on preoperative MRI and postoperative histology report, experiencing a marked recovery in symptoms after 1 month.
Asunto(s)
Meningioma , Compuestos de Organotecnecio , Trastornos Parkinsonianos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Tropanos , Humanos , Femenino , Anciano , Meningioma/diagnóstico por imagen , Meningioma/complicaciones , Trastornos Parkinsonianos/diagnóstico por imagen , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/complicaciones , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
OBJECTIVE: Petroclival meningiomas invade Meckel's cave through the porus trigeminus, leading to secondary trigeminal neuralgia. Microsurgery and stereotactic radiosurgery (SRS) are the typical treatment options. This study investigated symptom control, outcomes, and surgical strategies for PC meningioma-induced TN. METHODS: We retrospectively analyzed 28 TN patients with PC meningiomas who underwent microsurgical nerve decompression between January 2021 and February 2023. In all patients undergoing a transpetrosal approach, the porus trigeminus was opened to enable the removal of the entire tumor within Meckel's cave. Clinical outcomes were assessed using the Barrow Neurologic Institute (BNI) pain intensity scale. Risk factors for poor TN outcomes and poor facial numbness were analyzed. RESULTS: Among 28 patients, 21 (75%) underwent the transpetrosal approach, 5 (17.9%) underwent the retrosigmoid approach, and 2 (7.1%) underwent the Dolenc approach. Following microsurgery, 23 patients (82.1%) experienced TN relief without further medication (BNI I or II). TN recurrence occurred in 2 patients (7.1%), and 3 patients (10.7%) did not achieve TN relief. Cavernous sinus invasion was significantly correlated with poor TN outcomes (P = 0.047). A history of previous SRS (P = 0.011) and upper clivus type tumor (P = 0.018) were significantly associated with poor facial numbness. CONCLUSIONS: Microsurgical nerve decompression is effective in improving BNI scores in patients with TN associated with PC meningiomas. Considering the results of our study, the opening of the porus trigeminus can be considered as a suggested procedure in the treatment of PC meningiomas, especially in cases accompanied by TN.
Asunto(s)
Neoplasias Meníngeas , Meningioma , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/etiología , Meningioma/cirugía , Meningioma/complicaciones , Femenino , Masculino , Persona de Mediana Edad , Anciano , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/complicaciones , Estudios Retrospectivos , Adulto , Nervio Trigémino/cirugía , Microcirugia/métodos , Neoplasias de la Base del Cráneo/cirugía , Neoplasias de la Base del Cráneo/complicaciones , Procedimientos Neuroquirúrgicos/métodos , Radiocirugia/métodos , Descompresión Quirúrgica/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: Tuberculum sellae meningiomas (TSMs) usually compress the optic nerve and optic chiasma, thus affecting vision. Surgery is an effective means to remove tumors and improve visual outcomes. On a larger scale, this study attempted to further explore and confirm the factors related to postoperative visual outcomes to guide the treatment of TSMs. METHODS: Data were obtained from 208 patients with TSMs who underwent surgery at our institution between January 2010 and August 2022. Demographics, ophthalmologic examination results, imaging data, extent of resection, radiotherapy status, and surgical approaches were included in the analysis. Univariate and multivariate logistic regressions were used to assess the factors that could lead to favorable visual outcomes. RESULTS: The median follow-up duration was 63 months, and gross total resection (GTR) was achieved in 174 (83.7%) patients. According to our multivariate logistic regression analysis, age < 60 years (odds ratio [OR] = 0.310; P = 0.007), duration of preoperative visual symptoms (DPVS) < 10 months (OR = 0.495; P = 0.039), tumor size ≤ 27 mm (OR = 0.337; P = 0.002), GTR (OR = 3.834; P = 0.006), and a tumor vertical-to-horizontal dimensional ratio < 1 (OR = 2.593; P = 0.006) were found to be significant independent predictors of favorable visual outcomes. CONCLUSION: Age, DPVS, tumor size, GTR, and the tumor vertical-to-horizontal dimensional ratio were found to be powerful predictors of favorable visual outcomes. This study may help guide decisions regarding the treatment of TSMs.
