Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collis...Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.展开更多
Introduction: Meningiomas are tumors formed by arachnoid cells, typically attached to the inner surface of the dura mater. Malignant forms are rare and no case has been reported in the Malagasy literature. The objecti...Introduction: Meningiomas are tumors formed by arachnoid cells, typically attached to the inner surface of the dura mater. Malignant forms are rare and no case has been reported in the Malagasy literature. The objective of our study is to report two Malagasy cases of malignant meningioma and to discuss the epidemiological and anatomical-clinical particularities of this tumor. Observation: The first patient, a 41-year-old woman, presented with a rapidly progressive intracranial hypertension syndrome. The patient had undergone surgery two years earlier for a grade II meningioma and had no family history of meningioma, neurofibromatosis, or personal history of brain irradiation or head trauma. Her brain scan showed a heterogeneous polylobed left parieto-occipital mass with a meningeal implantation base. The anatomopathological examination of the samples revealed a malignant meningioma. The second patient was a 33-year-old man, operated for grade I meningioma eleven months before admission, with no other personal or family history. The patient was hospitalized for tumor recurrence with signs of intracranial hypertension. The brain computed tomography (CT) scan showed a heterogeneous extra-axial tumor in right temporo-parietal lobe. Surgical excision was performed. On histological examination, a proliferation of tumor cells of meningothelial appearance with papillary architecture was observed, leading to the diagnosis of malignant meningioma. Conclusion: Malignant meningioma is a rare and serious entity. The clinical manifestations are nonspecific and imaging may mimic a low-grade meningioma. The diagnosis of certainty is histological and is based on essentially morphological criteria. The latter condition the overall survival of the patient and the therapeutic conduct.展开更多
Meningiomas in children are rare. They represent only 1% to 3% of all intracranial tumors. It was a case report of a childhood girl meningioma, which is from the rare tumor and presenting by seizures, evolving in an a...Meningiomas in children are rare. They represent only 1% to 3% of all intracranial tumors. It was a case report of a childhood girl meningioma, which is from the rare tumor and presenting by seizures, evolving in an apyretic context. She had no notion of irradiation or particular personal history apart from wearing glasses since the age of 5 years. She weighed 70 kg (BMI = 31). Biological examinations were normal. The brain scan showed a left frontal extra-axial tumor process measuring 76 × 60 × 55 mm. Tumor resection was performed. Macroscopically, the surgical specimen was found to be 8 firm, lobulated, yellowish-white fragments measuring 14 × 11 × 2 cm and weighing 150 g in total. The histological examination showed a proliferation of meningothelial cells, with a tendency to stratify and to roll up on each other in an onion bulb shape, without excess of mitoses and without cortical infiltration, evoking a meningioma. Meningioma in children remains a rare tumor. In our case, seizures were the only revealing signs of this disease. Cerebral computed tomography oriented the diagnosis. Anatomopathological examination was essential for confirmation.展开更多
Summary: Optic nerve tumors are rare tumors, representing 3% - 5% of intracranial tumors developing mainly along the optic nerve and/or the chiasm. Optic nerve meningiomas are histologically benign tumors whose severi...Summary: Optic nerve tumors are rare tumors, representing 3% - 5% of intracranial tumors developing mainly along the optic nerve and/or the chiasm. Optic nerve meningiomas are histologically benign tumors whose severity is linked to diagnostic and especially therapeutic difficulties. The Optic nerve meningioma is the second leading cause of optic nerve tumor after glioma. Observation: We report the case of a 49-year-old woman from South Asia, who consults an ophthalmology department for progressive visual loss in her right eye for about a year with her glasses and would like to renew her optical correction. Having no particular medical history apart from left unilateral blindness is known for approximately 15 years. Magnetic Resonance Imaging (IRM) cerebral found a tissue mass with a clear outline and polylobules on the left temporo-peduncular. Through this case, we describe the circumstances of discovery of the disease, the clinical characteristics, as well as our diagnostic approach. Conclusion: In the majority of cases, these are benign tumours, the circumstances of which are discovered in multiple ways. A mostly unilateral and non-improvable loss of visual acuity must attract our attention. Renewing glasses may be the reason for discovering the disease. Today Magnetic Resonance Imaging (IRM) remains an important and capital examination for the diagnosis and monitoring of this pathology.展开更多
Background: Skull vault lesions are rare and represent 1% - 2% of all bone masses. Most cerebral metastases are the intra axial tumors, whereas extra-axial masses mimicking meningioma are extremely rare. Case presenta...Background: Skull vault lesions are rare and represent 1% - 2% of all bone masses. Most cerebral metastases are the intra axial tumors, whereas extra-axial masses mimicking meningioma are extremely rare. Case presentation: A 35-year-old woman with a history of mastectomy left breast cancer 5 years below radiotherapy was referred to the neurosurgery department with a parietal extra-axial mass parietal evolving for one year. CT scan with Magnetic resonance imaging revealed an extra-axial tumor with lysis bone. A craniotomy was performed to remove the mass that was located extra-axial. Histopathological examination revealed metastasis. Conclusions: Lesion skull vaults are rare but they should be considered in the differential diagnosis of intraosseous meningioma lesions. In this report, we discuss the clinical aspects of cases we observed, in which the metastasis bone was found thanks to the histological examination of a calvarial mass after surgery.展开更多
