Diagnostic approach to a rare case of anaplastic meningioma with osteosarcomatous differentiation and associated bone alterations

Anaplastic meningioma with osteosarcomatous differentiation is a very rare finding. We herewith present squash cytology, histopathology and immunohistochemistry findings of this rare case with systematic approach to diagnosis. A 38-year-old female presented with complaints of headache, vomiting, seizure with loss of consciousness and left side weakness. Radiologically, there was a heterogeneous hyperintense likely extra axial densely calcified solid lesion measuring approximately 4.2�1�5 cm along right high frontal convexity compressing the adjacent brain parenchyma. Histology sections revealed fibro collagenous tissue, devitalized bone, multiple vascular spaces lined by fibrous septa with giant cells, along with spindle cell and round proliferation at one end with vague whorl formation. High mitosis, (>20/10 hpf) along with malignant lacy osteoid closely abutting the highly pleomorphic cells were indicative of a malignant spindle cell neoplasm with osteosarcomatous differentiation. Systematic approach, immunohistochemistry with involvement of all the specialities involved led to the correct diagnosis and management of patient.

Association of radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas

Background: In neurosurgical practice meningiomas are one of the commonest intracranial tumors to seek surgical intervention which is classified into 3 histological grades and 15 subtypes according to the 2016 WHO classification of tumors of the CNS. The aim of this study was to evaluate the association between radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas. Methods: This was a cross sectional interventional study carried out in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka Medical College Hospital and National Institute of Neuroscience Hospital including 35 patients of intracranial meningiomas who fulfilled the selection criteria were enrolled in this study. Results: This study included 35 cases of intracranial meningiomas. There were 22 individuals (62.9%) in the 28-47 age group. The mean±standard deviation (SD) age of the participants was 45.97±9.56 years. There were 9 male participants (25.7%) and 26 female participants (74.3%) with ratio 1:3. We see that parasagittal location (50%) and sphenoid wing (33.3%) were more prevalent in grade II. We found significant distribution of the types of DTS among the histological grades of meningioma. The nodular cases (6,100%) were all grade II type. Mixed type was the most prevalent type among grade I. Conclusions: There is association of radiological type of dural tail sign in contrast MRI with histopathological grading of intracranial meningiomas and may be used as a good tools for forecasting tumor type and prognosis.

Comparative study between Tada formula method and three-dimensional reconstruction method for evaluating meningioma volume / 重庆医学

Objective To investigate the accuracy and application value of the Tada formula in evalua-ting the meningioma volume based on 3D reconstruction technology.Methods The thin-slice magnetic reso-nance images of 297 patients with meningioma treated in the neurosurgery department of 940 Hospital of PLA Joint logistics Support Force from January 2014 to May 2022 were retrospectively analyzed.The meningioma volume was evaluated by the Tada formula method and three-dimensional reconstruction method respectively.The accuracy of the evaluation of meningeal tumor volume by the Tada formula was analyzed by grouping sta-tistics.Results In the whole sample and the concentrated sample,the obtained meningioma total volumes had no statistical difference between the two methods(P＞0.05),the Spearman correlation coefficients were 0.995 and 0.993 respectively,and the intragroup correlation coefficients(ICC)were 0.992 and 0.989,respec-tively.In the Bland-Altman plot,most of the data points were within the limit of uniformity.Compared with different groups,the Tada formula had a slightly lower accuracy in the volume assessment of meningiomas with higher degree of irregularity,and a better accuracy in the volume assessment of supratentorial meningio-mas than subtentorial meningiomas.Conclusion The Tada formula could accurately evaluate the volume of meningioma,and it could be used as a preliminary method to evaluate meningioma volume in clinic

Efficacy of 6% hydroxyethyl starch 130/0.4 electrolyte solution for fluid therapy in patients undergoing meningioma resection / 中华麻醉学杂志