Asunto(s)
Neoplasias Meníngeas , Meningioma , Neoplasias de la Base del Cráneo , Humanos , Persona de Mediana Edad , Meningioma/complicaciones , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Resultado del Tratamiento , Silla Turca/diagnóstico por imagen , Silla Turca/cirugía , Silla Turca/patología , Procedimientos Neuroquirúrgicos/métodos , Neoplasias de la Base del Cráneo/cirugía , Estudios RetrospectivosRESUMEN
INTRODUCTION: Symptomatic intracranial hypertension (IH) due to venous outflow obstruction secondary to dural venous sinus (DVS) tumoral invasion affects up to 3% of intracranial meningioma patients. The literature regarding endovascular therapies of such patients is limited to a few case reports and a recent single-centre case series. PURPOSE: We describe our single-centre experience of endovascular therapy in patients with clinically symptomatic IH secondary to DVS meningioma invasion. METHODS: We performed a retrospective review of clinical and radiological data of all patients with refractory IH and meningiomas invading the DVS who were referred for possible DVS venoplasty and stenting. Seven endovascular procedures in six female patients were done. Presumed secondarily induced lateral transverse sinus stenosis was also stented in four patients as part of the primary intervention. RESULTS: All patients experienced complete symptomatic resolution at 6-month follow-up. Five patients had no symptom recurrence over a mean follow-up period of 3.5 years. One patient with multiple meningiomas developed recurrent IH 2 years following stenting secondary to in-stent tumour re-invasion. This was re-stented with consequent 6 months post-retreatment symptomatic relief at the time of writing. No procedure-related complications occurred. CONCLUSION: In the setting of DVS stenosis secondary to meningioma invasion, endovascular therapy is a safe and successful therapeutic option with promising mid-term results. The procedure should be considered in cases where complete surgical tumour resection is unlikely or carries a significant risk. If present, secondarily induced stenoses at the lateral ends of the transverse sinuses should also be considered for treatment.
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Hipertensión Intracraneal , Neoplasias Meníngeas , Meningioma , Seudotumor Cerebral , Humanos , Femenino , Meningioma/complicaciones , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Constricción Patológica/cirugía , Constricción Patológica/complicaciones , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Hipertensión Intracraneal/complicaciones , Stents/efectos adversos , Estudios Retrospectivos , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Resultado del Tratamiento , Seudotumor Cerebral/complicacionesRESUMEN
Objetivo: Analizar las complicaciones asociadas a la posición semisentada en pacientes intervenidos de patología del ángulo pontocerebeloso (APC).MétodosEstudio retrospectivo, se analizaron los pacientes operados de patología tumoral del APC por un abordaje retrosigmoideo en posición semisentada. Se analizó la incidencia, gravedad, momento de aparición, forma de resolución, duración y repercusiones del embolismo aéreo venoso (EAV), neumoencéfalo, hipotensión postural y otras complicaciones. Se analizó el tiempo de estancia en unidad de críticos (TUCRI), tiempo de estancia hospitalaria (TEH) y puntuación en escala de Rankin a los seis meses.ResultadosSe intervinieron 50 pacientes, once (22%) presentaron EAV (8 ± 4,5 minutos duración media): cinco (10%) durante la resección tumoral, cuatro (8%) durante la apertura dural. Diez (20%) se resolvieron tapando el lecho quirúrgico, aspirando burbujas y aplicando compresión de yugulares, uno (2%) requirió cambio de posición. Uno (2%) tuvo repercusión hemodinámica intraoperatoria. La única variable asociada con desarrollar EAV fue una anatomía patológica de meningioma OR = 4,58, p = 0,001. El TUCRI fue superior en pacientes con EAV (5,5 ± 1,06 vs. 1,9 ± 0,20 días, p = 0,01). No hubo diferencias en la escala Rankin. Todos presentaron neumoencéfalo posquirúrgico con buen nivel de consciencia, salvo uno (2%) que requirió de evacuación. Siete pacientes (14%) presentaron una hipotensión arterial, tres (6%) tras la colocación y uno (2%) tras un EAV, todos revertieron con vasoactivos. No se registraron otras complicaciones asociadas a la posición ni mortalidad en esta serie. (AU)