<strong>Aims:</strong> The current study aimed to evaluate the efficacy, side effects of radiotherapy and factors influencing treatment outcome in patients received radiotherapy for cerebral meningiomas. &...<strong>Aims:</strong> The current study aimed to evaluate the efficacy, side effects of radiotherapy and factors influencing treatment outcome in patients received radiotherapy for cerebral meningiomas. <strong>Methods and Material:</strong> In the last two decades, a total of 35 patients with cerebral meningioma who received radiotherapy in our clinic were evaluated statistically in terms of survival, toxicity and prognostic factors. The records of patients diagnosed with cerebral meningioma who underwent postoperative radiotherapy were retrospectively analyzed. Statistical analysis used: Statistical comparisons were made using IBM SPSS v24.0. Kaplan-Meier method was used to compare survival times. <strong>Results:</strong> Five of the patients had grade I meningioma showing recurrence, 18 were grade II meningioma and 12 were grade III meningioma. Patients were treated with 54 or 60 Gy adjuvant radiotherapy with 2 Gy daily fractions according to histopathological grade and operation type. Three and five-year overall survival rates were 56% and 40%, respectively and median overall survival was 36 months. Progression was observed in 15 of the 35 patients included in the study. Three and five-year progression-free survival (PFS) rates of the patients were 56% and 50%, respectively. There was a statistically significant correlation between histopathological grade and overall survival among patients. However;no statistical difference found in overall survival of patients in terms of tumor location, operation type and age. <strong>Conclusions:</strong> In the treatment of cerebral meningiomas, changes in radiotherapy dose and field designs can be predicted according to the tumor grade and operation type. In addition, it is thought that large scale studies are needed to determine prognostic factors more meticulously.展开更多
Meningiomas, the most common intracranial primary tumors, are always benign. Extracranial and distant metastases can occur in malignant meningiomas. This case report describes a male in his 50 s with malignant meningi...Meningiomas, the most common intracranial primary tumors, are always benign. Extracranial and distant metastases can occur in malignant meningiomas. This case report describes a male in his 50 s with malignant meningioma and metastases to the subcutaneous soft tissue. Preoperative color Doppler ultrasound showed that the tumor had an abundant blood flow. Intraoperative pathological examination revealed a malignant tumor. Postoperative pathological examination revealed malignant tumors in the forehead;thus, malignant meningiomas were suspected. Immunohistochemistry revealed grade Ⅲ malignant meningioma. Malignant meningiomas have the ability to readily spread and metastasize;however, cases of malignant meningiomas disintegrating the bone and metastasizing to the subcutaneous part of the head have not been reported.展开更多
Meningiomas are the most common extra-axial central nervous system tumours and often discovered in the middle to late adult life and especially in women. About 85%-90% of meningiomas are benign, 5%-10% are intermediat...Meningiomas are the most common extra-axial central nervous system tumours and often discovered in the middle to late adult life and especially in women. About 85%-90% of meningiomas are benign, 5%-10% are intermediate-grade, and 3%-5% are malignant. Metaplastic meningioma is a rare subtype of WHO Grade I meningioma histologically characterized by the presence of mesenchymal components. The presence of pure and extensive cartilaginous differentiation in meningiomas is extremely rare and remains a diagnostic dilemma. We report, perhaps the first case of this entity in a 52-year-old woman and discuss the pathogenesis, the imaging features and the histopathologicals data.展开更多
Objective:To discuss the role of 3D-computed tomography angiography(3D-CTA) technology in reducing injuries of large meningioma surgery.Methods:3D-CTA preoperative examinations were done in 473 patients with large men...Objective:To discuss the role of 3D-computed tomography angiography(3D-CTA) technology in reducing injuries of large meningioma surgery.Methods:3D-CTA preoperative examinations were done in 473 patients with large meningioma(simulated group).The images were analyzed by 30 post-processing workstation.By observing the major intracranial blood vessels,venous sinus,and the compression and invasion pattern in the nerve region,assessing risk level of the surgery,simulating the surgical procedures,the surgical removal plan,surgical routes and tumor blood-supplying artery embolisation plan were performed.Two hundred and fifty seven large meningioma patients who didn’t underwent 3D-CTA preoperative examination served as control group.The incidence of postoperative complications,intraoperative blood transfusion and the operation time were compared between these two groups.Results:Compared with the control group,the Simpson’s grade 1 and 11 resection rate was 80.3%(380/473),similar with that of the control(81.3%,209/257).The incidence of postoperative complications in 3D-CTA simulated group was 37.0%which was significantly lower than that(48.2%) of the control(P【0.01). The intraoperative blood supply for simulated group and the control was(523.4±208.1) mL and (592.0±263.3) mL,respectively,with significant difference between two groups(P【0.01).And the operation time[(314.8±106.3)]min was significantly lower in simulated group than that in the control[(358.4±147.9) min](P【0.01).Conclusions:Application of 3D-CTA imaging technology in risk level assessment before large-scaled meningioma resection could assist in the rational planning of tumor resectin,surgical routes,and is helpful in reducing injuries and complications and enhancing the prognosis of the patients.展开更多
Objective:Meningiomas are neoplasms that arise from the meninges of the central nervous system(CNS).They constitute about25.6%of CNS tumors diagnosed in Egypt.Some morphological variants of meningiomas display aggress...Objective:Meningiomas are neoplasms that arise from the meninges of the central nervous system(CNS).They constitute about25.6%of CNS tumors diagnosed in Egypt.Some morphological variants of meningiomas display aggressive behavior,leading to brain-invasive growth pattern.Although meningiomas are usually treated by complete surgical excision,the risk of postoperative recurrence remains.Hence,additional biomarkers for predicting aggressive behavior must be discovered.This study aims to explore the clinical and biological relevance of the protein expression levels ofβ-catenin and galectine-3 in meningioma and to understand the pathobiology of this neoplasm.Methods:This retrospective study was carried out on 153 cases of meningioma by using tissue microarrays and immunohistochemistry forβ-catenin and galectine-3.Results:Highβ-catenin expression was significantly associated with transitional and meningiotheliomatous meningiomas,low tumor grade,low recurrence rate,and low incidence of brain invasion.Meanwhile,high galectin-3 expression was associated with brain invasion,recurrence,high tumor grade,and tumor type.Logistic regression analysis indicated that among all variables included in the model,β-catenin and galactin-3 expression levels were significant predictors of tumor recurrence(P<0.001).Conclusions:Galectin-3 andβ-catenin are involved in meningioma recurrence but not in brain invasion.These molecules could be important potential therapeutic targets and predictors for meningiomas.展开更多
