This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on t...This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.展开更多
The expression of basic fibroblast growth factor (bFGF) and fibroblast growth factor receptor-1 (FGFR-1) in human meningiomas and the relationships between their expression and the tumors' histological features an...The expression of basic fibroblast growth factor (bFGF) and fibroblast growth factor receptor-1 (FGFR-1) in human meningiomas and the relationships between their expression and the tumors' histological features and angiogenesis were investigated by means of immunohistochemical technique. The expression of bFGF and FGFR-1 was detected by antibody of bFGF or FGFR-1. The tumors' angiogenesis was evaluated by microvascular density (MVD) and, which was observed by use of CD34-antibody immunohistochemically. The results showed that there were varied degrees of the expression of bFGF and FGFR-1 proteins in meningiomas. The expression was correlated with the tumors' histological characters and angiogenesis. It was concluded that bFGF and FGFR-1 might play important roles in meningiomas' angiogenesis and proliferation. The expression positive rate of bFGF and FGFR-1 may provide an indication of evaluating the histological and malignant degree of the tumor.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 bioti...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： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age...Background： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University（PU） models. The accuracy of each model was assessed using area under the receiver operating characteristics（ROC） and calibration curves.Results： The area under the ROC curve of the PU model [0.800; 95% confidence interval（CI）： 0.708-0.891] was higher than that of the Mayo model（0.753; 95% CI： 0.650-0.857） or VA model（0.728; 95% CI： 0.623-0.833）; however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.Conclusions： The three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.Background： Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.Methods： Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old（the mean age was 48.5 years old）. Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.Results： All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.Conclusions： This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.Background： The purposes of this study were to explore the effects of high mobility group protein box 1（HMGB1） gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. Methods： The expressions of HMGB1 in glioma cells（U251, U-87 MG and LN-18） and one control cell line（SVG p12） were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected： the expression of HMGB1 in human glioma cell lines U251 and U-87 MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87 MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. Results： As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells（U251, U-87 MG, and LN-18） in comparison with the control cell line（SVG p12）; the vitality, proliferation and invasive capabilities of U251 and U-87 MG cells in the HMGB1 siR NA-transfected group were significantly lower than those in the blank control group and negative control（NC） siR NA group（P〈0.05） but showed no significant difference between the blank control group and NC siR NA group. The percentage of apoptotic U251 and U-87 MG cells was significantly higher in the HMGB1 siR NA-transfected group than in the blank control group and NC siR NA group（P〈0.05） but was similar between the latter two groups. The HMGB1 siR NA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87 MG cells and significantly higher expression of Bax protein than in the blank control group and NC siR NA group（P〈0.05）; the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siR NA group. Conclusions： HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.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
To investigate the expression of integrin-α3 mRNA in meningiomas and its correlation with proliferation and invasion, the expression of integrin-α3 subunit was detected by using in situ hybridization in patients wit...To investigate the expression of integrin-α3 mRNA in meningiomas and its correlation with proliferation and invasion, the expression of integrin-α3 subunit was detected by using in situ hybridization in patients with meningiomas （36 cases） and normal dura （2 cases） and arachnoid tis- sues （2 cases）. SABC immunohistochemical assay was used to study the expression of Ki-67 nuclear antigen. The results showed that the expression of integrin-% mRNA in benign, atypical and malig- nant meningiomas was 2.52±0.362, 1.75±0.316 and 1.42±0.633, respectively. The expression levels of integrin-α3 mRNA was significantly lower in atypical or malignant meningiomas than those in benign meningiomas （P〈0.05, P〈0,01, respectively）. The expression of integrin-α3 mRNA in those with invasive biological behavior was lower than that in those without invasion （1.63±0.462 vs. 2.61±0.526, P〈0.01）. Moreover, the expression of integrin-α3 mRNA was inversely associated with Ki-67 labeling index in all cases. It suggested that integfin-α3 subunit participated in the modulatory process of growth of meningiomas. The proliferation activity and malignant grade of meningiomas were increased with the decreased expression of integrin-α3 subunit, and the down-regulation of integrin-α3 mRNA was associated with the invasive biological behaviors in meningiomas.展开更多