Objective:To evaluate the efficacy of 6% hydroxyethyl starch (HES) 130/0.4 electrolyte solution for fluid therapy in the patients undergoing meningioma resection.Methods:Ninety-two American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, with expected operation duration>3 h, undergoing elective meningioma resection, were divided into 2 groups ( n=46 each) using a random number table method: lactated Ringer′s solution (LR) group and HES group. LR was infused throughout operation in group LR, and 6% HES was intravenously infused in group HES, with the maximum dose not exceeding 50 ml/kg, and the excess part was supplemented with LR. Goal-directed fluid therapy was used to maintain stroke volume variation<13% and mean arterial pressure 70-90 mmHg. Arterial blood gas analysis was performed immediately before anesthesia induction (T 0), when 1 000 and 2 000 ml of fluid were infused (T 1, 2), and at the end of surgery (T 3) to record electrolyte and acid-base balance indexes. Thromboelastogram was simultaneously monitored. The occurrence of electrolyte disorder, acid-base imbalance and abnormal coagulation function and consumption of norepinephrine were recorded. Patients were followed up at 3 and 7 days after surgery, and the Chinese quality of recovery-15 scores were recorded. The hospitalization time and occurrence of brain edema, pulmonary edema, nausea and vomiting were recorded. Results:In group L and group H, 4 cases and 6 cases were excluded due to prolonged operation time, and 42 cases and 40 cases were finally included, respectively. Compared with LR group, the plasma Na + concentration was significantly increased at T 3, the plasma Cl - concentration and pH value were increased at T 1-3, the plasma Ca 2+ concentration was decreased at T 2, 3, reaction time was increased at T 3, coagulation time was increased and maximum amplitude was decreasedat T 2, 3, and coagulation Angle was decreased at T 1-3( P<0.05). No electrolyte disorder and abnormal coagulation function was found in the two groups. There was no statistically significant difference in the consumption of norepinephrine, postoperative Chinese quality of recovery-15 score, length of hospital stay and incidence of alkalosis, pulmonary edema, brain edema, and nausea and vomiting between the two groups ( P>0.05). Conclusions:The efficacy of liquid therapy is comparable between HES and LR in the patients undergoing meningioma resection.

Molecular Pathological Risk Grade Evaluates Biological Behavior and Prognosis of Patients with WHO Grade 1 Meningiomas / 肿瘤防治研究

Objective To explore the correlation of molecular pathological grading with WHO grade 1 meningioma recurrence, malignant progression, and patients’ survival. Methods The medical records and paraffin-embedded tissues of patients with surgically resected WHO grade 1 meningioma were collected. The molecular pathological risk grading suggested by Maas et al. was adopted, and the patients were graded as low, intermediate, and high risk. Univariate log-rank test and multivariate Cox regression analyses were performed to determine the relationship between molecular risk grading and patient progression-free survival (PFS), malignant progression-free survival (MPFS), and overall survival (OS). Results Among 198 patients, 152 (76.8%) were graded as low risk, showing no 1p deletion; 42 (21.2%) patients were graded as intermediate risk, including 18 patients with 1p deletion, 10 patients with 1p combined with 6q deletion, and 14 patients with 1p combined with 14q deletion; and 4 (2%) patients were graded as high risk, including two patients with TERT promoter mutation, one patient with CDKN2A/B homozygous deletion, and one patient with 1p, 6p, and 14q combined deletion. Multivariate analysis showed that molecular risk grading was negatively associated with PFS (HR: 0.029, 95%CI: 0.011-0.080), MPFS (HR: 0.032, 95%CI: 0.004-0.274), and OS (HR: 0.074, 95%CI: 0.032-0.174; P<0.05). Conclusion The biological behavior of histological grade 1 meningiomas still exhibits heterogeneity, and further molecular pathological risk grading can more accurately reflect their biological behavior and evaluate patient prognosis.

Schwannoma-like Breast Metastasis in the Meckel Cave: Case Report / Metástase de mama semelhante a um schwannoma no cavo de Meckel: Relato de caso

Tumors of the Meckel cave are very rare lesions, especially if they are malignant. We report the case of a patient who presented with a breast metastasis in the Meckel cave and a clinical presentation similar to that of a fifth nerve schwannoma.