AIM:To investigate clinical features of optic nerve sheath meningioma(ONSM) that was misdiagnosed,and to find methods to reduce the misdiagnoses.METHODS:Retrospective series study.Twenty-five misdisgnosed patients wit...AIM:To investigate clinical features of optic nerve sheath meningioma(ONSM) that was misdiagnosed,and to find methods to reduce the misdiagnoses.METHODS:Retrospective series study.Twenty-five misdisgnosed patients with unilateral ONSM were collected from Jan.2008 to Jan.2015 and the clinical records reviewed.RESULTS:Patients were misdiagnosed with acute papillitis most frequently(P=17),immediately followed by optic atrophy(P=8),ischemic optic neuropathy(P=5),acute retrobulbar optic neuritis(P=5),optic disc vasculitis(P =3).For each patient,the minimum frequency of misdiagnoses was once and the maximum was 4 times.As for the lasting time of being misdiagnosed,the shortest was 1.5mo and the longest was 45 mo.Twentyone cases(84%) were once treated with glucocorticoids,and its side effects was found in seventeen patients.Twenty patients(80%) complained with varying degree of vision loss.When a definite diagnosis was made,sixteen cases(64%) showed slight exophthalmos and eighteen cases(72%) had the tubular ONSM.CONCLUSION:ONSM without loss obvious exophthalmos is easily misdiagnosed in clinic,and for most of these ONSMs are tubular.展开更多
In order to investigate the expression of androgen receptor in meningiomas and its relation to tumor proliferative potential, we examined the expression of AR and proliferating cell nuclear antigen by avidine biotin c...In order to investigate the expression of androgen receptor in meningiomas and its relation to tumor proliferative potential, we examined the expression of AR and proliferating cell nuclear antigen by avidine biotin complex immunohistochemistry in 39 cases of meningiomas. Of the 39 cases of meningiomas, 20 showed positive AR immunoreactivity. The AR expression positivity rates were 31 % in benign meningiomas, 58 % in atypical meningiomas, 87.5 % in malignant meningiomas, respectively. In addition to the tumor cells, cells of microvascular endothelial proliferation were frequently AR positive. Malignant meningiomas had a significantly higher percentage of AR positive cells compared with atypical and benign meningiomas . The mean proliferating cell nuclear antigen labeling index was significantly higher in the malignant meningiomas when compared with atypical meningiomas and benign meningiomas . AR positive meningiomas had higher PCNA LI than AR negative meningiomas . The expression of AR in tumor tissues was significantly related with PCNA LI. These data indicated that AR in the meningiomas was correlated with histological grade and AR might participate in the growth of these tumors and tumor angiogenesis. The measurement of AR in these tumors may indirectly represent tumor growth potential.展开更多
BACKGROUND The simultaneous occurrence of schwannoma and meningioma in the absence of neurofibromatosis(NF)or a previous history of irradiation is exceedingly rare,as only 10 intracranial cases have been reported to d...BACKGROUND The simultaneous occurrence of schwannoma and meningioma in the absence of neurofibromatosis(NF)or a previous history of irradiation is exceedingly rare,as only 10 intracranial cases have been reported to date.Herein,we report a case of a coexistent cavernous sinus meningioma and ipsilateral vestibular schwannoma(VS)in a female patient without NF or a history of exposure to irradiation.CASE SUMMARY A 63-year-old woman presented with progressive left-side hearing loss and tinnitus over the previous year.In the past 6 mo,she developed facial numbness and intermittent headaches.Magnetic resonance imaging showed two lesions that were located on the left side of the cerebellopontine angle and parasellar region.Both lesions were totally resected via the left retrosigmoid approach.Histopathological examination revealed a VS and a meningioma.The patient did not have a family history or clinical or radiological signs of NF.CONCLUSION The coincident occurrence of VS and meningioma within close vicinity is very rare,and the pathogenesis is unclear.A careful whole-body examination needs to be conducted to exclude NF.Surgical treatment with the goal of total tumor resection is the best therapy.Additional studies are needed for a better understanding of the mechanisms that lead to the development of tumor growth in multiple locations.展开更多
BACKGROUND The coexistence of meningioma and other intracranial primary benign tumors is rare,especially in non-neurofibromatosis type 2,and there is limited guidance for the management of such patients.Here,we report...BACKGROUND The coexistence of meningioma and other intracranial primary benign tumors is rare,especially in non-neurofibromatosis type 2,and there is limited guidance for the management of such patients.Here,we report a series of 5 patients with concomitant meningioma and other intracranial benign tumors,including subependymoma and pituitary adenoma.CASE SUMMARY Five non-neurofibromatosis type 2 patients with simultaneous occurrence of meningioma and other intracranial benign tumors were retrospectively reviewed.The patients had no history of previous irradiation.The clinical features,pre-and postoperative imaging,surgical procedure and pathological findings were extracted from electronic medical records.There were 4 female patients(80%)and 1 male patient(20%).The mean age was 42.8 years(range:29-52 years).The coexisting tumors included subependymoma in 1 case(20%)and pituitary adenoma in 4 cases(80%).The most common clinical symptom was headache(3/5,60%).Four patients(80%)underwent craniotomy.One patient(20%)underwent transsphenoidal surgery followed by transcranial operation.All tumor diagnoses were confirmed by histopathological examination.The mean follow-up was 38.8 mo(range:23-96 mo),and all 5 patients were in a stable condition at the last follow-up.CONCLUSION The simultaneous occurrence of meningioma and other intracranial benign tumors is a rare clinical event.Histological examination is necessary for the accurate diagnosis.Neurosurgeons should select the appropriate surgical strategy according to the clinical features of each patient,which may provide a more favorable prognosis for individual patients.展开更多