The purpose of this essay was to illustrate the radiological and pathological findings in a wide spectrum of dural lesions mimicking meningiomas.Familiarity with and knowledge of these findings will narrow the differe...The purpose of this essay was to illustrate the radiological and pathological findings in a wide spectrum of dural lesions mimicking meningiomas.Familiarity with and knowledge of these findings will narrow the differential diagnosis and provide guidance for patient management.In this pictorial review,we describe the following entities:Solitary fibrous tumors,hemangiopericytoma,gliosarcoma,leiomyosarcoma,dural metastases,Hodgkin’s disease,plasmocytoma,Rosai-Dorfman disease,neurosarcoidosis,melanocytic neoplasms and plasma cell granuloma.展开更多
Tuberculum sellae meningiomas (TSMs) represent special surgical challenge for neurosurgeons. In this review, we summarize the most common clinical manifestations, diagnostic images, surgical approaches and prognostic ...Tuberculum sellae meningiomas (TSMs) represent special surgical challenge for neurosurgeons. In this review, we summarize the most common clinical manifestations, diagnostic images, surgical approaches and prognostic factors for outcome at single tertiary care teaching hospitals. Material and Methods: Prospective study was done between January 2010 and January 2017 (Minimum 24-month follow-up). Imaging and clinical data of 31 consecutive patients with TSMs were collected and analyzed. There were no exclusion criteria. Result: The majority of patients were >40 years old (22 patients;71%). There was a female preponderance 74%: 23 cases (M/F ratio was 1:3). The most common clinical presentation was visual impairment (24;77%). The mean tumor size was 3.3 cm. Thirty-one patients underwent surgical excision by different approaches. The overall visual improvement was 29% (9 of 31 patients) however visual deterioration occurred in 6.4% (2 of 31 patients). Favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). This finding was statistically significant (P ≤ 0.05). Also, visual outcome had significant correlations with edema surrounded tumor: arterial encasement by the tumor and brain-tumor interface. Two patients died 3 weeks postoperatively from brain stem infarction (overall incidence of mortality 6%) while the overall incidence of morbidity was 19% (6 of 31 patients). Conclusion: The most common symptom of Tuberculum sellae meningioma is visual affection. The favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). Also;visual prognosis had significant correlations with peritumoral edema, arterial encasement by the tumor, and brain-tumor interface.展开更多
BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various author...BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.展开更多
Objective To investigate microsurgical techniques in bilateral falcine meningiomas of central gyrus region surgery. Methods Sixteen patients with bilateral falcine meningiomas in central gyrus region were treateded wi...Objective To investigate microsurgical techniques in bilateral falcine meningiomas of central gyrus region surgery. Methods Sixteen patients with bilateral falcine meningiomas in central gyrus region were treateded with a series of microsurgical techniques,including midline crossing craniotomy,dural cut in a strip fashion展开更多
Objective： Intracranial meningiomas, especially those located at anterior and middle skull base, are difficult to be completely resected due to their complicated anatomy structures and adjacent vessels. It＇s essenti...Objective： Intracranial meningiomas, especially those located at anterior and middle skull base, are difficult to be completely resected due to their complicated anatomy structures and adjacent vessels. It＇s essential to locate the tumor and its vessels precisely during operation to reduce the risk of neurological deficits. The purpose of this study was to evaluate intraoperative ultrasonography in displaying intracranial meningioma and its surrounding arteries, and evaluate its potential to improve surgical precision and minimize surgical trauma. Methods： Between December 2011 and January 2013, 20 patients with anterior and middle skull base meningioma underwent surgery with the assistance of intraoperative ultrasonography in the Neurosurgery Department of Shanghai Huashan Hospital. There were 7 male and 13 female patients, aged from 31 to 66 years old. Their sonographic features were analyzed and the advantages of intraoperative ultrasonography were discussed. Results： The border of the rneningioma and its adjacent vessels could be exhibited on intraoperative ultrasonography. The sonographic visualization allowed the neurosurgeon to choose an appropriate approach before the operation. In addition, intraoperative ultrasonography could inform neurosurgeons about the location of the tumor, its relation to the surrounding arteries during the operation, thus these essential arteries could be protected carefully. Conclusions： Intraoperative ultrasonography is a useful intraoperative technique. When appropriately applied to assist surgical procedures for intracranial meningioma, it could offer very important intraoperative information （such as the tumor supplying vessels） that helps to improve surgical resection and therefore might reduce the postoperative morbidity.展开更多