Os tumores do cavo de Meckel são lesões muito raras, especialmente se forem malignos. Relatamos o caso de uma paciente que apresentou metástase mamária no cavo de Meckel e quadro clínico semelhante a schwannoma do quinto nervo.

Erdheim–Chester disease misdiagnosed as meningioma of the pontocerebellar angle: A case report and review of literature

Erdheim–Chester Disease (ECD) is a rare non-Langerhans form of systemic histiocytosis of unknown etiology with multiple organ involvement. It most commonly affects the long bones, lungs, heart, retroperitoneum, eyes, and kidneys and less commonly the brain and spinal cord. Although there are very few cases of supratentorial ECD mimicking intracranial meningioma reported in literature, to the best of our knowledge, there are no reports on ECD mimicking infratentorial pontocerebellar angle meningioma. The present study reports a case of ECD mimicking pontocerebellar angle meningioma. This study aimed to emphasize the importance of systemic evaluation using a multidisciplinary approach as well as the need for considering ECD as a differential diagnosis of xanthomatous meningioma.

A rare presentation of neurofibromatosis 2 as quadriparesis

Neurofibromatosis (NF) is a complex genetic disorder primarily recognized for its characteristic tumors affecting the nervous system and skin. We present an exceptional case of a patient diagnosed with NF type 2, exhibiting an atypical clinical manifestation-quadriplegia. This case underscores the rarity of such a presentation, as NF typically presents with neurocutaneous features such as café-au-lait macules, neurofibromas, and meningiomas. Our patient, a 46-year-old male, presented with gradual onset quadriplegia without any preceding symptoms of NF. Radiological evaluation revealed meningiomas as well as extensive spinal neurofibromas compressing the spinal cord. This case exemplifies the importance of considering NF as a differential diagnosis in patients presenting with unexpected neurological deficits. Timely recognition and management of such cases are crucial for preventing irreversible neurological damage. This report adds to the growing body of knowledge regarding the diverse clinical presentations of NF and emphasizes the need for comprehensive assessment and multidisciplinary collaboration in managing this intricate disorder within the realm of medicine.

Histomorphological spectrum of meningeal tumours and its association with MIB-1 labelling index

Background: Meningiomas are extremely common, slow growing tumours originating from meningeal covering of brain and spinal cord. They are mostly encountered in middle or later adult life. Females are affected more commonly than males. Grading of meningiomas based on histological features has certain limitations in predicting exact biological behavior hence ancillary studies like immunohistochemistry can be used to predict the nature of the lesion. Methods: This prospective cross-sectional study was conducted in pathology department in our institute. Total 105 cases, diagnosed as meningioma between October 2019 to May 2021 were included in the study. Immuno-staining was performed using MIB-1 antibody against ki67 antigen. Various statistical test methods like chi square test, unpaired t test and spearman’s rho correlation were used to evaluate the significant value. Results: Among 105 patients analysed there were 78.09% females (mean LI 4.01±3.25%) and 21.91% males (mean LI 3.17±2.64%). Mean age of presentation was 53.14 years and most common subtype was transitional meningioma with 51.43% cases. Histological grading revealed 95.24% WHO grade 1 tumor (mean LI- 3.33±2.22%), 4.76% WHO grade 2 (mean LI- 13.80±2.28%) and no case of WHO grade 3. There was correlation between values of MIB-1 LI and histological grade. Some differences for MIB-1 labelling index were found among the subtypes of meningioma of same grade. Conclusions: The MIB-1 is one important tool in addition to routine histological evaluation. High MIB-1 LI indicates higher grade of meningioma.

