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ObjectiveThis study aimed to identify a potential miRNA-mRNA axis in neurofibromatosis type 2 (NF2)-negative meningiomas, investigate their target relationships, and determine their biological functions. MethodsThe GSE17792 dataset, which contains data related to NF2-negative meningiomas, was downloaded from the Gene Expression Omnibus (GEO) database. The limma package of R software was used to determine the differentially expressed miRNAs (DeMiRNAs). The miRWalk 2.0 database was applied to obtain the target genes of DeMiRNAs. The Search Tool for the Retrieval of Interacting Genes (STRING) database was utilized to build protein-protein interaction (PPI) networks, and hub genes were identified via Cytoscape software. The expression and biological roles of the screened miRNAs were further validated. ResultsAltogether, 86 DeMiRNAs, consisting of 52 upregulated and 34 downregulated miRNAs, were found in NF2-negative meningioma tumor samples compared with arachnoid tissue controls. Fourteen miRNAs associated with 274 target genes were identified among these DeMiRNAs, and miRNA-target gene networks were constructed based on these data. Analysis with cytoHubba showed that two miRNAs (hsa-miR-650 and hsa-miR-623) were among the top 20 key hub genes in the PPI network. Further qRT-PCR experimental verification suggested that the expression of hsa-miR-650 was significantly higher in NF2-negative meningiomas than in normal brain tissues. Downregulation of hsa-miR-650 inhibited the proliferation and induced the apoptosis of NF2-negative meningioma cells. Finally, RAC1 was identified as a target of hsa-miR-650. ConclusionHsa-miR-650 acts as a tumor promoter and might function as a therapeutic target for patients with NF2-negative meningiomas.
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Minute pulmonary meningothelial-like nodules (MPMNs) are benign small lesions in the lungs, with similar pathological characteristics to the meningeal epithelium. MPMNs have similar imaging manifestations to malignant tumors, which can lead to misdiagnosis in clinical practice. There is no consensus on the pathogenesis of MPMNs, with some suggest that MPMNs derive from reactive proliferation, while others suggest that MPMNs share a common origin and molecular mechanism with meningiomas in the central nervous system. Understanding the characteristics of MPMNs and studying their pathogenesis will help improve the understanding and diagnosis of MPMNs. In this article, we reviewed the clinical, pathological, imaging characteristics, differential diagnosis and pathogenesis of MPMNs. We also analyze the existing research advances regarding the pathogenesis and propose prospects for further research. .
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RESUMEN Los meningiomas de la fosa posterior representan el 10 % en relación con los otros sitios en los que pueden estar localizados. Estas lesiones pueden provocar compromiso de la circulación de líquido cerebroespinal. Se presentó el caso de una paciente de 67 años de edad con antecedentes previos de trastornos en la deambulación, se observó dificultad para caminar, en 15 días de evolución. Se realizó diagnóstico por tomografía de lesión ocupante de espacio localizada en fosa posterior. La paciente fue operada y secundariamente presentó hidrocefalia aguda, no comunicante, se le realizó derivación ventrículo-peritoneal. No existieron otras complicaciones asociadas a la intervención quirúrgica.
ABSTRACT Posterior fossa meningiomas represent 10% in relation to the other sites where they may be located. These lesions can compromise cerebrospinal fluid circulation. We present a 67-year-old female patient with a previous history of walking disorders, observing walking difficulty with 15 days of evolution. Diagnosis was made by a tomography of the space-occupying lesion located in the posterior fossa. The patient underwent surgery and subsequently developed acute non-communicating hydrocephalus, for which a ventricle-peritoneal shunt was performed. No other complications were associated with surgical intervention.
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Encaminhamento e Consulta , Fossa Craniana Posterior , HidrocefaliaRESUMO
Resumen Los meningiomas son los tumores primarios más frecuentes del sistema nervioso central, tienden a ser benignos y de lento crecimiento. Pueden ser asintomáticos o incluso manifestarse únicamente con síntomas psiquiátricos, incluyendo un cuadro psicótico. No existen estudios clínicos controlados randomizados que estudien la relación entre meningioma y cuadros psicóticos. La evidencia disponible se basa en series y reportes de casos. Existe una relación entre la magnitud del edema perilesional y la presencia de síntomas psicóticos. Por otra parte, el tamaño de la lesión o su localización neuroanatómica específica tendrían menor relevancia. La resección quirúrgica de la lesión, en conjunto con el manejo psiquiátrico adecuado, usualmente conduce al cese de la sintomatología psicótica. En la evaluación de pacientes con síntomas psicóticos se debe tener un elevado índice de sospecha, en particular en cuadros de reciente inicio, con manifestaciones atípicas o resistentes al tratamiento. En estos casos se recomienda un estudio con neuroimágenes. Este artículo presenta el caso de una paciente evaluada en nuestro hospital diagnosticada con un meningioma frontal izquierdo de gran tamaño, que presentó sintomatología psicótica secundaria, y se expone una revisión bibliográfica actualizada de esta asociación.
