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PURPOSE: Theranostic approaches combining prostate-specific membrane antigen (PSMA)-PET/CT or PET/MRI with PSMA-targeted radionuclide therapy have improved clinical outcomes in patients with prostate cancer (PCa) especially metastatic castrate resistant prostate cancer. Dural metastases in PCa are rare but can pose a diagnostic challenge, as meningiomas, a more common dural based lesions have been shown to express PSMA. The aim of this study is to compare PSMA PET parameters between brain lesions classified as dural metastases and meningiomas in prostate cancer patients. METHODS: A retrospective analysis of PSMA PET/CT scans in patients with PCa and intracranial lesions was conducted. Brain lesions were categorized as dural metastases or meningiomas based on MRI characteristics, longitudinal follow-up, and histopathological characteristics. Standardized uptake values (SUVmax) of each brain lesion were measured, along with SUV ratio referencing parotid gland (SUVR). SUVs between lesions classified as metastases and meningiomas, respectively, were compared using Mann-Whitney-test. Diagnostic accuracy was evaluated using ROC analysis. RESULTS: 26 male patients (median age: 76.5 years, range: 59-96 years) met inclusion criteria. A total of 44 lesions (7 meningiomas and 37 metastases) were analyzed. Median SUVmax and SUVR were significantly lower in meningiomas compared to metastases (SUVmax: 2.7 vs. 11.5, p = 0.001; SUVR: 0.26 vs. 1.05, p < 0.001). ROC analysis demonstrated AUC 0.903; the optimal cut-off value for SUVR was 0.81 with 81.1 % sensitivity and 100 % specificity. CONCLUSION: PSMA PET has the potential to differentiate meningiomas from dural-based metastases in patients with PCa, which can optimize clinical management and thus improve patient outcomes.
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Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Próstata , Humanos , Masculino , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Anciano de 80 o más Años , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Glutamato Carboxipeptidasa II/metabolismo , Sensibilidad y Especificidad , Radiofármacos , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/secundario , Meningioma/diagnóstico por imagen , Meningioma/patología , Meningioma/secundario , Antígenos de Superficie/metabolismo , Imagen por Resonancia Magnética/métodosAsunto(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
BACKGROUND: Spheno-orbital meningioma (SOM) represents a unique variant of sphenoid wing meningiomas, distinguished by its propensity for bone infiltration and cranio-orbital involvement. SOM exhibits a considerable incidence of misdiagnosis and recurrence. PURPOSES: To elucidate the clinical, radiological, and pathological characteristics of SOM. METHODS: Review of electronic medical records, histopathology, radiological images and follow-up information of 100 SOM patients. RESULTS: Of the 100 patients (28 males, 72 females) with SOM, mean age was 46.8 ± 12.6 years and prevalent symptoms were proptosis (99%). All the CT scans showed hyperostosis with 89.3% of the hyperostosis having an irregular edge. In MRI scans, dural tail sign was observed across all patients and the cranio-orbital tumors often penetrated temporal muscle (74.1%), extraocular muscle (74.1%) and lacrimal gland (63%). All the 100 patients underwent surgical intervention, and among them, 62 individuals received postoperative radiotherapy. Grade I resections had a lower recurrence rate(16.7%), which further decreased with the addition of radiotherapy(13.9%). In contrast, all patients with grade II or higher grade resections without radiotherapy experienced recurrence, indicating a higher risk associated with less complete tumor removal. The pathological examination revealed that intraorbital sections exhibited comparable tumor density to intraorbital SOM tumors, along with increased fibrous density but decreased vascular distribution. CONCLUSIONS: Radiological characteristics of SOM included cranio-orbital tumors, hyperostosis of the sphenoid wing with an irregular edge, and dural tail sign. Combination of gross total resection and adjuvant radiotherapy was recommended to minimize recurrence rate. Intracranial SOM tumors tended to be softer and more bleed-prone than intraorbital sections, necessitating surgical precision.