Manejo quirúrgico de los meningiomas de la región petroclival: resultados y elección de una vía de abordaje / Surgical Management of Petroclival Region Meningiomas: Results and Approach Selection

Introducción: Los Meningiomas de la Región Petroclival (MRPC) son tumores benignos que crecen circunscritos en una región anatómica de difícil acceso quirúrgico comprendida entre el clivus superior y medio, y la cara posterior del hueso petroso, medial al conducto auditivo interno. El manejo quirúrgico de estos tumores representa un desafío en la neurocirugía moderna. El objetivo del presente trabajo es describir los resultados quirúrgicos en una serie de casos y orientar al lector a la selección del abordaje quirúrgico adecuado desde nuestra experiencia. Materiales y Métodos: Se analizaron las historias clínicas de 30 pacientes intervenidos con MRPC desde junio del 2005 hasta septiembre del 2022. Resultados: De los 30 MRPC tratados, la edad promedio fue 52,7 años y el sexo predominante fue el femenino en un 83,3% de los casos. La zona de implantación más común fue la fisura petroclival en un 66% de los casos. El abordaje quirúrgico más utilizado fue el retrosigmoideo en un 44% de las veces seguido del presigmoideo en un 23%. Se consiguió una resección superior o igual al 95% en el 73% de los casos intervenidos. Finalmente presentamos nueve casos clínicos relevantes. Conclusiones: Los resultados de esta serie coinciden con la percepción de la literatura sobre el manejo de esta patología. La elección de una vía de abordaje es un factor determinante para lograr un resultado quirúrgico prometedor (AU)

Background. Meningiomas of the Petroclival Region (MRPC) are benign tumors that arise circumscribed in an anatomical region of difficult surgical access comprised, between the superior and middle clivus, and the posterior aspect of the petrous bone medial to the internal auditory canal. The surgical management of these tumors represents a challenge in modern neurosurgery. The object of the present work is describing the surgical results in a series of cases and to guide the reader in the selection of the appropriate surgical approach based on our experience. Methods: We included 30 patients operated on with MRPC from June 2005 to September 2022. Results: Of the 30 MRPC treated, the average age was 52.7 years, and the predominant sex was female in 83.3% of the cases. The most common implantation site was the petroclival fissure in 66% of cases. The most used surgical approach was the retrosigmoid in 44% of the cases followed by the presigmoid in 23%. A resection of 95% or more was achieved in 73% of the cases. Finally, we present nine relevant clinical cases. Conclusions: The results of this series coincide with the perception of the literature on the management of this pathology. The choice of an approach is a determining factor in achieving a promising surgical outcome(AU)

Meningioma Meningotelial cerebeloso complicado con absceso único a Nocardia / Meningioma Meningotelial cerebellar complicated with unique abscess to Nocardia

La presentación de abscesos cerebrales relacionados a meningiomas es muy poco frecuente. Usualmente son causados por bacterias comunes, siendo la Nocardia un agente etiológico excepcional. Presentamos la primera descripción en Paraguay de un absceso cerebral a Nocardia Spp asociado a meningioma en un paciente inmunocomprometido por consumo prolongado de corticoides (dexametasona).

The presentation of cerebral abscesses related to meningiomas is very rare. They are usually caused by common bacteria, nocardia being an exceptional etiological agent. We present the first description in Paraguay of a cerebral abscess to Nocardia spp associated meningioma in an immunocompromised patient for prolonged corticosteroid consumption (dexamethasone).

Factores que influyen en el grado de resección y propuesta de escala preoperatoria para el manejo de meningiomas de base de cráneo / Predictive factors in the extent of resection and proposal of a preoperative scale for the management of skull base meningiomas

Objetivos: identificar factores que intervienen en el grado de resección de los meningiomas de base de cráneo y proponer una escala para calcular la probabilidad de resección total. Materiales y métodos: estudio unicéntrico, observacional, retrospectivo, de pacientes operados en el período 06/2018 ­ 06/2022. Se utilizaron como variables: edad, clínica, localización, tamaño, embolización previa, edema perilesional, calcio intratumoral, características en T2 y T1 e invasión ósea. El grado de resección se midió con la clasificación de Simpson tradicional y también se dividió en resección total (Simpson I, II y III) y subtotal (Simpson IV y V). Con los resultados se propuso una escala teniendo en cuenta las variables con significación estadística (p < 0.05). Se realizó una revisión bibliográfica del tema. Resultados: Se operaron un total de 23 pacientes. Fueron estadísticamente significativas asociadas con el grado de Simpson, la localización (p 0,002) y el tamaño (p 0,001). Asociada con resección total y subtotal, la invasión ósea (p 0,013). Para la escala utilizamos: localización (anterior 1 punto, posterior 2 puntos, medial 2 puntos y medial que involucra seno cavernoso 3 puntos), tamaño (<5 cm 1 punto, >5 cm 2 puntos) e invasión ósea (no 1 punto y si 2 puntos). Realizamos un análisis inferencial y se observó asociación entre la escala realizada y el grado de resección (p 0,005). Conclusión: En nuestro estudio se observó una asociación entre el tamaño, la localización y la invasión ósea con el grado de resección conseguido. Propusimos una escala para medir la probabilidad de resección total(AU)

