A Prospective Registry Study of 68Ga-DOTATATE PET/CT Incorporation Into Treatment Planning of Intracranial Meningiomas.

PURPOSE: The current standard for meningioma treatment planning involves magnetic resonance imaging-based guidance. Somatostatin receptor ligands such as 68Ga-DOTATATE are being explored for meningioma treatment planning due to near-universal expression of somatostatin receptors 1 and 2 in meningioma tissue. We hypothesized that 68Ga-DOTATATE positron emission tomography (PET)-guided treatment management for patients with meningiomas is safe and effective and can identify which patients benefit most from adjuvant radiation therapy. METHODS AND MATERIALS: A single-institution prospective registry study was created for inclusion of patients with intracranial meningiomas who received a 68Ga-DOTATATE PET/CT to assist with radiation oncologist decision making. Patients who received a PET scan from January 1, 2018, to February 25, 2022, were eligible for inclusion. RESULTS: Of the 60 patients included, 40%, 47%, and 5% had World Health Organization grades 1, 2, and 3 meningiomas, respectively, and 8% (5 patients) had no grade assigned. According to Radiation Therapy Oncology Group 0539 criteria, 22%, 72%, and 7% were categorized as high, intermediate, and low risk, respectively. After completing their PET scans, 48 patients, 11 patients, and 1 patient proceeded with radiation therapy, observation, and redo craniotomy, respectively. The median follow-up for the entire cohort was 19.5 months. Of the 3 patients (5%) who experienced local failure between 9.2 and 28.5 months after diagnosis, 2 had PET-avid disease in their postoperative cavity and elected for observation before recurrence, and 1 high-risk patient with multifocal disease experienced local failure 2 years after a second radiation course and multiple previous recurrences. Notably, 5 patients did not have any local PET uptake and were observed; none of these patients experienced recurrence. Only 1 grade 3 toxicity was attributed to PET-guided radiation. CONCLUSIONS: This study examined one of the largest known populations of patients with intracranial meningiomas followed by physicians who used 68Ga-DOTATATE PET-guided therapy. Incorporating 68Ga-DOTATATE PET into future trials may assist with clinician decision making and improve patient outcomes.

Incidental Meningioma With Altered PSMA Expression After Systemic Hormone Therapy and Local Radiotherapy Detected by 68 Ga-PSMA PET/CT.

ABSTRACT: A 59-year-old man underwent radical prostatectomy for adenocarcinoma in 2009. Because of the progression of PSA levels, a 68 Ga-PSMA PET/CT scan was performed in January 2020. A suspicious uptake was detected in the left cerebellar hemisphere, and there was no evidence of distant metastatic disease other than recurrent malignancy in the prostatectomy bed. MRI revealed a meningioma located in the left cerebellopontine angle. Although PSMA uptake of the lesion increased in the first imaging after hormone therapy, partial regression was noted after radiotherapy applied to this region.

Pleural metastasis of atypical meningioma: a novel therapeutic approach.

Meningiomas are the most common intracranial tumours in adults and they are infrequently associated with a metastasis clinical course. Pleural metastases are extremely rare and no guidelines on a specific treatment have been established. When localized, surgical resection is the mainstay of treatment, but there is a high risk of pleural recurrence. We aimed to describe a novel surgical approach in pleural metastasis of meningiomas. We report the case of a 41-year-old man with the medical history of surgically resected intracranial atypical meningioma. Nine years after diagnosis of atypical meningioma, a CT scan of the chest disclosed 10 pleural implants gathered in the fissure, in the paramediastinal pleura and at the base of the left hemithorax. Surgical resection was decided. Parietal and mediastinal pleura resection with visceral pleural lesions removal were performed. Cytoreductive surgery was associated with intrathoracic hyperthermic chemotherapy. Postoperative course was uneventful and no adjuvant therapy was undertaken. The patient is free of pleural recurrence 12 months post operatively. The present case report suggests that cytoreductive surgery with intrathoracic hyperthermic chemotherapy is feasible and safe in pleural metastasis from meningioma. Prolonged follow-up and prospective studies are mandatory to assess its oncological benefit.

MR-guided laser interstitial thermal therapy in the treatment of recurrent intracranial meningiomas.

OBJECTIVE: Recurrent meningiomas can prove problematic for treatment, especially if anaplastic, as options are limited primarily to surgery and radiation therapy. Laser interstitial thermal therapy (LITT) is a minimally invasive technique for achieving immediate cytoreduction. This study seeks to determine the utility of LITT in the setting of recurrent meningiomas. MATERIALS AND METHODS: Patients undergoing LITT for tumor treatment at our institution between November 2014 and February 2016 were identified. Those with biopsy-confirmed meningiomas were reviewed with attention to ablation volume, survival, demographic data, and complications. Data from imaging performed at set intervals post-operatively were available for all. RESULTS: Four patients were identified, three of whom had successful treatment with a total of four ablations. The one case that did not result in a successful ablation was due to problems with stereotactic placing of the laser catheter. One patient had a grade 1 meningioma, with the other two being Grade 3. Immediate ablation volumes averaged 75% of preoperative tumor volume and increased to 97% at 2 weeks before dropping to 65% at 3 months. One patient had acute hemiparesis with speech difficulty, which resolved after 6 months. At date of last follow-up, two of three had progression at an average of nine weeks, and one had no progression at 28 weeks. CONCLUSION: LITT appeared to be a potentially viable treatment for recurrent meningiomas. Ablation volumes increased over time, but not beyond the initial meningioma volume. Larger studies are needed to better determine complications and outcomes. Lasers Surg. Med. 51:245-250, 2019. © 2018 Wiley Periodicals, Inc.