Meningiomas are the most frequent central nervous primary tumors, which tend to be benign and present a slow growth. They may be asymptomatic or present clinically just with psychiatric symptoms including a psychotic state. There are no clinical randomized controlled trials that study the relationship between meningioma and a psychotic episode. Available evidence is based on case reports and series. There is a relationship between the magnitude of perilesional edema and the presence of psychotic symptoms. On the other hand, the size of the tumor or its specific neuroanatomic location would have less relevance. Surgical resection of the tumor associated with psychiatric management usually leads to the cessation of psychotic symptoms. In the assessment of patients with psychotic symptoms, there must be a high index of suspicion, particularly in first psychotic episodes, atypical manifestations and resistance to treatment. In these cases, a neuroimaging study is recommended. This article presents the case of a patient evaluated in our hospital and diagnosed with a large left frontal meningioma with secondary psychotic symptoms, and an updated bibliographic review of this association is presented.
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Humanos , Feminino , Adulto , Transtornos Psicóticos/etiologia , Neoplasias Meníngeas/complicações , Meningioma/complicações , Transtornos Psicóticos/tratamento farmacológico , Antipsicóticos/uso terapêutico , Haloperidol/uso terapêutico , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagemRESUMO
It is well known in the literature that Apparent Diffusion Coefficient (ADC) obtained during diffusion-weighted MRI of brain is sensitive in detecting and differentiating low-grade and aggressive meningiomas. However, other studies establish no correlation between mean-ADC and ultimate classification as benign, atypical or malignant. We wanted to assess the correlation between, A. mean of MRI Apparent Diffusion Coefficient (mean-ADC) and B. meningioma biomarker Ki-67 proliferation index, in cases of both low-grade and aggressive meningioma. We also wanted to assess the sensitivity of mean-ADC for diagnosing an aggressive meningioma.METHODSWe analysed 66 surgically treated meningioma patients with complete histopathology report (HPR) in Government Medical College, Kozhikode during the period of study (Nov-2017-Oct-2018), also having a pre-operative mean-ADC value during Diffusion Weighted Imaging (DWI) investigation at the same centre. For the latter, a standard MRI brain protocol including diffusion imaging was conducted and ADC map was generated. Regions of interest (ROIs) were manually drawn within the tumour on ADC map and mean-ADC values were measured.RESULTSUsing Pearson correlation coefficient, we found a significant negative correlation between Ki-67 proliferation index and mean-ADC in meningioma cases. We also calculate 0.79 x 10-3 mm2/s being a reasonable mean-ADC cut-off value due to its sensitivity of 84% and specificity of 77% in differentiating between typical and atypical meningiomas.CONCLUSIONSThe non-invasive calculation of mean-ADC is a valid diagnostic tool. Further, mean ADC can be used as a good test to differentiate typical and atypical meningiomas. The latter is a particularly valid conclusion, since there were few results from conventional MRI studies to differentiate between various typical and atypical meningiomas.
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Objective To describe our surgical techniques, analyze their safety and their postoperative outcomes for foramen magnum tumors (FMTs). Methods From 1986 to 2014, 34 patients with FMTs underwent surgeries using either the lateral suboccipital approach, standard midline suboccipital craniotomy, or the far lateral approach, depending on the anatomic location of the lesions. Results In the present series, there were 22 (64.7%) female and 12 (35.2%)male patients. The age of the patients ranged from12 to 63 years old.We observed 1 operativemortality (2.9%). A total of 28 patients (82.3%) achieved a score of 4 or 5 in the Glasgow Outcome Scale (GOS). Gross total resection (GTR) was obtained in 22 (64.7%) patients. After the surgery, 9 (26%) patients developed lower cranial nerve dysfunction (LCNd) weakness. The follow-up varied from 1 to 24 years (mean: 13.2 years). Conclusion Themajority of tumors located in the FMcan be safely and efficiently removed usingeither thelateral suboccipital approach, standardmiddlelinesuboccipital craniotomy, or the far lateral approach, depending on the anatomic location of the lesions.