Objectives: identify factors that intervene in the degree of resection of skull base meningiomas and propose a scale to calculate the probability of total resection. Materials and methods: single-center, observational, retrospective study of patients operated in the period 06/2018 - 06/2022. The following variables were used: age, symptoms, location, size, previous embolization, perilesional edema, intratumoral calcium, characteristics in T2 and T1 and bone invasion. The degree of resection was measured using the traditional Simpson scale and was also divided into total (Simpson I, II, and III) and subtotal (Simpson IV and V) resection. With the results, a scale was proposed taking into account the variables with statistical significance (p < 0.05). A bibliographic review of the subject was carried out. Results: A total of 23 patients were operated. They were statistically significant associated with Simpson's grade the location (p 0.002) and size (p 0.001). Associated with total and subtotal resection, the bone invasion (p 0.013). For the scale we use: location (anterior 1 point, posterior 2 points, medial 2 points and medial involving the cavernous sinus 3 points), size (<5 cm 1 point, >5 cm 2 points) and bone invasion (no 1 point and yes 2 points). We performed an inferential analysis and an association was observed between the scale used and the degree of resection (p 0.005). Conclusion: In our study, an association was observed between the size, location and bone invasion with the degree of resection achieved. We proposed a scale to measure the probability of total resection(AU)

STUDY OF MENINGIOMAS WITH HISTOPATHOLOGICAL AND RADIOLOGICAL CORRELATION

Background: Meningiomas are tumours originating from meningothelial cells. They are commonly located at intracranial, intraspinal or occasionally ectopic site. They show histological diversity and are categorized into three grades by WHO 2007 Classi?cation. This grading helps in predicting their behaviour and deciding treatment strategy. To study the frequency, clinical details, histological typing and grading of 50 cases of Aims and Objective: meningiomas. To evaluate diagnostic accuracy of radio-imaging and there correlation with histopathological diagnosis is made Total 50 cases of histopathologically con?rmed cases of meningiomas were studied with above mentioned Methods: aims and objectives. Analysis of histological features, typing and grading of all cases were done. Meningioma are the Result: most common extra-axial tumour. Obvious female predominance was observed. The most common histological subtype was meningothelial followed by ?broblastic. In all cases radiological diagnosis correlated with histopathological diagnosis Conclusion: Meningiomas are slow growing extra-axial tumours majority being intracranial, benign grade I followed by grade II and rarely grade III neoplasms occurring most commonly in elderly females

Enfermedad de Rosai-Dorfman intracraneal: un infrecuente diagnóstico diferencial del meningioma. Reporte de un caso ilustrativo

La Enfermedad de Rosai-Dorfman es un trastorno infrecuente y de etiología desconocida. La presentación intracraneal es aún más rara y suele imitar la apariencia de un meningioma en las imágenes del encéfalo. Se presenta el caso de un paciente varón de 38 años que ingresa por una tumoración intracraneal, extra-axial y supratentorial asociada a déficit neurológico leve; con diagnóstico presuntivo de meningioma de la convexidad. Después de la intervención quirúrgica, el diagnóstico histológico definitivo fue de Enfermedad de Rosai-Dorfman intracraneal. Se debe considerar la Enfermedad de Rosai-Dorfman intracraneal dentro del diagnóstico diferencial de una lesión intracraneal extra-axial sugestiva de un meningioma debido a la similitud en las neuroimágenes y la presentación clínica entre ambas patologías.