The effect of hyperbaric oxygen on clinical outcome of patients after resection of meningiomas with conspicuous peritumoral brain edema.

OBJECTIVE: The goal of this study was to determine the effect of hyperbaric oxygen therapy on the clinical outcome of patients after resection of meningiomas with conspicuous peritumoral brain edema (PTBE). PATIENTS AND METHODS: 232 patients with intracranial meningiomas and conspicuous PTBE were allocated to the HBO2 Group or the Control Group (116 in each group). The Karnofsky Performance Score (KPS), the focal brain edema and the encephalomalacia in the operative region, as well as the number of patients with neurological deficits were compared statistically between the two groups at different times after the operation. RESULTS: On the third day after operation, the KPS and focal brain edema in the operative region between the HBO2 Group and the Control Group were not significantly different (p > 0.05), but 15 days after surgery, compared with the Control Group, the KPS of the HBO2 Group appeared obviously higher (p < 0.05), and the focal brain edema in the operative region was definitely smaller (p < 0.05). Six months after surgery, the volume of encephalomalacia in operative region and the number of patients with neurological deficits in the HBO2 Group were significantly less than those in the Control Group (p < 0.05). CONCLUSION: HBO2 therapy is effective in reducing edema formation and neurological deficits after resection of meningiomas with conspicuous PTBE.

CT myelography for differential diagnosis between intramedullary and intradural-extramedullary spinal tumors in the region of the conus medullaris.

We reviewed the myelograms and computed tomographic myelograms of 12 cases of intraspinal tumor with a "cupping sign" on the myelogram in the region of the conus medullaris from 1986 to 1988. There were 5 intramedullary tumors, 4 of them having an exophytic component, and 7 intradural-extramedullary tumors. The myelograms revealed that 4 of the 5 intramedullary tumors showed expansion and the outline of the conus medullaris was irregular, whereas 1 of the tumors showed smooth compression (crescent-shaped) and displacement of the conus medullaris. Six of the 7 intradural-extramedullary tumors showed smooth compression and displacement of the conus medullaris, while 1 of the tumors had caused expansion of the conus medullaris. Complete blockage of the passage of the contrast medium was noted in 3 of the 5 intramedullary tumors, while a partial block was noted in 3 of the 7 intradural-extramedullary tumors. Two of the 7 intradural-extramedulllary tumors showed an extradural tumor component, such as a dumb-bell tumor and a enlarged intervertebral neural foramen. Tumor calcification was noted in 1 of the 7 intradural-extramedullary tumors. Dural ectasia was noted in 2 of the 7 intradural-extramedullary tumors which were later proven to be neurofibromatosis. We conclude that smooth compression (crescent-shaped) and displacement of the conus medullaris, existence of an extradural tumor component, and eroded intervertebral neural foramina favor intradural-extramedullary tumors, while expansion and a conus medullaris with an irregular outline favors intramedullary tumors.

Meningeal osteomas and chronic renal failure.

Osteomas, although usually found in the frontal and ethmoid sinuses or the mandible, may be located on the inner table of the skull. We report the incidence, distribution, histologic features, and clinical correlates of intracranial osteomas arising in the dura mater and the falx cerebri in 200 consecutive adult autopsies. Ten patients (5 per cent of autopsies) were found to have meningeal osteomas. The tumors were usually located at the dural-falx junction at the superior longitudinal sinus. Histologically, they resembled osteomas arising from other sites, but undecalcified sections generally demonstrated histologic features of active bone remodeling--namely, the presence of abundant osteoid and numerous osteoclasts, and, in some instances, osteitis fibrosa. The age and sex distributions were similar among autopsied patients with meningeal osteomas (mean age, 66 years; 60 per cent female) and those without (mean age, 64 years; 58 per cent female). Although the incidence of uremia in the general autopsy population was only 13 per cent, 60 per cent of patients with osteomas died with concomitant renal failure. The authors consider these cases of meningeal ossifications and reports of meningeal calcifications to represent osteomas arising from the dura mater and the falx cerebri. Thus, intracranial osteomas may be more common than was previously recognized. In some instances, the abnormal biochemical state accompanying chronic renal failure may stimulate new bone formation in the osteogenic tissue of the dura mater.

[Comparison of CT, scintigraphy, and angiography in the topographic and pathological diagnosis of 300 supratentorial tumors (author's transl)]. / Comparaison des tomodensitométrie, cinégammagraphie, et angiographie dans les diagnostics topographique et histologique pré-opératoires de 300 tumeurs intracrániennes sus-tentorielles.

The results of CT, scintigraphy (CSS), and angiography in 300 supratentorial cerebral tumors were compared with regard to the topographic and pathological diagnosis proposed in the initial reports. CT elucidated the topography in 98% of the cases and the pathology in variable percentages, depending on the type of tumor. The use of scintigraphy provided a high accuracy of pathological diagnosis. Except for meningiomas, arteriography was less accurate than the two other methods of examination. A radiological management of supratentorial cerebral tumors is proposed based on clinical and CT data.

Correlation between the appearances of the ventricular system at carotid angiography and computer assisted axial tomography.

Computer assisted axial tomography and the venous phase of carotid angiography provide complementary assessments of the ventricular and paraventricular structures. The computer assisted tomography more readily defines the ventricular system, but can prove weak in differentiating paraventricular gliomas, solitary metastasis and infarcts. Angiography plays a major role in differentiating between these three conditions, but is poor in accurately localizing and identifying intra- and paraventricular hemorrhage which is characteristically and expeditiously uncovered by C.T. scanning.