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Procedimentos Neurocirúrgicos/métodos , Forame Magno/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Prontuários Médicos , Estudos Retrospectivos , Resultado do Tratamento , Craniotomia/métodos , Forame Magno/anormalidades , Forame Magno/fisiopatologia , Meningioma/patologiaRESUMO
Background: CNS neoplasms are a heterogenous group contributing to <2% of all the malignant neoplasms. Imaging and histopathology play a great role in diagnosing these lesions. Aim of the study is to correlate radiological findings with that of histopathology and evaluate the role of Ki 67 proliferative index in various grades of Astrocytomas and MeningiomasMethods: This is an observational study for a period 2 years from July 2015 to June 2017 in Department of Pathology Andhra Medical College. The total number of specimens of CNS tumors received during this period were126. The specimens were routinely processed and stained with H&E. The tumors were classified based on WHO 2016 classification. In total 71 cases-45 cases of meningiomas and 26 cases of astrocytomas, the expression of Ki 67 labelling index was recorded in various grades of these tumors and results tabulated.Results: Among 126 cases, tumors predominantly encountered were of meningeal origin accounting to 45 cases (35.71%) followed by tumors of neuroepithelial origin 35 cases (27.78%). Tumors were seen in all age groups, but common was among 41-50 years of age group with metastatic tumors being seen in >60 year group. Tumors were more common in males with male: female ratio being 1.25:1. Ki 67 proliferative index increased as the grade of tumor increased in both astrocytomas and meningiomas.Conclusions: Grading of meningiomas and astrocytomas are very much essential with reference to prognosis and therapy. Histopathology plays a great role in grading these lesions but Ki 67 proliferative index adds as an adjunct and helps in confirmation and predicting the recurrence of these lesions.
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Background: Although meningiomas represent only ~20% ofintracranial tumors, they have been referred to as “the soul ofneurosurgery.” Meningiomas are the most common nonglialprimary tumors of the central nervous system, representing 15to 20% of primary brain tumors. Peak incidence occursbetween the fourth and sixth decades. The female/male ratio isreported variously as 2:1 to 4:1. Management of meningiomacan be done either by surgery, by radiotherapy or by medicaltreatment or combination of any of three approaches.Aims & objectives: The aims & objectives of this study wereto identify the incidence and pathological nature of intracranialmeningiomas. Also to study surgical outcomes of patientsundergoing intracranial meningioma surgery.Methods & Materials: This study was done at neurosurgerydepartment at a tertiary care centre. Retrospective analysis ofdata collected through hospital information system of patientsoperated for intracranial meningiomas between September2014 & March 2017.Results: In present study of 100 cases of intracranialmeningioma, majority were occurring at convexity 34 (34%)followed by falcine 14 (14%), sphenoid wing 10 (10%) etc. Outof 100 cases around 70% cases occurred in 4th, 5th and 6thdecade. There was a female preponderance in our series witha male:female ratio of 1:1.63. The most commonhistopathological type of tumor was meningothelialmeningioma (38%) followed by others. The commonestcomplication noted in present series was post-operative limbweakness either hemiparesis or monoparesis. Overall outcomeafter surgery was seen as 66% neurologically intact patientsand mortality was only 6%.Conclusion: Present study reported that maximum incidenceof meningiomas is in 3rd, 4th & 5th decade and Females weremore affected than male with ratio of 1.63:1. In our study themost common histopathological type of tumor wasmeningothelial meningioma. The most common complicationswere limb weakness, followed by decreased vision and lowercranial nerve palsy which improved with time.