BACKGROUND： As aging in elderly people, their brain tissue has degeneration and brain atrophy of different severity, and the volume of cranial cavity is relatively enlarged, it has greater compensatory ability to the...BACKGROUND： As aging in elderly people, their brain tissue has degeneration and brain atrophy of different severity, and the volume of cranial cavity is relatively enlarged, it has greater compensatory ability to the space occupying lesion, and it is difficult to detect the meningioma because it grows to expand slowly, the tumor locates in non-functional region, and there are atypical symptoms and deficiency of localization signs. OBJECTIVE： To investigate the clinicopathologic features of senile meningiomas. DESIGN： A retrospective analysis. SETTING： Affiliated Hospital of Hebei University. PARTICIPANTS： Forty-nine elderly patients with meningioma were selected from the Department of Neurosurgery, Affiliated Hospital of Hebei University from May 1999 to March 2005, including 15 males and 34 females, 60-74 years of age, and they were all diagnosed by CT and MRI. METHODS： The sites of tumors were identified by CT and MRI examinations in all the patients. The tumors were partially or totally resected according to their own conditions. The types of the resected tumor were pathologically observed. The conditions of postoperative recovery were observed after 1, 3 and 6 months, and without new neurological dysfunction or complication was considered as good outcome. MAIN OUTCOME MEASURES： ① Sites and pathological types of the tumor; ② Postoperative outcomes and complications. RESULTS： All the 49 patients were involved in the analysis of results. ① The tumors had wide distributions with a main location in brain convexity. Among the 49 cases of meningioma, there were 25 cases of fibrocystic type, 12 cases of meningothelial type, 6 cases of psammomatous type, 4 cases of angiomatous type and 2 cases of microcystic type. ② Among the 49 patients, 35 had good outcome, 8 had self-care ability, 4 required care by others, 2 （4.1%） died postoperatively. No long-term complication related to the operation was observed during the follow-up postoperatively. CONCLUSION： Meningioma has a main location in brain convexity, and its pathological type is mainly fibrocystic one, and there is good operative outcome.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： Several studies have shown that midkine directly participates in tumor cell growth and invasion, as well as the regulation of angiogenesis. OBJECTIVE： To investigate midkine expression in meningioma tiss...BACKGROUND： Several studies have shown that midkine directly participates in tumor cell growth and invasion, as well as the regulation of angiogenesis. OBJECTIVE： To investigate midkine expression in meningioma tissue in relation to angiogenesis, invasion, peritumoral edema, and clinicopathology. DESIGN, TIME AND SETTING： The present clinical, case-controlled, neuropathological study was performed at the Laboratory of Molecular Organism, People＇s Hospital of Deyang City between May 2007 and April 2008. MATERIALS： Fifty-two meningioma tissues were classified by WHO tumor classification of the central nervous system, comprising 40 grade Ⅰ meningioma, five grade Ⅱ meningioma, and seven grade Ⅲ meningioma. Ten normal, human cerebral maters were selected from cerebral trauma patients. METHODS： Midkine protein expression and mean microvessel density were detected using immunohistochemical techniques. Simultaneously, all data were statistically analyzed. MAIN OUTCOME MEASURES： Midkine expression and microvessel density in meningiomas and normal cerebral maters. RESULTS： The positive midkine expression rate was 64% in the meningioma tissues. However, midkine expression was not detected in normal cerebral mater tissue. The mean microvessel density was 82.0 ± 22.7 in the meningiomas, and 25.8± 6.2 in the normal cerebral mater tissues. There was significant difference in midkine expression and mean microvessel density between meningioma tissues and human cerebral maters （P 〈 0.05）. Midkine expression positively correlated with microvessel density （r = 0.756, P 〈 0.05）. Midkine expression did not correlate to patient age, gender, or tumor size, location, and shape （P 〉 0.05）. However, it closely correlated with patient clinical condition, pathological grade, invasion, and peritumoral edema （r = 0.3785,0.741 2,0.6518, 0.614 2, P 〈 0.05）. CONCLUSION： Midkine protein was overexpressed in meningiomas and correlated to tumor angiogenesis, invasion, pefitumoral edema, and clinicopathology.展开更多
BACKGROUND Deep Sylvian meningiomas are rare and difficult to diagnose when small tumours lead to various symptoms.The difficulty associated with surgery is underestimated.Our case involved a mass(11 mm×12 mm...BACKGROUND Deep Sylvian meningiomas are rare and difficult to diagnose when small tumours lead to various symptoms.The difficulty associated with surgery is underestimated.Our case involved a mass(11 mm×12 mm×12 mm in size)in the right Sylvian fissure.It is the smallest deep Sylvian meningioma known and might be more easily misdiagnosed than previous examples.CASE SUMMARY A well-enhanced mass in the right Sylvian fissure of a 26-year-old male with a three-month history of seizure was identified via magnetic resonance imaging.The patient underwent operations twice for seizure control.During the first operation,the tumour was surrounded by the second segment of the middle cerebral artery and its numerous perforators.Partial resection had to be selected due to mild arterial damage.After the first operation,the patient presented with simple partial seizure.During reoperation,we isolated the anatomical structure near the tumour and the tumour over and removed it from its dorsal side by piecemeal resection.CONCLUSION This case reported the smallest deep Sylvian meningioma according to a literature review.Preoperative diagnosis is a crucial step due to deep Sylvian meningioma firmly adhering to the middle cerebral artery and its perforators.Adequate preparation is crucial to ensure the success of 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