BACKGROUND Grade II and III meningiomas[World Health Organization(WHO)classification]rarely have extracranial metastases via the blood circulation;however,we experienced a case with a metaplastic atypical meningioma a...BACKGROUND Grade II and III meningiomas[World Health Organization(WHO)classification]rarely have extracranial metastases via the blood circulation;however,we experienced a case with a metaplastic atypical meningioma and local dedifferentiation that metastasized to the jugular vein,carotid artery and subclavian artery at the cervicothoracic junction.Such cases have seldom been reported before.CASE SUMMARY The patient was a 30-year-old man who developed right neck masses with dysphagia,labored breathing,dizziness,and occasional earaches.Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness,and the post-operative pathology was a metaplastic atypical meningioma(WHO grade II)with local de-differentiation(WHO III).Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space.Head and neck angiography showed that the right common carotid artery was compressed and completely occluded,and the jugular vein was enveloped by the tumor and occluded.A balloon occlusion test showed no perfusion in the right common carotid artery.Tumor resection,carotid artery ligation,and subclavian artery reconstruction were performed.The tumor was a malignant meningioma.Postoperatively,the patient had Horner's syndrome and hoarseness.CONCLUSION This case highlights the importance of the link between a large cervical mass and a primary intracranial tumor.Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid,it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.展开更多
Meningiomas are usually benign growths that rarely invade the substance of the brain, thus presenting the potential for curative surgery. Their sometimes difficult locations and propensity to recur if not completely e...Meningiomas are usually benign growths that rarely invade the substance of the brain, thus presenting the potential for curative surgery. Their sometimes difficult locations and propensity to recur if not completely excised represent formidable problems for the patient and the neurologic surgeon. This report describes a case of giant intracranial and extracranial meningioma of the falx cerebri. The tumor had displaced the anterior third of the superior sagittal sinusand a massive extracranial protrusion was eroding the calvarium, left supraorbital rim, frontal sinus and the left maxillary sinus. We present the surgical approach.展开更多
Objective: Many approaches have been used for surgical removal of olfactory groove meningioma (OGM) as pterional, bifrontal, interhemispheric, and frontolateral approach. We evaluated the role of unilateral subfrontal...Objective: Many approaches have been used for surgical removal of olfactory groove meningioma (OGM) as pterional, bifrontal, interhemispheric, and frontolateral approach. We evaluated the role of unilateral subfrontal approach for the removal of giant OGM “bigger than 6-cm”. Patients and Methods: Nine patients with giant OGM had unilateral subfrontal approach between 1st of January 2015 and December 2017 in Cairo University Hospitals. A retrospective study we done analyzing clinical data, neuroimaging, surgical result and extent of tumor resection. Results: Total tumor resection was achieved in seven cases “Simpson grade I and II”. Subtotal resection was achieved in two cases, one case there was enchasing of the anterior cerebral artery. The other case subtotal resection was achieved due to old age of the patient. The frontal air sinus and cribriform plate and ethmoidal sinus were repaired using fat, fascia lata and vascularized pericranium flab with the use of histoacryl: One case developed hydrocephalus which required the insertion of a ventriculo-peritoneal shunt. One case developed wound infection and meningitis which required medical treatment only. There is no case of CSF leak or mortality in our series. Conclusion: The unilateral subfrontal approach is a safe and efficient approach for removal of giant olfactory groove meningioma. It combines the benefits of the bifrontal, frontolateral and pterional approach with early access to CSF drainage and early attack of the blood supply of the tumor.展开更多
Background: Purpose of this study was to evaluate various parameters of meningioma after surgical treatment and analyze predictive factors for recurrence. Methods: During 1992-2007, 353 patients were operated for intr...Background: Purpose of this study was to evaluate various parameters of meningioma after surgical treatment and analyze predictive factors for recurrence. Methods: During 1992-2007, 353 patients were operated for intracranial meningioma in our department. They were followed since, and related data were combined with parameters such as tumor histology (WHO system), tumor location and the extent of tumor resection (Simpson’s scale). The results were analyzed with respect to tumor reappearance. This study was approved by the ethics committee of G. Papanikolaou Hospital. Results: The mean follow up period was 6.45 years. The overall percentage of recurrence was 21.52%. Grade 1 meningiomas (benign) recurred at a rate of 19.1%, grade 2 tumors (atypical) showed 41.7% rate of recurrence and grade 3 meningiomas (malignant) recurred at a rate of 75%. Tumor histopathology was not significant to recurrence (p > 0.001). The location of meningiomas was not found to be significant to recurrence (p > 0.001). Complete tumor resection was accomplished in 269 patients (76.2%). Incomplete resection (Simpson grades 2-5) took place in 84 cases (23.8%). The recurrence rate after complete resection was 13.8%, while the rate for cases with incomplete resection was 46.7%. The extent of removal was significantly associated with recurrence (p < 0.001). Conclusions: Tumor recurrence was observed at 21.5% of patients in our series of intracranial meningioma surgery. The rate of recurrence was related primarily to the extent of surgical removal. Neither tumor site, nor tumor histology were predictive factors for recurrence (ma-lignant meningiomas excluded).展开更多
BACKGROUND: AND PURPOSE: The measurement of relative cerebral blood volume (rCBV) and the volume transfer constant (K(trans)) by means of dynamic contrast-enhanced (DCE) perfusion MR imaging (pMRI) can be useful in ch...BACKGROUND: AND PURPOSE: The measurement of relative cerebral blood volume (rCBV) and the volume transfer constant (K(trans)) by means of dynamic contrast-enhanced (DCE) perfusion MR imaging (pMRI) can be useful in characterizing brain tumors. The purpose of our study was to evaluate the utility of these measurements in differentiating typical meningiomas and atypical meningiomas. METHODS: Fifteen patients with pathologically confirmed typical meningiomas and seven with atypical meningiomas underwent conventional imaging and DCE pMRI before resection.rCBV measurements were calculated by using standard intravascular展开更多