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Vinte e dois casos de meningiomas em cães, diagnosticados num período de aproximadamente 18 anos, foram revisados. Os neoplasmas foram graduados e classificados histologicamente de acordo com os critérios da Organização Mundial da Saúde (OMS de 2007) para meningiomas em humanos adaptados para cães, em Grau I (G-I; benignos), Grau II (G-II; atípicos) e Grau III (G-III; anaplásico ou maligno). Dos protocolos de necropsias foram retiradas adicionalmente informações referentes ao sexo, idade, raça, evolução clínica, sinais clínicos, localização anatômica e achados macroscópicos. Os meningiomas intracranianos supratentoriais foram os mais frequentes em relação às demais localizações intracranianas ou intraespinhais. Os intracranianos caracterizaram-se principalmente por sinais clínicos de alteração tálamo-cortical. Os intraespinhais caracterizaram-se principalmente por causarem ataxia. Meningiomas G-I foram os mais frequentes (63,6%) nos 22 cães, seguidos pelos G-III (22,7%) e G-II (13,6%). Os G-I caracterizaram-se por ter o subtipo psammomatoso como o mais frequente, mais de um padrão morfológico em um mesmo tumor, e um terço deles apresentando áreas de invasão do tecido nervoso, 71,4% dos casos acometendo fêmeas, uma média de idade de 11 anos, cães com raça definida como os mais acometidos e por ter o maior tempo de sobrevivência após a manifestação dos sinais clínicos. Os meningiomas G-II caracterizaram-se por ter o subtipo cordoide como o mais frequente, invasão do tecido nervoso em um terço dos casos, somente fêmeas acometidas, uma média de idade de 12 anos, dois terços dos cães acometidos sem raça definida e o tempo máximo de sobrevivência de 20 dias. Os meningiomas G-III caracterizaram-se por ter o subtipo papilar como o mais frequente, invasão do tecido nervoso em 80% dos casos, 60% dos casos acometendo fêmeas, uma média de idade de 8 anos, 80% dos cães acometidos da raça Boxer e o tempo máximo de sobrevivência de 90 dias. Este estudo permitiu estabelecer uma relação entre os três graus histológicos observados em 22 casos de meningiomas em cães com vários parâmetros clínico-epidemiológicos e patológicos, fornecendo informações úteis para um melhor conhecimento da correlação entre a graduação histológica e a evolução clínica desses neoplasmas.(AU)
Twenty two cases of meningiomas in dogs, diagnosed in about 18 years, were analyzed. The neoplasms were histologicaly classified and graded according to the World and Health Organization (WHO of 2007) for human meningiomas, adapted for dogs, in Grade I (G-I; benign), Grade II (G-II; atypical), and Grade III (G-III; anaplastic or malignant). Additional data about gender, age, breed, skull conformation, clinical course and signs, anatomic localization, gross and histological findings were obtained from the necropsy reports. Intracranial and supratentorial meningiomas were the most frequent in relation to the other intracranial or intraspinal sites. The intracranial ones were characterized mainly by clinical signs of thalamic-cortical alteration. Intraspinal ones were mainly characterized by ataxia. G-I meningiomas were the most frequent (63.6%) in dogs, followed by G-III (22.7%) and G-II (13.6%). GI were characterized by having the psammomatous subtype as the most frequent, more than one morphological pattern in the same tumor, one third presenting areas of invasion of nervous tissue, 71.4% of cases involving females, a mean age of 11 years, pure breed dogs as the most affected ones and for having the longest survival time after the manifestation of clinical signs. G-II meningiomas were characterized by having the chordoid subtype as the most frequent, invasion of nervous tissue in one third of cases, only females affected, a mean age of 12 years, two-thirds of the dogs affected were mongrels and the maximum survival time of 20 days. The G-III meningiomas were characterized by having the papillary subtype as the most frequent, invasion of the nervous tissue in 80% of the cases, 60% of the cases involving females, a mean age of 8 years, 80% of dogs affected were Boxers and the maximum survival time of 90 days. In conclusion, this study allowed to establish a relationship between the three histological grades observed in 22 cases of meningiomas in dogs with various clinical-epidemiological and pathological parameters, providing useful information for a better understanding of the correlation between the histological grading and the clinical evolution of these neoplasms.(AU)
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Animais , Cães , Cães/anatomia & histologia , Cães/crescimento & desenvolvimento , Meningioma/diagnóstico , Meningioma/patologiaRESUMO
Objective To investigate clinical application of lateral supraorbital approach in microsurgery for tuberculum sellae meningioma.Methods A retrospective analysis was performed of the 46 patients with tuberculum sellae meningioma who had received microsurgery at Department of Neurosurgery,The First Affiliated Hospital to Soochow University from January 2010 to September 2017.Of the 46 patients,the lateral supraorbital approach was applied in 18 and the pterional approach in 28.The excision of tumor,operation time,hospital stay and visual improvement were compared between the 2 operative approaches.Results There was no significant difference in tumor excision rate between the patients using the lateral supraorbital approach and those using the pterional approach (P>0.05).The operation time and hospital stay for the patients using the lateral supraorbital approach were significantly less than for those using the pterional approach (P<0.05).Of the 12 cases with preoperative visual deterioration in the former patients,5 obtained no obvious visual change but 7 visual improvement;of the 23 cases with preoperative visual deterioration in the latter patients,9 obtained no obvious change,12 visual improvement and 2 further visual deterioration.Conclusion Neuro-microsurgery via the lateral supraorbital approach is a safe and mini-invasive treatment for tuberculum sellae meningioma.