OBJECTIVE To analyze our management strategy and results of treating patients affected by meningiomas invading the sagittal or transverse sinuses.METHOOS Review of data from 35 patients with pathologically confirmed m...OBJECTIVE To analyze our management strategy and results of treating patients affected by meningiomas invading the sagittal or transverse sinuses.METHOOS Review of data from 35 patients with pathologically confirmed meningiomas（29 of the sagittal sinus and 6 of the transverse sinus） surgically treated between from July 1999 and June 2003, including clinical manifestations, mode of diagnosis and curative effect of microsurgery etc. For our surgical decision-making, meningiomas were classified into six types based on the degree of sinus involvement.RESULTS A Simpson＇s Grade Ⅰ resection was achieved in 27 cases （77.1%）, Grade Ⅱ in 6 （17.1%） and Grade Ⅲ in 2 （5.7%）. No patients died after the operations. The recurrence rate in the study overall was 2.9%, with a follow-up period from 3 to 6 years.CONCLUSION Application of microsurgical techniques, protection of the sinus, avoidance of damages to the cerebral cortex, veins of the central sulcus, as well as other veins from the tumor, are the major factors for increasing the rate of total resection, reducing complications and improving the quality of life for the patients with meningiomas invading the sagittal or transverse sinuses.展开更多
The cases of 82 patients with cavernous sinus meningioma (CSM) treated with Stereotactic Radiosurgery (SRS) at our institution from 1992 to 2005 were retrospectively reviewed. The mean follow-up time was 8.38 years. P...The cases of 82 patients with cavernous sinus meningioma (CSM) treated with Stereotactic Radiosurgery (SRS) at our institution from 1992 to 2005 were retrospectively reviewed. The mean follow-up time was 8.38 years. Patients’?age ranged between 16 and 78 years (mean 51). There were 35 patients who had been operated before, and two of them had been treated with fractionated radiotherapy. Twenty-three from 35 patients were surgically intervened?(65.7%)?and?presented post-surgical morbidity. Only in 3 cases the surgery was considered complete. The patients were referred for SRS treatment due to having tumour remains or a tumour growth. The mean volume of the tumour was 17.96 (+/?13.67) cm3.?All the patients had been treated with a Linear Accelerator (LINAC) using a high precision positioning and radiation system (SRS 2000) University of Florida. The clinical progress of the patients was assessed using preand post-SRS radiological imaging, post-surgical and pre-post-SRS morbidity and mortality. Tumour volume decreased significantly with RS in 61 of 82 patients (74.4%). The tumour volume remained stable 12 patients (14.6%) and only in 9 patients (11%) was there tumour growth after SRS. Of these, 5 required surgical intervention, and 7 of the 82 underwent SRS or another fractionated stereotactic radiotherapy after the RS. Morbidity due to the SRS was only seen in 14 out of the 82 patients treated with SRS, five of them recovered completely. SRS is a high precise and effective treatment with low morbidity, becoming more and more the option of choices?in the treatment of cavernous sinus meningioma.展开更多
Introduction: Meningiomas are the most common type of extra-axial neoplasm. Peritumoral brain edema (PTBE) can be seen around meningiomas while it may be absent in others. Despite that Ki67 proliferative index has bee...Introduction: Meningiomas are the most common type of extra-axial neoplasm. Peritumoral brain edema (PTBE) can be seen around meningiomas while it may be absent in others. Despite that Ki67 proliferative index has been previously correlated with meningioma grades, no definite relationship has been established in relation to PTBE in meningioma patients. Objective: Correlate the peritumoral brain edema with the Ki67 proliferative index of meningiomas. Patients & Methods: Aclinical prospective study was conducted on 56 patients (47 women, 9 men;mean age 50.89 ± 12.55 years) diagnosed with meningiomas. All patients were evaluated regarding the presence of brain edema surrounding the lesion in pre-operative neuroimaging using T2W and FLAIR MR images. Immunohistochemical staining of Ki67 index (representing proliferative activity) was done. Correlation between presence of PTBE and Ki67 index values was evaluated. Results: PTBE was found in nearly half of the patients (48.2%), while the remaining (51.8%) of patients did not exhibit PTBE in their pre-operative neuroimaging. The mean value of Ki67 index in meningioma patients with PTBE was 4.83% compared to a value of 1.83% in patients without PTBE, P value = 0.014. Conclusion: High Ki67 indices are evident in meningiomas with surrounding peritumoral brain edema (PTBE).展开更多
文摘This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.