AIM: To investigate neurofibromatosis type 2(NF2) gene mutation at mRNA levels in sporadic orbitocranial meningioma and its association with progesterone receptor(PR) mR NA expression.METHODS: This was a case-control ...AIM: To investigate neurofibromatosis type 2(NF2) gene mutation at mRNA levels in sporadic orbitocranial meningioma and its association with progesterone receptor(PR) mR NA expression.METHODS: This was a case-control study. Thirty-four sporadic meningioma patients with no familial NF2-related meningioma history were recruited. They were interviewed for their obstetric, gynecologic, and contraception history. PR investigation was performed with real-time polymerase chain reaction(PCR). NF2 mutation was investigated using Qbiomarker Somatic Mutation PCR Assay at NF2 mRNA level after its cDNA extraction(four mRNA mutation cytoband coordinates for nucleotide change: c.634 C>T/p.Q212, c.655 G>A/p.V219 M, c.784 C>T/p.R262 and c.1228 C>T/p. Q410). RESULTS: After mutation analysis at mRNA level, NF2 gene mutation was found in 35.29% patients. Non-mutation group was strongly associated with exogenous hormonal exposure(non-mutation vs mutation: 95.5% vs 83.3%, P<0.001). PR mR NA was found significantly lower in nonmutation group(P=0.033) which presumed as long term exogenous progesterone exposure. However, mutation group was associated with higher rate of progression to gradeⅡ(mutation vs non-mutation, 18.2% vs 5%, P<0.001) and was associated more in fibrous and anaplastic tumor tissue.CONCLUSION: NF2 mutation-meningioma is associated with higher grade of meningioma. Non NF2 mutationmeningioma is strongly associated with exogenous progesterone exposure and lower PR expression.展开更多
文摘Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.
文摘Introduction: Meningiomas are tumors formed by arachnoid cells, typically attached to the inner surface of the dura mater. Malignant forms are rare and no case has been reported in the Malagasy literature. The objective of our study is to report two Malagasy cases of malignant meningioma and to discuss the epidemiological and anatomical-clinical particularities of this tumor. Observation: The first patient, a 41-year-old woman, presented with a rapidly progressive intracranial hypertension syndrome. The patient had undergone surgery two years earlier for a grade II meningioma and had no family history of meningioma, neurofibromatosis, or personal history of brain irradiation or head trauma. Her brain scan showed a heterogeneous polylobed left parieto-occipital mass with a meningeal implantation base. The anatomopathological examination of the samples revealed a malignant meningioma. The second patient was a 33-year-old man, operated for grade I meningioma eleven months before admission, with no other personal or family history. The patient was hospitalized for tumor recurrence with signs of intracranial hypertension. The brain computed tomography (CT) scan showed a heterogeneous extra-axial tumor in right temporo-parietal lobe. Surgical excision was performed. On histological examination, a proliferation of tumor cells of meningothelial appearance with papillary architecture was observed, leading to the diagnosis of malignant meningioma. Conclusion: Malignant meningioma is a rare and serious entity. The clinical manifestations are nonspecific and imaging may mimic a low-grade meningioma. The diagnosis of certainty is histological and is based on essentially morphological criteria. The latter condition the overall survival of the patient and the therapeutic conduct.
文摘Meningiomas in children are rare. They represent only 1% to 3% of all intracranial tumors. It was a case report of a childhood girl meningioma, which is from the rare tumor and presenting by seizures, evolving in an apyretic context. She had no notion of irradiation or particular personal history apart from wearing glasses since the age of 5 years. She weighed 70 kg (BMI = 31). Biological examinations were normal. The brain scan showed a left frontal extra-axial tumor process measuring 76 × 60 × 55 mm. Tumor resection was performed. Macroscopically, the surgical specimen was found to be 8 firm, lobulated, yellowish-white fragments measuring 14 × 11 × 2 cm and weighing 150 g in total. The histological examination showed a proliferation of meningothelial cells, with a tendency to stratify and to roll up on each other in an onion bulb shape, without excess of mitoses and without cortical infiltration, evoking a meningioma. Meningioma in children remains a rare tumor. In our case, seizures were the only revealing signs of this disease. Cerebral computed tomography oriented the diagnosis. Anatomopathological examination was essential for confirmation.
文摘Summary: Optic nerve tumors are rare tumors, representing 3% - 5% of intracranial tumors developing mainly along the optic nerve and/or the chiasm. Optic nerve meningiomas are histologically benign tumors whose severity is linked to diagnostic and especially therapeutic difficulties. The Optic nerve meningioma is the second leading cause of optic nerve tumor after glioma. Observation: We report the case of a 49-year-old woman from South Asia, who consults an ophthalmology department for progressive visual loss in her right eye for about a year with her glasses and would like to renew her optical correction. Having no particular medical history apart from left unilateral blindness is known for approximately 15 years. Magnetic Resonance Imaging (IRM) cerebral found a tissue mass with a clear outline and polylobules on the left temporo-peduncular. Through this case, we describe the circumstances of discovery of the disease, the clinical characteristics, as well as our diagnostic approach. Conclusion: In the majority of cases, these are benign tumours, the circumstances of which are discovered in multiple ways. A mostly unilateral and non-improvable loss of visual acuity must attract our attention. Renewing glasses may be the reason for discovering the disease. Today Magnetic Resonance Imaging (IRM) remains an important and capital examination for the diagnosis and monitoring of this pathology.
文摘Background: Skull vault lesions are rare and represent 1% - 2% of all bone masses. Most cerebral metastases are the intra axial tumors, whereas extra-axial masses mimicking meningioma are extremely rare. Case presentation: A 35-year-old woman with a history of mastectomy left breast cancer 5 years below radiotherapy was referred to the neurosurgery department with a parietal extra-axial mass parietal evolving for one year. CT scan with Magnetic resonance imaging revealed an extra-axial tumor with lysis bone. A craniotomy was performed to remove the mass that was located extra-axial. Histopathological examination revealed metastasis. Conclusions: Lesion skull vaults are rare but they should be considered in the differential diagnosis of intraosseous meningioma lesions. In this report, we discuss the clinical aspects of cases we observed, in which the metastasis bone was found thanks to the histological examination of a calvarial mass after surgery.