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Objective Meningiomas in the trigone of the lateral ventricle are characterized by deep location and low inci-dence. A few studies have been done on its treatment at home and abroad. This study was to explore the access,techniques,and clini-cal effect of microsurgery for lateral ventricular trigone meningiomas (LVTM). Methods We retrospectively analyzed the clinical data about 36 cases of LVTM treated by microsurgery in our hospital from December 2011 to December 2015. The operation involved lumbar cistern tube drainage, intraoperative drainage of cerebrospinal fluid, a unilateral parieto-occipital U-shaped cut, approach through the interparietal fissure,a sagittal incision about 3 cm long at the interparietal fissure for exposure and resection of the tumor. We followed up the patients for a mean of 17 months postoperatively and analyzed the results and complications. Results Simpson grade I removal of the tumors was achieved in all the 36 cases. Postoperative complications included homonymous hemianopia in 4 cases, central nervous system infections in 3,secondary epilepsy in 2,subcutaneous hydrops in 2,and intratumoral hemorrhage in 1 (which necessitated a second operation). Extended temporal horn of the right lateral ventricle occurred at 32 months after surgery,which was treated by fistulation. Homonymous hemianopia was improved in 2 of the 4 ca-ses. All the patients were capable of daily life activities and none experienced recurrence. Conclusion Sufficient preoperative evalu-ation of the tumor characteristics,rational selection of surgical approach,and expert operation techniques are the key factors for the mi-crosurgical treatment of meningiomas in the trigone of the lateral ventricle.
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Objective To introduce the microsurgery treatment method for large parasellar meningiomas by pterional craniotomy and its curative effect. Methods The clinical data of 34 patients with large parasellar meningiomas, who underwent microsurgery via pterional or extensive pterional craniotomy in Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine Jul. 2006 to Aug. 2016, were retrospectively analyzed. The patients included 13 men and 21 women with ages ranging from 21 to 72 (average, 49±13) years old. The course of disease ranged from 1 to 55 (average, 13±10) months. Maximum diameter of tumors ranged from 3.3 to 5.2 (average, [4.3±0.6]) cm. Results No surgical death occurred in this study. Postoperatively, the cranial imaging examination showed that 24 of 34 cases were totally removed, 5 cases were subtotally removed, and 5 cases were partially removed. The postoperative follow-up time was 24-48 (average, 36±13) months. Twenty-eight cases had good prognoses with Karnofsky score being 80 to 100, and six cases had fair prognoses with Karnofsky score being 60 to 79. Five cases had postoperative oculomotor paralysis, which was improved with nutritional nerve treatment. Conclusion The microsurgical treatment via pterional or extensive pterional craniotomy can improve the total resection rate of the large parasellar meningiomas. Palliative operations combined with postoperative radiotherapy may be employed for the tumors that can only be subtotally and partially removed.
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BACKGROUND: Tuberculum sellae meningiomas is a serious challenge for neurosurgeons. It accounts for up to 10% of all intracranial meningiomas. The difficulty in surgically excising a Tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their perforators. The authors discuss the main approaches and the complications based on their experience in comparison to previously reported data. METHODS: We report our personal case series of 38 patients with Tuberculum sellae meningiomas; 36 patients under went craniotomy for tumor resection (12 bifrontal, 12 pterional, 6 supraciliary, 4 unilateral frontals, and 2fronto-orbito-zygomatic); in two patients, the excision was performed through an endoscopic endonasal approach. The Simpson grade of meningioma resection as wellhe non-visual morbidity and the mortality rates were analyzed. RESULTS: Thirty-one patients had Simpson grades 1 and 2 excisions, while seven had Simpson grade 4 excisions. The overall rate of non-visual morbidity was 13.15% (5 of 38 patients) and mortality was 5.3% (2 of 38). CONCLUSION: The primary symptom leading to the diagnosis of a Tuberculum sellae meningioma is visual compromise and the main goal of surgeryo achieve improvement of vision. Favorable outcomes were achieved with appropriate selection of surgical approach. More studies are necessary to define the prognostic factors for patients in this scenario.