Rosai-Dorfman disease is an infrequent condition with no known etiology. The intracranial presentation is even rarer, and it resembles the appearance of a meningioma in image studies. We present the case of a 38-year-old male patient who was admitted because of an extra-axial supratentorial cranial tumor, associated to mild neurological deficit. The presumptive diagnosis was convexity meningioma. After surgery, the definitive histologic diagnosis was intracranial Rosai-Dorfman disease. This condition should be considered in the differential diagnosis of an extra-axial intracranial lesion suggesting meningioma, because of similar neuroimaging results and the similar clinical picture.

Clinical Characteristics and Surgical Results for Patients with Asymptomatic Meningioma / 华中科技大学学报(医学版)

Objective To summarize the clinical features of asymptomatic meningioma patients and evaluate the factors re-lated to surgical complications and prognosis,and to provide evidence for screening asymptomatic meningioma patients suitable for early surgical intervention.Methods The medical records of meningioma patients who underwent surgery from January 1st 2015 to December 31st 2020 at Neurosurgery Department of Tongji Hospital Affiliated to Tongji Medical College were retro-spectively reviewed.The clinical characteristics were compared between symptomatic and asymptomatic meningioma.Factors re-lated to the effects of surgery,postsurgical complications or patient prognosis were analyzed through Chi-squared test and multi-variate binary Logistic regression analysis.Results Elder age(HR:2.042;95％CI:1.002-4.098;P=0.021),smaller tumor size(HR:1.666;95％CI:1.009-3.857;P=0.014),intracranial superficial location(HR:2.221;95％CI:1.236-3.994;P=0.008)and no peritumoral brain edema(HR:8.917;95％CI:5.028-15.813;P＜0.01)were significant features of asymptomat-ic meningioma compared to those of symptomatic ones.The benefit of early surgery for asymptomatic meningioma was the a-chievement of higher total resection rate(88.6％)(P=0.035).Among the total resection cases,72％located in the intracranial superficial area,while merely 28％located in the intracranial deep area.Ninety-two percent of asymptomatic patients had re-turned to normal work and life at 6 months after operation.A parietal location was a significant factor indicating postsurgical complications(HR:3.351;95％CI:1.258-11.355;P=0.024),while elder age(≥60 years old)(HR:0.875;95％CI:0.825-0.999;P=0.041)was a significant factor indicating poor patient prognosis.Conclusion Asymptomatic meningioma is more common in elderly patients,usually located superficially in cranial cavity,with smaller size and without peritumoral edema.A more prominent total resection rate can be achieved in this type of meningioma.An early surgical resection would be recommen-ded as a proper treatment strategy.Tumor site and age are potential indicators for predicting postoperative complications and prognosis of patients.Comprehensive evaluation should be consider before surgery.

Clinical distribution of primary intracranial tumors and risk factors for postoperative complications / 中国神经精神疾病杂志

Objective To examine the clinical distribution of primary intracranial tumors and analyze the risk factors for postoperative complications.Methods From January 2018 to December 2022,the clinical data of 961 patients with primary intracranial tumor in the Department of Neurosurgery of Tiantan Hospital in Beijing were collected and analyzed retrospectively.To examine the clinical distribution of patients with primary intracranial tumor and present the incidence of postoperative complications.To compare the basic data of patients with and without postoperative complications,and analyze the risk factors leading to postoperative complications.Results There were 363 cases of glioma,231 cases of meningioma,158 cases of sellar tumors,142 cases of neurilemmoma and 67 cases of other types of tumors.There were 679 cases of supratentorial tumors and 282 cases of infratentorial tumors.Postoperative complications occurred in 279 patients,and the incidence of postoperative complications was 29.03％.The incidences of intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis and central nervous system infection were 9.37％,5.41％,4.99％,4.47％and 4.27％,respectively.After surgery,D-dimer(D-D),fibrin degradation products(FPD),prothrombin time(PT)in patients with primary intracranial tumors were significantly higher than those in patients without primary intracranial tumors(P<0.05).Activation of partial thromboplastin time(APTT),and thrombin time(TT)levels were significantly higher than those before surgery(P<0.05).Fibrinogen(FIB)was significantly lower than that before surgery(P<0.05).There were significant differences in tumor location,intraoperative blood loss,operation time,anesthesia recovery time and postoperative coagulation function between patients with and without postoperative complications(P<0.05).Conclusions The common types of primary intracranial tumors include gliomas,meningiomas,sellar tumors and neurilemmoma,etc.Surgical treatment has a high risk of postoperative complications.Common postoperative complications include intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis,and central nervous system infection.Tumor location,operation duration,intraoperative blood loss,anesthesia recovery time and postoperative coagulation dysfunction are all risk factors for postoperative complications.