文摘<strong>Aims:</strong> The current study aimed to evaluate the efficacy, side effects of radiotherapy and factors influencing treatment outcome in patients received radiotherapy for cerebral meningiomas. <strong>Methods and Material:</strong> In the last two decades, a total of 35 patients with cerebral meningioma who received radiotherapy in our clinic were evaluated statistically in terms of survival, toxicity and prognostic factors. The records of patients diagnosed with cerebral meningioma who underwent postoperative radiotherapy were retrospectively analyzed. Statistical analysis used: Statistical comparisons were made using IBM SPSS v24.0. Kaplan-Meier method was used to compare survival times. <strong>Results:</strong> Five of the patients had grade I meningioma showing recurrence, 18 were grade II meningioma and 12 were grade III meningioma. Patients were treated with 54 or 60 Gy adjuvant radiotherapy with 2 Gy daily fractions according to histopathological grade and operation type. Three and five-year overall survival rates were 56% and 40%, respectively and median overall survival was 36 months. Progression was observed in 15 of the 35 patients included in the study. Three and five-year progression-free survival (PFS) rates of the patients were 56% and 50%, respectively. There was a statistically significant correlation between histopathological grade and overall survival among patients. However;no statistical difference found in overall survival of patients in terms of tumor location, operation type and age. <strong>Conclusions:</strong> In the treatment of cerebral meningiomas, changes in radiotherapy dose and field designs can be predicted according to the tumor grade and operation type. In addition, it is thought that large scale studies are needed to determine prognostic factors more meticulously.
文摘Meningiomas, the most common intracranial primary tumors, are always benign. Extracranial and distant metastases can occur in malignant meningiomas. This case report describes a male in his 50 s with malignant meningioma and metastases to the subcutaneous soft tissue. Preoperative color Doppler ultrasound showed that the tumor had an abundant blood flow. Intraoperative pathological examination revealed a malignant tumor. Postoperative pathological examination revealed malignant tumors in the forehead;thus, malignant meningiomas were suspected. Immunohistochemistry revealed grade Ⅲ malignant meningioma. Malignant meningiomas have the ability to readily spread and metastasize;however, cases of malignant meningiomas disintegrating the bone and metastasizing to the subcutaneous part of the head have not been reported.
文摘Meningiomas are the most common extra-axial central nervous system tumours and often discovered in the middle to late adult life and especially in women. About 85%-90% of meningiomas are benign, 5%-10% are intermediate-grade, and 3%-5% are malignant. Metaplastic meningioma is a rare subtype of WHO Grade I meningioma histologically characterized by the presence of mesenchymal components. The presence of pure and extensive cartilaginous differentiation in meningiomas is extremely rare and remains a diagnostic dilemma. We report, perhaps the first case of this entity in a 52-year-old woman and discuss the pathogenesis, the imaging features and the histopathologicals data.
基金supported by Natural Science Foundationof Hannan Province(808246)
文摘Objective:To discuss the role of 3D-computed tomography angiography(3D-CTA) technology in reducing injuries of large meningioma surgery.Methods:3D-CTA preoperative examinations were done in 473 patients with large meningioma(simulated group).The images were analyzed by 30 post-processing workstation.By observing the major intracranial blood vessels,venous sinus,and the compression and invasion pattern in the nerve region,assessing risk level of the surgery,simulating the surgical procedures,the surgical removal plan,surgical routes and tumor blood-supplying artery embolisation plan were performed.Two hundred and fifty seven large meningioma patients who didn’t underwent 3D-CTA preoperative examination served as control group.The incidence of postoperative complications,intraoperative blood transfusion and the operation time were compared between these two groups.Results:Compared with the control group,the Simpson’s grade 1 and 11 resection rate was 80.3%(380/473),similar with that of the control(81.3%,209/257).The incidence of postoperative complications in 3D-CTA simulated group was 37.0%which was significantly lower than that(48.2%) of the control(P【0.01). The intraoperative blood supply for simulated group and the control was(523.4±208.1) mL and (592.0±263.3) mL,respectively,with significant difference between two groups(P【0.01).And the operation time[(314.8±106.3)]min was significantly lower in simulated group than that in the control[(358.4±147.9) min](P【0.01).Conclusions:Application of 3D-CTA imaging technology in risk level assessment before large-scaled meningioma resection could assist in the rational planning of tumor resectin,surgical routes,and is helpful in reducing injuries and complications and enhancing the prognosis of the patients.
文摘Objective:Meningiomas are neoplasms that arise from the meninges of the central nervous system(CNS).They constitute about25.6%of CNS tumors diagnosed in Egypt.Some morphological variants of meningiomas display aggressive behavior,leading to brain-invasive growth pattern.Although meningiomas are usually treated by complete surgical excision,the risk of postoperative recurrence remains.Hence,additional biomarkers for predicting aggressive behavior must be discovered.This study aims to explore the clinical and biological relevance of the protein expression levels ofβ-catenin and galectine-3 in meningioma and to understand the pathobiology of this neoplasm.Methods:This retrospective study was carried out on 153 cases of meningioma by using tissue microarrays and immunohistochemistry forβ-catenin and galectine-3.Results:Highβ-catenin expression was significantly associated with transitional and meningiotheliomatous meningiomas,low tumor grade,low recurrence rate,and low incidence of brain invasion.Meanwhile,high galectin-3 expression was associated with brain invasion,recurrence,high tumor grade,and tumor type.Logistic regression analysis indicated that among all variables included in the model,β-catenin and galactin-3 expression levels were significant predictors of tumor recurrence(P<0.001).Conclusions:Galectin-3 andβ-catenin are involved in meningioma recurrence but not in brain invasion.These molecules could be important potential therapeutic targets and predictors for meningiomas.