Objective: To analyze the primary complications related to semisitting position in patients undergoing cerebelo-pontine angle surgery.MethodsRetrospective data analysis from patients undergoing elective tumoral cerebelo-pontine angle surgery in a semisitting position. The incidence, severity, occurrence moment, treatment, duration, and outcomes of venous air embolism (VAE), pneumocephalus, postural hypotension, and other complications were recorded. Neurointensive care unit (NICU), length of stay (LOS), hospital LOS, and modified Rankin scale scores were calculated six months after surgery.ResultsFifty patients were operated on. Eleven (22%) presented VAE (mean duration 8 ± 4.5 min): five (10%) during tumor resection, and four (8%) during dural opening. Ten (20%) were resolved by covering the surgical bed, air bubbles aspiration, jugular compression, and one (2%) tilted to a steep Trendelenburg position. One (2%) had intraoperative hemodynamic instability. The only variable associated with VAE was meningioma at histopathology OR = 4.58, P = 0.001. NICU was higher in patients with VAE (5.5 ± 1.06 vs. 1.9 ± 0.20 days, P = 0.01). There were no differences in the Rankin scale. All patients presented postoperative pneumocephalus with a good level of consciousness, except one (2%) who required evacuation. Seven patients (14%) showed postural hypotension, three (6%) after positioning, and one (2%) after developing a VAE; all were reversed with usual vasoactive drugs. No other position-related complications or mortality were registered in this series. (AU)
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Humanos , Embolia Aérea/diagnóstico , Embolia Aérea/etiología , Embolia Aérea/prevención & control , Hipotensión Ortostática/complicaciones , Hipotensión Ortostática/cirugía , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Spinal meningiomas coexisting with schwannomas in patients without neurofibromatosis are extremely rare lesions. There were only 15 cases reported to date, which were concurrent intradural tumors of different pathological types. CASE PRESENTATION: Herein, we present a rare case of a 15-year-old child with concurrent spinal dorsal meningioma and ventral giant invasive schwannoma at C7-T3 and T10-S5 spinal levels. Preoperative magnetic resonance imaging and computed tomography indicated the schwannoma across the thoracic and lumbosacral transitional vertebra, with extensive bony erosion of the sacrum. The results of surgical resection were mostly satisfactory. CONCLUSIONS: The present case is the youngest patient diagnosed with concurrent intradural tumors at different spinal levels. The pathogenetic mechanism remains unclear. The clinical presentations are always atypical. Surgical resection of the tumors is the first choice. We use the non-fusion surgery to preserve the function of the lumbar spine.
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Neoplasias Meníngeas , Meningioma , Neurilemoma , Neurofibromatosis , Neoplasias de la Columna Vertebral , Adolescente , Humanos , Neoplasias Meníngeas/complicaciones , Meningioma/cirugía , Neurilemoma/patología , Neurofibromatosis/complicaciones , Neoplasias de la Columna Vertebral/cirugíaRESUMEN
OBJECTIVE: CD44 is a major cell surface receptor involved in cell adhesion and migration. The overexpression of CD44 is a poor prognostic factor in many neoplasms, including meningiomas. The aim of this study was to investigate the association between CD44 gene expression and clinical signatures of primary meningiomas. METHODS: CD44 gene expression was quantitatively evaluated by snap freezing tumor tissues obtained from 106 patients with primary meningioma. The relationships between CD44 expression and clinical signatures of meningiomas, including histological malignancy, tumor volume, and peritumoral brain edema (PTBE), were analyzed. PTBE was assessed using the Steinhoff classification (SC) system (from SC 0 to SC III). RESULTS: CD44 gene expression in WHO grade 2 and 3 meningiomas was significantly higher than that in grade 1 meningiomas. In addition, CD44 expression increased with the severity of PTBE. Particularly, among the grade 1 meningiomas or small-sized tumors (maximum tumor diameter < 43 mm), CD44 expression in tumors with severe PTBE (SC II or III) was significantly higher than that in tumors without or with mild PTBE (SC 0 or I). Multivariate logistic regression analysis also revealed that overexpression of CD44 was an independent significant factor of severe PTBE development in primary meningiomas. CONCLUSIONS: In addition to tumor cell aggressiveness, CD44 expression promotes the development of PTBE in meningioma. Since PTBE is a strong factor of tumor-related epilepsy or cognitive dysfunction in patients with meningioma, CD44 is thus a potential therapeutic target in meningioma with PTBE.