文摘The expression of basic fibroblast growth factor (bFGF) and fibroblast growth factor receptor-1 (FGFR-1) in human meningiomas and the relationships between their expression and the tumors' histological features and angiogenesis were investigated by means of immunohistochemical technique. The expression of bFGF and FGFR-1 was detected by antibody of bFGF or FGFR-1. The tumors' angiogenesis was evaluated by microvascular density (MVD) and, which was observed by use of CD34-antibody immunohistochemically. The results showed that there were varied degrees of the expression of bFGF and FGFR-1 proteins in meningiomas. The expression was correlated with the tumors' histological characters and angiogenesis. It was concluded that bFGF and FGFR-1 might play important roles in meningiomas' angiogenesis and proliferation. The expression positive rate of bFGF and FGFR-1 may provide an indication of evaluating the histological and malignant degree of the tumor.
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.
基金supported by National Natural Science Foundation of China (81200936, 81372707)Shanghai Committee of Science and Technology (12JC1401800)
文摘Background： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University（PU） models. The accuracy of each model was assessed using area under the receiver operating characteristics（ROC） and calibration curves.Results： The area under the ROC curve of the PU model [0.800; 95% confidence interval（CI）： 0.708-0.891] was higher than that of the Mayo model（0.753; 95% CI： 0.650-0.857） or VA model（0.728; 95% CI： 0.623-0.833）; however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.Conclusions： The three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.Background： Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.Methods： Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old（the mean age was 48.5 years old）. Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.Results： All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.Conclusions： This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.Background： The purposes of this study were to explore the effects of high mobility group protein box 1（HMGB1） gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. Methods： The expressions of HMGB1 in glioma cells（U251, U-87 MG and LN-18） and one control cell line（SVG p12） were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected： the expression of HMGB1 in human glioma cell lines U251 and U-87 MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87 MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. Results： As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells（U251, U-87 MG, and LN-18） in comparison with the control cell line（SVG p12）; the vitality, proliferation and invasive capabilities of U251 and U-87 MG cells in the HMGB1 siR NA-transfected group were significantly lower than those in the blank control group and negative control（NC） siR NA group（P〈0.05） but showed no significant difference between the blank control group and NC siR NA group. The percentage of apoptotic U251 and U-87 MG cells was significantly higher in the HMGB1 siR NA-transfected group than in the blank control group and NC siR NA group（P〈0.05） but was similar between the latter two groups. The HMGB1 siR NA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87 MG cells and significantly higher expression of Bax protein than in the blank control group and NC siR NA group（P〈0.05）; the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siR NA group. Conclusions： HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.
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To investigate the expression of integrin-α3 mRNA in meningiomas and its correlation with proliferation and invasion, the expression of integrin-α3 subunit was detected by using in situ hybridization in patients with meningiomas （36 cases） and normal dura （2 cases） and arachnoid tis- sues （2 cases）. SABC immunohistochemical assay was used to study the expression of Ki-67 nuclear antigen. The results showed that the expression of integrin-% mRNA in benign, atypical and malig- nant meningiomas was 2.52±0.362, 1.75±0.316 and 1.42±0.633, respectively. The expression levels of integrin-α3 mRNA was significantly lower in atypical or malignant meningiomas than those in benign meningiomas （P〈0.05, P〈0,01, respectively）. The expression of integrin-α3 mRNA in those with invasive biological behavior was lower than that in those without invasion （1.63±0.462 vs. 2.61±0.526, P〈0.01）. Moreover, the expression of integrin-α3 mRNA was inversely associated with Ki-67 labeling index in all cases. It suggested that integfin-α3 subunit participated in the modulatory process of growth of meningiomas. The proliferation activity and malignant grade of meningiomas were increased with the decreased expression of integrin-α3 subunit, and the down-regulation of integrin-α3 mRNA was associated with the invasive biological behaviors in meningiomas.