文摘AIM:To investigate clinical features of optic nerve sheath meningioma(ONSM) that was misdiagnosed,and to find methods to reduce the misdiagnoses.METHODS:Retrospective series study.Twenty-five misdisgnosed patients with unilateral ONSM were collected from Jan.2008 to Jan.2015 and the clinical records reviewed.RESULTS:Patients were misdiagnosed with acute papillitis most frequently(P=17),immediately followed by optic atrophy(P=8),ischemic optic neuropathy(P=5),acute retrobulbar optic neuritis(P=5),optic disc vasculitis(P =3).For each patient,the minimum frequency of misdiagnoses was once and the maximum was 4 times.As for the lasting time of being misdiagnosed,the shortest was 1.5mo and the longest was 45 mo.Twentyone cases(84%) were once treated with glucocorticoids,and its side effects was found in seventeen patients.Twenty patients(80%) complained with varying degree of vision loss.When a definite diagnosis was made,sixteen cases(64%) showed slight exophthalmos and eighteen cases(72%) had the tubular ONSM.CONCLUSION:ONSM without loss obvious exophthalmos is easily misdiagnosed in clinic,and for most of these ONSMs are tubular.
文摘In order to investigate the expression of androgen receptor in meningiomas and its relation to tumor proliferative potential, we examined the expression of AR and proliferating cell nuclear antigen by avidine biotin complex immunohistochemistry in 39 cases of meningiomas. Of the 39 cases of meningiomas, 20 showed positive AR immunoreactivity. The AR expression positivity rates were 31 % in benign meningiomas, 58 % in atypical meningiomas, 87.5 % in malignant meningiomas, respectively. In addition to the tumor cells, cells of microvascular endothelial proliferation were frequently AR positive. Malignant meningiomas had a significantly higher percentage of AR positive cells compared with atypical and benign meningiomas . The mean proliferating cell nuclear antigen labeling index was significantly higher in the malignant meningiomas when compared with atypical meningiomas and benign meningiomas . AR positive meningiomas had higher PCNA LI than AR negative meningiomas . The expression of AR in tumor tissues was significantly related with PCNA LI. These data indicated that AR in the meningiomas was correlated with histological grade and AR might participate in the growth of these tumors and tumor angiogenesis. The measurement of AR in these tumors may indirectly represent tumor growth potential.
文摘BACKGROUND The simultaneous occurrence of schwannoma and meningioma in the absence of neurofibromatosis(NF)or a previous history of irradiation is exceedingly rare,as only 10 intracranial cases have been reported to date.Herein,we report a case of a coexistent cavernous sinus meningioma and ipsilateral vestibular schwannoma(VS)in a female patient without NF or a history of exposure to irradiation.CASE SUMMARY A 63-year-old woman presented with progressive left-side hearing loss and tinnitus over the previous year.In the past 6 mo,she developed facial numbness and intermittent headaches.Magnetic resonance imaging showed two lesions that were located on the left side of the cerebellopontine angle and parasellar region.Both lesions were totally resected via the left retrosigmoid approach.Histopathological examination revealed a VS and a meningioma.The patient did not have a family history or clinical or radiological signs of NF.CONCLUSION The coincident occurrence of VS and meningioma within close vicinity is very rare,and the pathogenesis is unclear.A careful whole-body examination needs to be conducted to exclude NF.Surgical treatment with the goal of total tumor resection is the best therapy.Additional studies are needed for a better understanding of the mechanisms that lead to the development of tumor growth in multiple locations.
基金Supported by the LiaoNing Revitalization Talents Program,No.XLYC1807253the National Natural Science Foundation of China,No.81772653。
文摘BACKGROUND The coexistence of meningioma and other intracranial primary benign tumors is rare,especially in non-neurofibromatosis type 2,and there is limited guidance for the management of such patients.Here,we report a series of 5 patients with concomitant meningioma and other intracranial benign tumors,including subependymoma and pituitary adenoma.CASE SUMMARY Five non-neurofibromatosis type 2 patients with simultaneous occurrence of meningioma and other intracranial benign tumors were retrospectively reviewed.The patients had no history of previous irradiation.The clinical features,pre-and postoperative imaging,surgical procedure and pathological findings were extracted from electronic medical records.There were 4 female patients(80%)and 1 male patient(20%).The mean age was 42.8 years(range:29-52 years).The coexisting tumors included subependymoma in 1 case(20%)and pituitary adenoma in 4 cases(80%).The most common clinical symptom was headache(3/5,60%).Four patients(80%)underwent craniotomy.One patient(20%)underwent transsphenoidal surgery followed by transcranial operation.All tumor diagnoses were confirmed by histopathological examination.The mean follow-up was 38.8 mo(range:23-96 mo),and all 5 patients were in a stable condition at the last follow-up.CONCLUSION The simultaneous occurrence of meningioma and other intracranial benign tumors is a rare clinical event.Histological examination is necessary for the accurate diagnosis.Neurosurgeons should select the appropriate surgical strategy according to the clinical features of each patient,which may provide a more favorable prognosis for individual patients.
文摘BACKGROUND Grade II and III meningiomas[World Health Organization(WHO)classification]rarely have extracranial metastases via the blood circulation;however,we experienced a case with a metaplastic atypical meningioma and local dedifferentiation that metastasized to the jugular vein,carotid artery and subclavian artery at the cervicothoracic junction.Such cases have seldom been reported before.CASE SUMMARY The patient was a 30-year-old man who developed right neck masses with dysphagia,labored breathing,dizziness,and occasional earaches.Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness,and the post-operative pathology was a metaplastic atypical meningioma(WHO grade II)with local de-differentiation(WHO III).Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space.Head and neck angiography showed that the right common carotid artery was compressed and completely occluded,and the jugular vein was enveloped by the tumor and occluded.A balloon occlusion test showed no perfusion in the right common carotid artery.Tumor resection,carotid artery ligation,and subclavian artery reconstruction were performed.The tumor was a malignant meningioma.Postoperatively,the patient had Horner's syndrome and hoarseness.CONCLUSION This case highlights the importance of the link between a large cervical mass and a primary intracranial tumor.Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid,it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.