INTRODUÇÃO: Os meningiomas de tubérculo selar certamente representam um desafio para os neurocirurgiões no que se refere ao manejo cirúrgico. Estes tumores representam até 10% de todos os meningiomas intracranianos. A dificuldade em ressecar cirurgicamente estes meningiomas provém da sua relação com os nervos ópticos, com o quiasma óptico e com as artérias carótidas internas, cerebrais anteriores e suas perfurantes. Discutimos as principais abordagens e as complicações com base em nossa série de pacientes e numa revisão da literatura. CASUÍSTICA E MÉTODOS: Relatamos nossa série de casos pessoais de 38 pacientes com meningiomas de tubérculo selar. Trinta e seis pacientes foram submetidos a craniotomia para ressecção tumoral (12 bifrontal, 12 pterional, 6 supraciliar, 4 unilateral frontal e 2 fronto-orbito-zigomático) e 2 receberam abordagem endoscópica endonasal. A escala de Simpson, bem comoaxas de morbidade e mortalidade foram analisadas durante o período pós-operatório, em função das diferentes abordagens. RESULTADOS: Trinta e um pacientes foram submetidos a excisões de grau I e II da escala de Simpson; os demais foram submetidos a excisão de grau IV da mesma escala. A taxa global de morbidade sem acometimento visual foi de 13,15% (5 de 38 pacientes), enquanto a mortalidade evidenciada foi de 5,3% (2 dentre 38 pacientes). CONCLUSÃO: O principal sintoma que leva ao diagnóstico de meningioma de tubérculo selar é o comprometimento visual, de modo que o principal objetivo da cirurgia é alcançar a melhora da visão nestes pacientes. Os resultados alcançados foram favoráveis quando associados com a seleção apropriada da abordagem cirúrgica. Mais estudos são necessários para definir os fatores prognósticos para os pacientes com meningioma de tubérculo selar após intervenção cirúrgica.
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Humanos , Neoplasias Meníngeas , Meningioma/cirurgia , Nervo Óptico , Base do Crânio , Craniotomia/métodosRESUMO
ABSTRACT Objective To describe a unique operative strategy, instead the classical pterional approach, and to analyses it safety and effectiveness for removal of anterior cranial fossa meningiomas. Method We identify 38 patients with tuberculum sellae and olphactory groove meningiomas operated between 1986 and 2013. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed and analyzed retrospectively. The pterional craniotomy is extended toward the frontal bone providing access through the subfrontal route, besides the usual anterolateral view provided by the classical pterional approach. Results Surgical mortality occurred in one patient (2.6%). Gross total resection was achieved in 27 patients (86.8%). Median time of follow-up was 69.4 months. Conclusion The extended pterional approach allows excellent results. Total removal of meningiomas of the anterior cranial fossa was obtained in 86.8 % of patients, with low morbidity and mortality.
RESUMO Objetivo Descrever a craniotomia pterional estendida, ao invés da abordagem pterional clássica, e analisar sua segurança e eficácia para a remoção dos meningiomas da fossa anterior. Método Identificamos 38 pacientes com meningiomas do tubérculo da sela e da goteira olfatória operados entre 1986 e 2013. Os prontuários, relatórios cirúrgicos, exames de imagem e acompanhamento pós-operatório foram analisados retrospectivamente. A craniotomia pterional com extensão para o osso frontal permite acesso pela via subfrontal além da via anterolateral do acesso pterional clássico. Resultados A mortalidade cirúrgica foi de 2,6% (um paciente). A remoção total foi alcançada em 86,8% (27 pacientes) com um tempo médio de seguimento de 69,4 meses. Conclusão A abordagem pterional estendida permite excelentes resultados. A remoção total dos meningiomas da fossa craniana anterior foi obtida em 86,8% dos pacientes, com baixa morbi-mortalidade.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Procedimentos Neurocirúrgicos/métodos , Fossa Craniana Anterior/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia/métodos , Sela Túrcica/cirurgia , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Procedimentos Neurocirúrgicos/mortalidade , Craniotomia/métodos , Craniotomia/mortalidade , Neoplasias Meníngeas/mortalidade , Meningioma/mortalidade , Microcirurgia/mortalidadeRESUMO
O meningioma intramedular é uma entidade relatada clinicamente de forma rara, tendo apenas nove relatos. Neste estudo, descrevemos o caso de um paciente masculino, 67 anos, com evolução de 25 anos, severos déficits motores, sensitivos e autonômicos. O diagnóstico foi confirmado por ressonância magnética mostrando uma massa intramedular central ao nível de C6-C7. O paciente foi submetido à microneurocirurgia com monitoração neurofisiológica, obtendo-se ressecção total e em bloco da lesão tumoral. Os achados histopatológicos e imuno-histoquímicos confirmaram meningioma angiomatoso com expressão multifocal de GFAP e de neurofilamento. O transoperatório ocorreu sem intercorrências, mas, quinze dias após, o paciente evoluiu com piora motora à esquerda. Apesar de extremamente raros, os meningiomas devem ser considerados um diagnóstico possível de tumoração intramedular.