Watertight suture technique in skull base reconstruction after expanded endoscopic endonasal excision of tuberculum sellae meningioma / 中华神经医学杂志

Objective:To explore the feasibility and clinical efficacy of watertight suture technique in skull base reconstruction after expanded endoscopic endonasal excision of tuberculum sellae meningioma.Methods:Fourteen patients with tuberculum sellae meningioma accepted expanded endoscopic endonasal excision of tuberculum sellae meningioma in Department of Neurosurgery, First Affiliated Hospital of Xinxiang Medical University from January 2018 to May 2022 were chosen. During reconstruction of skull base, femoral fascia was used to repair the dural defect of sellar base with watertight suture, and then the sellar base was covered with a larger layer of femoral fascia for reinforcement; no nasal septum mucosal flap was used. The clinical data and treatment efficacy of these patients were retrospectively analyzed.Results:Total resection showed by imaging was achieved in all 14 patients. During the surgery, Valsalva ventilation test confirmed that at least 12 stitches were needed to achieve watertight suture status; watertight suture status was achieved in 13 of the 14 patients, without cerebrospinal fluid (CSF) leakage; watertight suture status was not achieved in one patient due to tumor invasion of the sella floor dura and having an extensive excision, and CSF leakage appeared transiently after surgery but disappeared 2 weeks after surgery (bed rest). Among the 11 patients with visual damage and optic field defect, 9 patients improved obviously and 2 patients did not improve. Follow-up was performed for 5-53 months, with an average of (26.8±8.4) months; no tumor recurrence or CSF leakage were found in these patients; up to the last follow-up, the 2 patients with visual damage and optic field defect did not improve.Conclusion:Skull base reconstruction using watertight suture technique after expanded endoscopic endonasal excision of tuberculum sellae meningioma is reliable.

Resection of anterior skull base meningiomas in 12 patients via neuroendoscopic supraorbital keyhole approach / 中华神经医学杂志

Objective:To analyze the clinical efficacy of resection of anterior skull base meningiomas via neuroendoscopic supraorbital keyhole approach. Methods:Twelve patients with anterior skull base meningiomas resected via neuroendoscopic supraorbital keyhole approach in Department of Neurosurgery, Huaihe Hospital of He'nan University from May 2020 to May 2022 were chosen. A retrospective analysis was performed on the clinical data of these patients. Results:Postoperative brain enhanced MRI showed resection degree of Simpson grading Ⅰ in 2 patients and Simpson grading Ⅱ in 10 patients. Pathological examination indicated meningiomas in all patients. All patients were followed up for 3 months-2 years, and no cerebrospinal fluid leakage or endoscopy-related complications occurred. Among the 6 patients with preoperative vision and visual field changes, 4 patients got obviously improved and 2 patients got slightly improved. The 2 patients with blunt headache before surgery had completely normal symptoms. Of the 2 patients with preoperative hyposmia, one recovered to normal and the other one got slightly improved in symptoms.Conclusion:Resection of anterior skull base meningiomas via neuroendoscopic supraorbital keyhole approach can effectively improve resection rate, reduce complication incidence, and improve cure rate.