文摘Meningiomas are usually benign growths that rarely invade the substance of the brain, thus presenting the potential for curative surgery. Their sometimes difficult locations and propensity to recur if not completely excised represent formidable problems for the patient and the neurologic surgeon. This report describes a case of giant intracranial and extracranial meningioma of the falx cerebri. The tumor had displaced the anterior third of the superior sagittal sinusand a massive extracranial protrusion was eroding the calvarium, left supraorbital rim, frontal sinus and the left maxillary sinus. We present the surgical approach.
文摘Objective: Many approaches have been used for surgical removal of olfactory groove meningioma (OGM) as pterional, bifrontal, interhemispheric, and frontolateral approach. We evaluated the role of unilateral subfrontal approach for the removal of giant OGM “bigger than 6-cm”. Patients and Methods: Nine patients with giant OGM had unilateral subfrontal approach between 1st of January 2015 and December 2017 in Cairo University Hospitals. A retrospective study we done analyzing clinical data, neuroimaging, surgical result and extent of tumor resection. Results: Total tumor resection was achieved in seven cases “Simpson grade I and II”. Subtotal resection was achieved in two cases, one case there was enchasing of the anterior cerebral artery. The other case subtotal resection was achieved due to old age of the patient. The frontal air sinus and cribriform plate and ethmoidal sinus were repaired using fat, fascia lata and vascularized pericranium flab with the use of histoacryl: One case developed hydrocephalus which required the insertion of a ventriculo-peritoneal shunt. One case developed wound infection and meningitis which required medical treatment only. There is no case of CSF leak or mortality in our series. Conclusion: The unilateral subfrontal approach is a safe and efficient approach for removal of giant olfactory groove meningioma. It combines the benefits of the bifrontal, frontolateral and pterional approach with early access to CSF drainage and early attack of the blood supply of the tumor.
文摘Background: Purpose of this study was to evaluate various parameters of meningioma after surgical treatment and analyze predictive factors for recurrence. Methods: During 1992-2007, 353 patients were operated for intracranial meningioma in our department. They were followed since, and related data were combined with parameters such as tumor histology (WHO system), tumor location and the extent of tumor resection (Simpson’s scale). The results were analyzed with respect to tumor reappearance. This study was approved by the ethics committee of G. Papanikolaou Hospital. Results: The mean follow up period was 6.45 years. The overall percentage of recurrence was 21.52%. Grade 1 meningiomas (benign) recurred at a rate of 19.1%, grade 2 tumors (atypical) showed 41.7% rate of recurrence and grade 3 meningiomas (malignant) recurred at a rate of 75%. Tumor histopathology was not significant to recurrence (p > 0.001). The location of meningiomas was not found to be significant to recurrence (p > 0.001). Complete tumor resection was accomplished in 269 patients (76.2%). Incomplete resection (Simpson grades 2-5) took place in 84 cases (23.8%). The recurrence rate after complete resection was 13.8%, while the rate for cases with incomplete resection was 46.7%. The extent of removal was significantly associated with recurrence (p < 0.001). Conclusions: Tumor recurrence was observed at 21.5% of patients in our series of intracranial meningioma surgery. The rate of recurrence was related primarily to the extent of surgical removal. Neither tumor site, nor tumor histology were predictive factors for recurrence (ma-lignant meningiomas excluded).
文摘BACKGROUND: AND PURPOSE: The measurement of relative cerebral blood volume (rCBV) and the volume transfer constant (K(trans)) by means of dynamic contrast-enhanced (DCE) perfusion MR imaging (pMRI) can be useful in characterizing brain tumors. The purpose of our study was to evaluate the utility of these measurements in differentiating typical meningiomas and atypical meningiomas. METHODS: Fifteen patients with pathologically confirmed typical meningiomas and seven with atypical meningiomas underwent conventional imaging and DCE pMRI before resection.rCBV measurements were calculated by using standard intravascular
文摘AIM: To investigate neurofibromatosis type 2(NF2) gene mutation at mRNA levels in sporadic orbitocranial meningioma and its association with progesterone receptor(PR) mR NA expression.METHODS: This was a case-control study. Thirty-four sporadic meningioma patients with no familial NF2-related meningioma history were recruited. They were interviewed for their obstetric, gynecologic, and contraception history. PR investigation was performed with real-time polymerase chain reaction(PCR). NF2 mutation was investigated using Qbiomarker Somatic Mutation PCR Assay at NF2 mRNA level after its cDNA extraction(four mRNA mutation cytoband coordinates for nucleotide change: c.634 C>T/p.Q212, c.655 G>A/p.V219 M, c.784 C>T/p.R262 and c.1228 C>T/p. Q410). RESULTS: After mutation analysis at mRNA level, NF2 gene mutation was found in 35.29% patients. Non-mutation group was strongly associated with exogenous hormonal exposure(non-mutation vs mutation: 95.5% vs 83.3%, P<0.001). PR mR NA was found significantly lower in nonmutation group(P=0.033) which presumed as long term exogenous progesterone exposure. However, mutation group was associated with higher rate of progression to gradeⅡ(mutation vs non-mutation, 18.2% vs 5%, P<0.001) and was associated more in fibrous and anaplastic tumor tissue.CONCLUSION: NF2 mutation-meningioma is associated with higher grade of meningioma. Non NF2 mutationmeningioma is strongly associated with exogenous progesterone exposure and lower PR expression.