Intramedullary meningioma is a rarely reported clinical entity, with only 9 cases reported to date. We describe a male patient, 67 years old, with 25 years of evolution and severe motor, sensory, and autonomic deficits. Preoperative magnetic resonance imaging (MRI) showed an intramedullary mass at the C6-C7 level. The patient underwent microneurosurgery and neurophysiological monitoring confirmed total in bloc resection. The histopathological and immunohistochemical findings confirmed angiomatous meningioma with multifocal expression of glial fibrillary acidic protein (GFAP) and neurofilament. Trans-operative was uneventful and, fifteen days later, he Costa et al.
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Humanos , Masculino , Idoso , Meningioma , Neoplasias da Medula EspinalRESUMO
Introducción: En 1942 Stout y Murray describieron un tumor extraneural compuesto por una proliferación de vasos sanguíneos con endotelio normal rodeados de células neoplásicas que presumiblemente surgían de los Pericitos. La Neoplasia fue llamada Hemangiopericitoma. Se trata de un tumor agresivo, más frecuente en adultos. En los niños son extremadamente raros, solo 11 casos han sido reportados en la literatura. Se originan de la transformación maligna de los Pericitos de Zimmerman. Descripción del caso: Presentamos el caso de una adolescente de 16 años, con antecedente de convulsiones generalizadas en el año 2009, detectándose en el 2014 lesión ocupante de espacio parieto-occipital derecha, la cual es extirpada, informándose como meningioma. Evoluciona con recidiva tumoral 3 meses más tarde, evaluándose por inmunomarcación nueva muestra de lesión, con la que se arriba al diagnóstico de hemangiopericitoma. Conclusión: El Hemangiopericitoma cerebral es una patología rara, de muy baja prevalencia, y de gran similitud clínica e imagenológica con los meningiomas. Incluso genera gran cantidad de diagnósticos erróneos con la histopatología convencional. Por todo lo antes mencionado, es muy importante tener presente esta patología a la hora de pensar en diagnósticos diferenciales de meningiomas, siendo fundamental la inmunomarcación para confirmar uno u otro diagnóstico.
Introduction: In 1942, Stout and Murray described an extraneural tumor composed of a proliferation of blood capillaries with normal endothelium and surrounded by neoplastic cells, which presumably arose from pericytes. The neoplasm was thus labeled an hemangiopericytoma. This aggressive tumor is more common in adults than in children, in whom it is extremely rare, with only 11 cases reported in the literature. It stems from the malignant transformation of pericytes of Zimmerman. Case report: We present the case of a 16-year old teen with a history of generalized seizures in 2009, in whom a spaceoccupying parieto-occipital lesion was detected and removed in 2014, at which time it was diagnosed as a meningioma. However, upon tumor recurrence three months later, further immuno-staining revealed the lesion to be a hemangiopericytoma. Conclusion: Cerebral hemangiopericytomas have a very low prevalence and high degree of clinical and imaging similarity with meningiomas. This similarity frequently leads to misdiagnosis with conventional histopathology. For this reason, it is crucial to remember this pathology in the differential diagnosis of a meningioma, so that appropriate immuno-staining is performed to either confirm or rule out its presence.