Differences of clinical features and surgical efficacy between the elderly and the middle-aged and young patients with meningiomas in the central cortex area / 中华神经医学杂志

Objective:To explore the differences of clinical features and surgical efficacy between the elderly and the middle-aged and young patients with meningiomas in the central cortex area.Methods:Forty-three elderly patients with meningiomas in the central cortex area (≥60 years old) and 63 middle-aged and young patients with meningiomas in the central cortex area (18-59 years old), accepted surgery in Department of Neurosurgery, Guangdong 999 Brain Hospital from January 2011 to December 2020, were chosen. The differences of symptom, gross tumor volume, peritumoral edema degrees, intraoperative blood loss, tumor resection degrees, complications, and hospital stays between the 2 groups were analyzed.Results:The elderly patients had significantly higher proportion of preoperative muscle strength decline, lower proportion of preoperative headache, larger preoperative tumor volume, more severe peritumoral edema degrees before and after surgery, small volume of intraoperative blood loss, and longer hospital stays compared with the middle-aged and young patients ( P<0.05). However, no significant differences in distributions of tumor resection Simpson grades, proportion of new neurological dysfunction, incidence of postoperative complications, and proportions of reoperations and tumor recurrence were noted between the 2 groups ( P>0.05). Significant difference in distributions of peritumoral edema degrees among patients with different WHO grades was noted in the elderly group ( P<0.05), and significant difference in distribution of peritumoral edema degrees among patients with different tumor volumes was noted in the middle-aged and young group ( P<0.05). Conclusions:Although differences in clinical characteristics exist between the elderly and the middle-aged and young patients with meningiomas in the central cortex area, no significant difference in surgical efficacy is noted between the 2 groups. The peritumoral edema degree in the elderly patients is related to tumor pathological grades, while that in middle-aged and young patients is related to tumor volumes.

Aquaporin-4 Expression in Meningioma Malignancy Progression / Expressão da aquaporina-4 na progressão da malignidade dos meningiomas

Objectives The aim of the present study is to analyze if aquaporin-4 (AQP4) may also be a tumor progression marker for meningiomas. Methods This is an immunohistochemistry study realized at the Universidade de São Paulo, São Paulo, state of São Paulo, Brazil: frozen meningioma samples from 81 patients (57 females and 24 males, age range from 22 to 81 years old, average 56.5 14.1 years old), including 57 meningiomas World Health Organization (WHO) grade I (GI); 19 grade II (GII), and 5 grade III (GIII) were analyzed. The relative expression level of AQP4 was analyzed by quantitative polymerase chain reaction (qPCR), using the SYBR Green approach and for staining detection. Tissue sections were routinely processed and subjected to antigen retrieval. Results The expression of AQP4 in meningioma samples ranged from 0 to 10.26, with a median of 0.001 in GI cases, of 0.008 in GII cases, and of 0.006 in GIII cases. Although not statistically significant (p » 0.942), GI meningiomas have a lower median AQP4 expression level than higher malignant grade cases. Conclusion The AQP4 gene and protein expressions presented no association with meningioma malignant progression.

Objetivo O objetivo do presente estudo é analisar se a aquaporina-4 (AQP4) também pode ser um marcador de progressão tumoral para meningiomas. Métodos Trata-se de um estudo imunohistoquímico realizado na Universidade de São Paulo, SP, Brasil. Amostras congeladas de meningioma de 81 pacientes (57 mulheres e 24 homens, faixa etária de 22 a 81 anos, média de 56,5 14,1 anos), incluindo 57 meningiomas grau I (GI) da Organização Mundial da Saúde (OMS); 19 grau II (GII) e 5 grau III (GIII) foram analisados. O nível de expressão relativa de AQP4 foi analisado por reação em cadeia de polimerase quantitativa (qPCR, sigla em inglês), usando a abordagem SYBR Green e para detecção de manchas. As seções de tecido foram rotineiramente processadas e sujeitas a recuperação de antígeno. Resultados A expressão de AQP4 em amostras de meningioma variou de 0 a 10,26, com mediana de 0,001 nos casos GI; 0,008 nos casos GII; e 0,006 nos casos GIII. Embora não sejam estatisticamente significantes (p » 0,942), os meningiomas GI apresentam mediana mais baixa do nível de expressão de AQP4 do que os casos de grau maligno mais alto. Conclusão Expressões de genes e proteínas AQP4 apresentadas na associação com progressão maligna do meningioma.