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Imagen por Resonancia Magnética , Neoplasias Meníngeas , Meningioma , Neoplasias Orbitales , Hueso Esfenoides , Tomografía Computarizada por Rayos X , Humanos , Meningioma/diagnóstico por imagen , Meningioma/patología , Meningioma/diagnóstico , Masculino , Persona de Mediana Edad , Femenino , Adulto , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/patología , Neoplasias Orbitales/diagnóstico , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/diagnóstico , Hueso Esfenoides/patología , Hueso Esfenoides/diagnóstico por imagen , Estudios Retrospectivos , Anciano , Recurrencia Local de Neoplasia , Estudios de Seguimiento , Adulto JovenRESUMEN
Meningiomas are associated with inactivation of NF2/Merlin, but approximately one-third of meningiomas with favorable clinical outcomes retain Merlin expression. Biochemical mechanisms underlying Merlin-intact meningioma growth are incompletely understood, and non-invasive biomarkers that may be used to guide treatment de-escalation or imaging surveillance are lacking. Here, we use single-cell RNA sequencing, proximity-labeling proteomic mass spectrometry, mechanistic and functional approaches, and magnetic resonance imaging (MRI) across meningioma xenografts and patients to define biochemical mechanisms and an imaging biomarker that underlie Merlin-intact meningiomas. We find Merlin serine 13 (S13) dephosphorylation drives meningioma Wnt signaling and tumor growth by attenuating inhibitory interactions with ß-catenin and activating the Wnt pathway. MRI analyses show Merlin-intact meningiomas with S13 phosphorylation and favorable clinical outcomes are associated with high apparent diffusion coefficient (ADC). These results define mechanisms underlying a potential imaging biomarker that could be used to guide treatment de-escalation or imaging surveillance for patients with Merlin-intact meningiomas.
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Imagen por Resonancia Magnética , Neoplasias Meníngeas , Meningioma , Neurofibromina 2 , Vía de Señalización Wnt , Meningioma/diagnóstico por imagen , Meningioma/metabolismo , Meningioma/patología , Meningioma/genética , Humanos , Fosforilación , Neurofibromina 2/metabolismo , Neurofibromina 2/genética , Animales , Imagen por Resonancia Magnética/métodos , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/metabolismo , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/genética , Ratones , Línea Celular Tumoral , beta Catenina/metabolismo , beta Catenina/genética , Femenino , Serina/metabolismo , Masculino , Proteómica/métodos , Biomarcadores de Tumor/metabolismo , Biomarcadores de Tumor/genéticaRESUMEN
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
OBJECTIVE: Meningiomas are the most common primary central nervous tumor and are often treated with radiation therapy. This study examines the long-term volumetric changes of intracranial meningiomas in response to radiation therapy. The objective is to analyze and model the volumetric changes following treatment. METHODS: Data from a retrospective single-institution database (2005-2015) were used, with inclusion criteria being patients with a diagnosis of meningiomas, along with additional inclusion criteria consisting of treatment with radiation, having at least three magnetic resonance imaging (MRI) scans with one or more before and after radiation treatment, and the patients following up for at least eighteen months. Exclusion criteria consisted of patients less than 18 years old, patients receiving surgery and/or adjuvant chemotherapy following radiation, and patients without any available details regarding radiation treatment parameters. Tumor volumes were measured via T1-weighted post-contrast MRI and calculated using the ABC/2 ellipsoidal approximation, a method allowing for the measurement of non-linear growth volume reduction. RESULTS: Of 48 meningioma patients considered, 10â¯% experienced post-radiation growth, while 75â¯% witnessed a ≥50â¯% decrease in volume over a follow-up period of 0.3-14.9 years. Median decay rate was 0.81, and within 1.17 years, 90â¯% achieved the predicted volume reduction. Predicted vs. actual volumes showed a mean difference of 0.009 ± 0.347 cc. Initial tumor volumes strongly correlated (Pearson's R=0.98, R-squared=0.96) with final asymptotic volumes, which had a median of 1.50 cc, with interquartile range (IQR) = [0.39, 3.67]. CONCLUSION: 90â¯% of patients achieved tumor-volume reduction at 1.17 years post-treatment, reaching a non-zero asymptote strongly correlated with initial tumor volume, and 75â¯% experienced at least a 50â¯% volume decrease. Individual volume changes for responsive meningiomas can be modeled and predicted using exponential decay curves.