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Humanos , Hemangiopericitoma , MeningiomaRESUMO
Objective To study the clinical classification and the corresponding surgical treatment of the bilateral parafalcine meningiomas.Methods Retrospectively analyzed the clinical data of 37 patients with bilateral parafalcine meningiomas from June 2005 to June 2015.The clinical classification was proposed according to the basement of the tumour,the distance between the basement and symmetry of the tumor.Results 19 cases were male, 18 cases were female.The average age was 55.2 years,average duration was 1.8 years.The clinical classification:Ⅰtype:bilateral tumors with the same basement 33 cases(Ⅰ a type:bilateral symmetry 8 cases,Ⅰb type:bilateral asymmetric 25 cases);Ⅱ type:bilateral tumor had different basement 4 cases(Ⅱa type:far apart 2 cases;Ⅱb type:close apart 2 cases).Surgery results:25 cases of Simpson Ⅰ excision,6 cases of Simpon Ⅱ excision,5 cases of Simpson Ⅲ excision,complete resection rate was 86.5% (32 /37 ).No operative death cases,the postoperative recovery was good,the clinical symptoms reduced or disappeared,an average follow -up of 35.8 months,no recur-rence cases.Conclusion The clinical classification of the bilateral parafalcine meningiomas was proposed according to the basement of the tumour,the distance between the basement and symmetry of the tumor,can guide the operation scheme,improve the surgical curative effect,has a certain clinical significance.
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Abstract? AIM: To analyze the ocular manifestations of meningiomas in the trigone of the lateral ventricle, discuss the relevant factors of visual impairment in these patients and things need attention clinically.?METHODS:Retrospectively study on the clinical data of 90 eyes in 45 patients diagnosed of trigonal meningiomas treated at Beijing Tian Tan Hospital from October 2011 to October 2015.Preoperative examinations including visual acuity, optic disc findings, visual field, size of tumors and other change in MRI were analyzed.?RESULTS: Patients'age was 12-68 years old ( mean 41.7 ±13.7 years ). Male/female ratio was 1 ∶4.6. Decreased visual acuity occurred in 18 eyes.Optic disc edema was found in 24 eyes and optic disc pale in 6 eyes. Fourty -seven eyes had visual field defect, mostly homonymous hemianopia or defect. The maximum diameter of tumors was 2.1-9.6cm (4.8±1.7cm).Range of tumor volume was 3.02-193.2cm3(48.3±47.8cm3).A positive correlation of preoperative visual field defect was found with tumor volume, tumor maximum diameter, and brain midline shift respectively. While the preoperative visual field defect was not found any correlation with age, gender, course, and the enlargement of the ventricle and the edema of the tissue around the tumors. After Mann-Whitney U test, the differences on tumor volume, the maximum diameter of tumors, and brain midline shift between the two groups were significant.? CONCLUSION: Patients with trigonal meningiomas often have ocular signs and symptoms.The major reason of visual field defect is the damage of optic radiation around the tumor.The specific position of injured optic radiation determines the type and extent of visual field defect.Both ophthalmologist and neurosurgeon should pay attention to tumors nearby posterior visual pathway. Doing neurophthalmology examinations for these patients and realizing the position between the tumor and posterior visual pathway will be helpful and necessary in surgical planning.
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Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomas and provide a review of our experience.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dura-Máter/patologia , Neoplasias Meníngeas/patologia , Meningioma/patologiaRESUMO
Objective:To study CT and MRI radiological expression of benign and malignant meningiomas to provide a reliable evidence for clinical surgery scheme determination. Methods: The radiological and pathological data of 40 cases with meningiomas undergoing surgery in hospital were analyzed, and the benign and malignant lesions of meningiomas were judged according to imaging features such as meningioma shape, edge, signal or density, peritumorous edema, intratumorous calcification, multiple tumors, tumor brain interface status etc.Results: (1)Tumor signal or density: T1 signal inhomogeneous in 6 cases(15.0%), T2 signal inhomogeneous in 8 cases(20.0%), the signal homogeneous in 26 cases (65.0%), CT density is inhomogeneous in 15 cases(37.5%), CT density is homogeneous in 25 cases(62.5%); (2)Tumor edge: regular in 27 cases(67.5%), coarse, irregular, lobulated, with mural nodules in 13 cases(32.5%); (3)Dural tail sign in 36 cases (90.0%); (4)Skull invasion in 6 cases(15.0%); (5)Calcification within the tumor in 7 cases(17.5%); (6)Peritumoral edema in 14 cases(35.0%); (7)Multiple tumors in 6 cases(15.0%); (8)Enhance performance: Obvious homogeneous enhancement in 27 cases(67.5%), Obvious inhomogeneous enhancement in 13 cases(32.5%).Conclusion: Benign and malignant meningiomas with a certain radiological feature, the curative effect and prognosis may be properly evaluated by the radiological expression of meningiomas.