文摘The purpose of this essay was to illustrate the radiological and pathological findings in a wide spectrum of dural lesions mimicking meningiomas.Familiarity with and knowledge of these findings will narrow the differential diagnosis and provide guidance for patient management.In this pictorial review,we describe the following entities:Solitary fibrous tumors,hemangiopericytoma,gliosarcoma,leiomyosarcoma,dural metastases,Hodgkin’s disease,plasmocytoma,Rosai-Dorfman disease,neurosarcoidosis,melanocytic neoplasms and plasma cell granuloma.
文摘Tuberculum sellae meningiomas (TSMs) represent special surgical challenge for neurosurgeons. In this review, we summarize the most common clinical manifestations, diagnostic images, surgical approaches and prognostic factors for outcome at single tertiary care teaching hospitals. Material and Methods: Prospective study was done between January 2010 and January 2017 (Minimum 24-month follow-up). Imaging and clinical data of 31 consecutive patients with TSMs were collected and analyzed. There were no exclusion criteria. Result: The majority of patients were >40 years old (22 patients;71%). There was a female preponderance 74%: 23 cases (M/F ratio was 1:3). The most common clinical presentation was visual impairment (24;77%). The mean tumor size was 3.3 cm. Thirty-one patients underwent surgical excision by different approaches. The overall visual improvement was 29% (9 of 31 patients) however visual deterioration occurred in 6.4% (2 of 31 patients). Favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). This finding was statistically significant (P ≤ 0.05). Also, visual outcome had significant correlations with edema surrounded tumor: arterial encasement by the tumor and brain-tumor interface. Two patients died 3 weeks postoperatively from brain stem infarction (overall incidence of mortality 6%) while the overall incidence of morbidity was 19% (6 of 31 patients). Conclusion: The most common symptom of Tuberculum sellae meningioma is visual affection. The favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). Also;visual prognosis had significant correlations with peritumoral edema, arterial encasement by the tumor, and brain-tumor interface.
文摘BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.
文摘Objective To investigate microsurgical techniques in bilateral falcine meningiomas of central gyrus region surgery. Methods Sixteen patients with bilateral falcine meningiomas in central gyrus region were treateded with a series of microsurgical techniques,including midline crossing craniotomy,dural cut in a strip fashion
基金supported by National Natural Science Foundation of China (81200936, 30872675, 30901549)Shanghai Committee of Science and Technology(12JC1401800)2011 Shanghai Medical College Young Scientist Fund of Fudan University (11L-24)
文摘Objective： Intracranial meningiomas, especially those located at anterior and middle skull base, are difficult to be completely resected due to their complicated anatomy structures and adjacent vessels. It＇s essential to locate the tumor and its vessels precisely during operation to reduce the risk of neurological deficits. The purpose of this study was to evaluate intraoperative ultrasonography in displaying intracranial meningioma and its surrounding arteries, and evaluate its potential to improve surgical precision and minimize surgical trauma. Methods： Between December 2011 and January 2013, 20 patients with anterior and middle skull base meningioma underwent surgery with the assistance of intraoperative ultrasonography in the Neurosurgery Department of Shanghai Huashan Hospital. There were 7 male and 13 female patients, aged from 31 to 66 years old. Their sonographic features were analyzed and the advantages of intraoperative ultrasonography were discussed. Results： The border of the rneningioma and its adjacent vessels could be exhibited on intraoperative ultrasonography. The sonographic visualization allowed the neurosurgeon to choose an appropriate approach before the operation. In addition, intraoperative ultrasonography could inform neurosurgeons about the location of the tumor, its relation to the surrounding arteries during the operation, thus these essential arteries could be protected carefully. Conclusions： Intraoperative ultrasonography is a useful intraoperative technique. When appropriately applied to assist surgical procedures for intracranial meningioma, it could offer very important intraoperative information （such as the tumor supplying vessels） that helps to improve surgical resection and therefore might reduce the postoperative morbidity.