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Neoplasias Meníngeas , Meningioma , Carga Tumoral , Humanos , Meningioma/radioterapia , Meningioma/diagnóstico por imagen , Meningioma/patología , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Femenino , Persona de Mediana Edad , Masculino , Anciano , Estudios Retrospectivos , Adulto , Imagen por Resonancia Magnética , Modelos Teóricos , Anciano de 80 o más Años , Resultado del TratamientoRESUMEN
Recurrence of meningiomas after surgery and radiotherapy deserves specific attention because of the lack of active third-line therapies. Somatostatin receptors are usually overexpressed on the cell membrane of meningiomas, and this has led the way to a radionuclide theranostic approach. Diagnoses with 68Ga-DOTA-octreotide and peptide receptor radionuclide therapy (PRRT) with 90Y/177Lu-DOTA-octreotide are currently possible options within experimental protocols or as compassionate use in small patient groups. Methods: From October 2009 to October 2021, 42 meningioma patients with radiologic recurrence after standard therapies were treated with 90Y-DOTATOC (dosage of 1.1 or 5.5 GBq) or with 177Lu-DOTATATE (dosage of 3.7 or 5.5 GBq) in a mean of 4 cycles. All patients showed intense uptake at diagnostic 68Ga-DOTATOC PET/CT or in an 111In-octreotide scan. Results: Of 42 patients treated, 5 patients received 90Y-DOTATOC with a cumulative activity of 11.1 GBq and 37 patients received 177Lu-DOTATATE with a cumulative activity of 22 GBq. The disease control rate was 57%. With a median follow-up of 63 mo, median progression-free survival was 16 mo, and median overall survival was 36 mo. Retreatment 177Lu-PRRT was performed in 6 patients with an administered median activity of 13 GBq in a mean of 5 cycles. With a 75.8-mo follow-up, median progression-free survival and overall survival were 6.5 and 17 mo, respectively. Only 1 patient discontinued the treatment because of grade 3 platelet toxicity. A rapidly transient grade 2 neutropenia was recorded in 1 retreated patient. Conclusion: PRRT in patients with advanced meningiomas overexpressing somatostatin receptor 2 was active and well tolerated, showing a 57% disease control rate. Furthermore, PRRT could represent a potential retreatment option. Further studies, also in combination with other treatments, are warranted.
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Neoplasias Meníngeas , Meningioma , Octreótido , Humanos , Meningioma/radioterapia , Meningioma/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Anciano , Octreótido/análogos & derivados , Octreótido/uso terapéutico , Octreótido/efectos adversos , Estudios de Seguimiento , Adulto , Resultado del Tratamiento , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/diagnóstico por imagen , Receptores de Péptidos/metabolismo , Receptores de Somatostatina/metabolismo , Compuestos Organometálicos/uso terapéutico , Anciano de 80 o más AñosRESUMEN
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: Although the imaging findings of intracranial solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) and meningioma are similar, their treatment and prognosis are quite different. Accurate preoperative identification of these two types of tumors is crucial for individualized treatment. OBJECTIVE: The aim of this study was to develop a radiomics model for the differentiation of intracranial SFT/HPC and meningioma based on multiparametric magnetic resonance imaging (mpMRI). MATERIAL AND METHODS: A total of 99 patients from July 2012 to July 2018 with histologically and immunohistochemically confirmed SFT/HPC (n = 40) or meningiomas (n = 59) were retrospectively analyzed. A total of 1118 features were extracted based on its image shape, intensity and texture features. The logistic regression (LR) and multi-layer artificial neural network (ANN) classifiers were used to classify SFT/HPC and meningioma. The predictive performance was calculated using receiver operating characteristic curves (ROC). RESULTS: We found significant difference in terms of sex between the SFT/HPC and meningioma group (χ2= 4.829, P < 0.05), but no significant difference was found in age (P > 0.05). The most significant radiomics features included five shape and four first-order level features. For the LR classifier, the prediction accuracy of SFT/HPC was 71.0% and meningioma was 78.7%. For the ANN classifier, the prediction accuracy of SFT/HPC was 83.9% and meningioma was 80.9%. Both of the two classifiers achieved a high accuracy rate, but ANN was better. CONCLUSIONS: Radiomics features, especially when combined with an ANN classifier, can provide satisfactory performance in distinguishing SFT/HPC and meningioma.