文摘BACKGROUND： As aging in elderly people, their brain tissue has degeneration and brain atrophy of different severity, and the volume of cranial cavity is relatively enlarged, it has greater compensatory ability to the space occupying lesion, and it is difficult to detect the meningioma because it grows to expand slowly, the tumor locates in non-functional region, and there are atypical symptoms and deficiency of localization signs. OBJECTIVE： To investigate the clinicopathologic features of senile meningiomas. DESIGN： A retrospective analysis. SETTING： Affiliated Hospital of Hebei University. PARTICIPANTS： Forty-nine elderly patients with meningioma were selected from the Department of Neurosurgery, Affiliated Hospital of Hebei University from May 1999 to March 2005, including 15 males and 34 females, 60-74 years of age, and they were all diagnosed by CT and MRI. METHODS： The sites of tumors were identified by CT and MRI examinations in all the patients. The tumors were partially or totally resected according to their own conditions. The types of the resected tumor were pathologically observed. The conditions of postoperative recovery were observed after 1, 3 and 6 months, and without new neurological dysfunction or complication was considered as good outcome. MAIN OUTCOME MEASURES： ① Sites and pathological types of the tumor; ② Postoperative outcomes and complications. RESULTS： All the 49 patients were involved in the analysis of results. ① The tumors had wide distributions with a main location in brain convexity. Among the 49 cases of meningioma, there were 25 cases of fibrocystic type, 12 cases of meningothelial type, 6 cases of psammomatous type, 4 cases of angiomatous type and 2 cases of microcystic type. ② Among the 49 patients, 35 had good outcome, 8 had self-care ability, 4 required care by others, 2 （4.1%） died postoperatively. No long-term complication related to the operation was observed during the follow-up postoperatively. CONCLUSION： Meningioma has a main location in brain convexity, and its pathological type is mainly fibrocystic one, and there is good operative outcome.
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： Several studies have shown that midkine directly participates in tumor cell growth and invasion, as well as the regulation of angiogenesis. OBJECTIVE： To investigate midkine expression in meningioma tissue in relation to angiogenesis, invasion, peritumoral edema, and clinicopathology. DESIGN, TIME AND SETTING： The present clinical, case-controlled, neuropathological study was performed at the Laboratory of Molecular Organism, People＇s Hospital of Deyang City between May 2007 and April 2008. MATERIALS： Fifty-two meningioma tissues were classified by WHO tumor classification of the central nervous system, comprising 40 grade Ⅰ meningioma, five grade Ⅱ meningioma, and seven grade Ⅲ meningioma. Ten normal, human cerebral maters were selected from cerebral trauma patients. METHODS： Midkine protein expression and mean microvessel density were detected using immunohistochemical techniques. Simultaneously, all data were statistically analyzed. MAIN OUTCOME MEASURES： Midkine expression and microvessel density in meningiomas and normal cerebral maters. RESULTS： The positive midkine expression rate was 64% in the meningioma tissues. However, midkine expression was not detected in normal cerebral mater tissue. The mean microvessel density was 82.0 ± 22.7 in the meningiomas, and 25.8± 6.2 in the normal cerebral mater tissues. There was significant difference in midkine expression and mean microvessel density between meningioma tissues and human cerebral maters （P 〈 0.05）. Midkine expression positively correlated with microvessel density （r = 0.756, P 〈 0.05）. Midkine expression did not correlate to patient age, gender, or tumor size, location, and shape （P 〉 0.05）. However, it closely correlated with patient clinical condition, pathological grade, invasion, and peritumoral edema （r = 0.3785,0.741 2,0.6518, 0.614 2, P 〈 0.05）. CONCLUSION： Midkine protein was overexpressed in meningiomas and correlated to tumor angiogenesis, invasion, pefitumoral edema, and clinicopathology.
基金Supported by the key research and development program of Ningxia,No.2018BFG02007.