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Hemangiopericitoma , Neoplasias Meníngeas , Meningioma , Imágenes de Resonancia Magnética Multiparamétrica , Tumores Fibrosos Solitarios , Humanos , Meningioma/diagnóstico por imagen , Meningioma/patología , Hemangiopericitoma/diagnóstico por imagen , Hemangiopericitoma/patología , Tumores Fibrosos Solitarios/diagnóstico por imagen , Tumores Fibrosos Solitarios/patología , Femenino , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Imágenes de Resonancia Magnética Multiparamétrica/métodos , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Anciano , Diagnóstico Diferencial , Redes Neurales de la Computación , Imagen por Resonancia Magnética/métodos , RadiómicaRESUMEN
ABSTRACT: This case study presents the first demonstration of FAPI ligand uptake in a patient with optic nerve sheath meningioma. The patient, a 23-year-old woman who had previously undergone surgery for refractory optic meningioma, was referred to our department for 177Lu-DOTATATE therapy. After 3 cycles of 177Lu-DOTATATE administration, her proptosis significantly decreased. Two months after her last therapeutic cycle, a 99mTc-FAPI scan was performed. The scan revealed a mass with moderately increased uptake in the left retro-orbital region. This study is believed to be the first to demonstrate FAPI ligand uptake in a patient with optic nerve sheath meningioma.
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Meningioma , Humanos , Meningioma/diagnóstico por imagen , Meningioma/metabolismo , Femenino , Adulto Joven , Neoplasias del Nervio Óptico/diagnóstico por imagen , Neoplasias Meníngeas/diagnóstico por imagen , Transporte Biológico , Compuestos de OrganotecnecioRESUMEN
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
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.
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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.
Asunto(s)
Fosa Craneal Posterior , Imagen por Resonancia Magnética , Meningioma , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Fosa Craneal Posterior/cirugía , Fosa Craneal Posterior/diagnóstico por imagen , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Meningioma/patología , Procedimientos Neuroquirúrgicos/métodos , Ángulo Pontocerebeloso/cirugía , Ángulo Pontocerebeloso/diagnóstico por imagen , Ángulo Pontocerebeloso/patología , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Neurilemoma/cirugía , Neurilemoma/diagnóstico por imagen , Neurilemoma/patología , Adulto JovenRESUMEN
ABSTRACT: 18 F-THK5351 demonstrates a strong binding affinity and selectivity for tau. However, off-target binding with monoamine oxidase-B enzyme, highly expressed in the outer mitochondrial membranes of astrocytes, is possible. In a case with isocitrate dehydrogenase-wildtype glioblastoma, 11 C-MET PET and 18 F-THK5351 PET exhibited increased uptake in the tumor. Conversely, in another case with intracranial meningioma, MET PET revealed increased uptake in the tumor, whereas 18 F-THK5351 PET showed no abnormal uptake in the tumor. However, it is challenging to distinguish meningiomas from glioblastomas on MRI. 18 F-THK5351 PET might help differentiate between isocitrate dehydrogenase-wildtype glioblastoma and meningioma.