文摘BACKGROUND Deep Sylvian meningiomas are rare and difficult to diagnose when small tumours lead to various symptoms.The difficulty associated with surgery is underestimated.Our case involved a mass(11 mm×12 mm×12 mm in size)in the right Sylvian fissure.It is the smallest deep Sylvian meningioma known and might be more easily misdiagnosed than previous examples.CASE SUMMARY A well-enhanced mass in the right Sylvian fissure of a 26-year-old male with a three-month history of seizure was identified via magnetic resonance imaging.The patient underwent operations twice for seizure control.During the first operation,the tumour was surrounded by the second segment of the middle cerebral artery and its numerous perforators.Partial resection had to be selected due to mild arterial damage.After the first operation,the patient presented with simple partial seizure.During reoperation,we isolated the anatomical structure near the tumour and the tumour over and removed it from its dorsal side by piecemeal resection.CONCLUSION This case reported the smallest deep Sylvian meningioma according to a literature review.Preoperative diagnosis is a crucial step due to deep Sylvian meningioma firmly adhering to the middle cerebral artery and its perforators.Adequate preparation is crucial to ensure the success of 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OBJECTIVE To analyze our management strategy and results of treating patients affected by meningiomas invading the sagittal or transverse sinuses.METHOOS Review of data from 35 patients with pathologically confirmed meningiomas（29 of the sagittal sinus and 6 of the transverse sinus） surgically treated between from July 1999 and June 2003, including clinical manifestations, mode of diagnosis and curative effect of microsurgery etc. For our surgical decision-making, meningiomas were classified into six types based on the degree of sinus involvement.RESULTS A Simpson＇s Grade Ⅰ resection was achieved in 27 cases （77.1%）, Grade Ⅱ in 6 （17.1%） and Grade Ⅲ in 2 （5.7%）. No patients died after the operations. The recurrence rate in the study overall was 2.9%, with a follow-up period from 3 to 6 years.CONCLUSION Application of microsurgical techniques, protection of the sinus, avoidance of damages to the cerebral cortex, veins of the central sulcus, as well as other veins from the tumor, are the major factors for increasing the rate of total resection, reducing complications and improving the quality of life for the patients with meningiomas invading the sagittal or transverse sinuses.
文摘The cases of 82 patients with cavernous sinus meningioma (CSM) treated with Stereotactic Radiosurgery (SRS) at our institution from 1992 to 2005 were retrospectively reviewed. The mean follow-up time was 8.38 years. Patients’?age ranged between 16 and 78 years (mean 51). There were 35 patients who had been operated before, and two of them had been treated with fractionated radiotherapy. Twenty-three from 35 patients were surgically intervened?(65.7%)?and?presented post-surgical morbidity. Only in 3 cases the surgery was considered complete. The patients were referred for SRS treatment due to having tumour remains or a tumour growth. The mean volume of the tumour was 17.96 (+/?13.67) cm3.?All the patients had been treated with a Linear Accelerator (LINAC) using a high precision positioning and radiation system (SRS 2000) University of Florida. The clinical progress of the patients was assessed using preand post-SRS radiological imaging, post-surgical and pre-post-SRS morbidity and mortality. Tumour volume decreased significantly with RS in 61 of 82 patients (74.4%). The tumour volume remained stable 12 patients (14.6%) and only in 9 patients (11%) was there tumour growth after SRS. Of these, 5 required surgical intervention, and 7 of the 82 underwent SRS or another fractionated stereotactic radiotherapy after the RS. Morbidity due to the SRS was only seen in 14 out of the 82 patients treated with SRS, five of them recovered completely. SRS is a high precise and effective treatment with low morbidity, becoming more and more the option of choices?in the treatment of cavernous sinus meningioma.
文摘Introduction: Meningiomas are the most common type of extra-axial neoplasm. Peritumoral brain edema (PTBE) can be seen around meningiomas while it may be absent in others. Despite that Ki67 proliferative index has been previously correlated with meningioma grades, no definite relationship has been established in relation to PTBE in meningioma patients. Objective: Correlate the peritumoral brain edema with the Ki67 proliferative index of meningiomas. Patients & Methods: Aclinical prospective study was conducted on 56 patients (47 women, 9 men;mean age 50.89 ± 12.55 years) diagnosed with meningiomas. All patients were evaluated regarding the presence of brain edema surrounding the lesion in pre-operative neuroimaging using T2W and FLAIR MR images. Immunohistochemical staining of Ki67 index (representing proliferative activity) was done. Correlation between presence of PTBE and Ki67 index values was evaluated. Results: PTBE was found in nearly half of the patients (48.2%), while the remaining (51.8%) of patients did not exhibit PTBE in their pre-operative neuroimaging. The mean value of Ki67 index in meningioma patients with PTBE was 4.83% compared to a value of 1.83% in patients without PTBE, P value = 0.014. Conclusion: High Ki67 indices are evident in meningiomas with surrounding peritumoral brain edema (PTBE).
