Peritumoral edema in meningiomas: pathophysiology, predictors, and principles for treatment.

Meningiomas is a tumor of the meninges and is among the most common intracranial neoplasms in adults, accounting for over a third of all primary brain tumors in the United States. Meningiomas can be associated with peritumoral brain edema (PTBE) which if not managed appropriately can lead to poor clinical outcomes. In this review, we summarize the relevant pathophysiology, predictors, and principles for treatment of PTBE. The results of various case-reports and case-series have found that meningioma-associated PTBE have patterns in age, tumor size, and hormone receptor positivity. Our study describes how increased age, increased tumor size, tumor location in the middle fossa, and positive expression of hormone receptors, VEGF, and MMP-9 can all be predictors for worse clinical outcomes. We also characterize treatment options for PTBE such as glucocorticoids and VEGF inhibitors along with the ongoing clinical trials attempting to alleviate PTBE in meningioma cases. The trends summarized in this review can be used to better predict the behavior of meningioma-associated PTBE and establish prognosis models to identify at risk patients.

Can Routine Blood Biochemistry Parameters be Predictive Prognostic Marker(s) in Operated Patients with Meningioma WHO Grade 1?

Background Today, there is a need for new and independent additional advanced markers that can predict the prognosis of meningioma patients, postoperatively. The present study aimed to find out postoperative short-term prognostic markers in patients with meningioma using their demographic data and routine blood biochemistry findings evaluated preoperatively. Methods The Glasgow Coma Scale (GCS), and Glasgow Outcome Scale (GOS) scores of the patients were recorded. Additionally, preoperatively obtained serum glucose, Creactive protein (CRP), sodium, potassium, creatinine, blood urea nitrogen, aspartate aminotransferase (AST), alanine aminotransferase, and hemoglobin level values, platelet, leukocyte, neutrophil, lymphocyte, eosinophil, basophil, andmonocyte count results, erythrocyte sedimentation rate (ESR), neutrophil-lymphocyte ratio, plateletlymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) values were evaluated. Results In the present study, 23 operated patients with meningioma World Health Organization (WHO) grade 1 (17 females, 6 males) were included. Correlation test results revealed that the GCS score, platelet count, and serum potassium level values could directly predict the short-term prognosis of these patients. Additionally, these test results suggested that the lymphocyte, monocyte, and eosinophil count values, PLR, LMR, ESR, serum glucose, CRP, and AST level values could be indirect markers in predicting the short-term prognosis. However, likelihood ratio test results revealed that only monocyte count value, LMR value, and serum CRP level value could be the markers for prediction of the short-term prognosis. Conclusion At the end of the present study, it was concluded that the monocyte count value, LMR value, and serum CRP level value could be the best markers in predicting the short-term prognosis of the operated meningioma patients.

Meningioma parasagital y hematoma subdural crónico, una asociación inusual / Parasagittal meningioma and chronic subdural hematoma, unusual association

RESUMEN En muchas ocasiones, los pacientes con tumores cerebrales tienen una variedad de síntomas psiquiátricos inespecíficos. Algunos de estos pueden constituir la primera o única manifestación del tumor, sin la presencia de ningún síntoma o signo neurológico. El diagnóstico ha de basarse en la anamnesis completa y en la exploración neurológica; la neuroimagen confirmará el diagnóstico clínico. Con el presente trabajo se describió la asociación inusual de hematoma subdural crónico y meningioma parasagital en un caso presentado. Se trató de un paciente de 68 años con antecedentes de esquizofrenia. Acudió a consulta con una hemiparesia izquierda. Se le realizó una tomografía axial computarizada de cráneo y arrojó un hematoma subdural crónico y un meningioma parasagital derecho. Se le aplicó tratamiento quirúrgico en dos tiempos operatorios. Su evolución posquirúrgica transcurrió sin complicaciones (AU).

ABSTRACT In many cases, patients with brain tumors have a variety of nonspecific psychiatric symptoms. Some of them can be the first or the only manifestation of the tumor, without presenting any neurological signs or symptoms. The diagnosis must be based on the complete anamnesis and on the neurological examination. The neuroimaging will confirm the clinical diagnosis. The unusual association of a chronic subdural hematoma and a parasagittal meningioma was described in a case presented in the current work. It dealt with a patient, aged 68 years with antecedents of schizophrenia. He assisted the consultation with left hemiparesis. A skull computed tomography showed a chronic subdural hematoma and a right parasagittal meningioma. He underwent a two-steps surgery. His post-surgery evolution ran without complications (AU).

Pregnancy and brain tumors; a systematic review of the literature.

The incidence of primary brain tumors during pregnancy is uncommon. The etiology of these can range from different genetic syndromes such as Li Fraumeni, neurofibromatosis type I, and hormonal associated tumors. The number of meningiomas gradually tends to increase during pregnancy, suggesting a relationship between non-malignant meningiomas and hormonal changes. Clinical features are non specific or can be misinterpreted with pregnancy symptoms such as headache, vomiting and dizziness. It is worth mentioning that the symptoms due to intracranial tumors are no different in pregnant compared with non pregnant patients. However, retrospective studies in glioma behavior suggested that both tumor volume and growth, increased during pregnancy. These changes were correlated with clinical worsening and increased frequency of seizures. The diagnosis requires a proper neurologic exploration and the support of imaging studies. Treatment of tumors is very controversial since we look for the preservation of both mother and fetus. In theory, the best therapy for the mother will also be the best therapy for the fetus. During pregnancy, ideally the treatment is symptomatic, to preserve the fetus, and definite treatment may be performed after birth; the latter is not always accomplished since patients may present with impending herniation or a malignant tumor for which immediate management is necessary. We intend to give an updated review in the literature on the adequate treatment of brain tumors during pregnancy and the anesthetic management during the definite treatment. Literature data was obtained from Pubmed using the search terms: "Pregnancy", "Brain", "Tumors". A total of forty-three articles were selected.

Evaluating anti-tumor activity of palbociclib plus radiation in anaplastic and radiation-induced meningiomas: pre-clinical investigations.

PURPOSE: Meningiomas are common brain tumors, the majority of which are considered benign. Despite surgery and/or radiation therapy, recurrence rates are approximately 8-10%. One likely cause is the dysregulation of cyclin D-cyclin-dependent kinases 4 and 6 (CDK4/6)-retinoblastoma (Rb) pathway, which controls the cell cycle restriction point. This pathway is commonly dysregulated in anaplastic meningioma cell lines (AM) and radiation-induced meningioma cells (RIM), making it a rational target for anti-meningioma therapy. In this study, we investigate the effect of a CDK4/6 inhibitor, palbociclib, with radiation in relevant pre-clinical models. METHODS: In vitro cell culture, ex vivo slice culture and in vivo cell line-derived orthotopic xenograft animal models of AM/RIM were utilized to assess treatment efficacy with palbociclib plus radiation. Treatment effects were examined by immunoblot, cell viability, apoptosis, and cell cycle progression. RESULTS: The in vitro and ex vivo studies demonstrate that palbociclib plus radiation treatment reduced proliferation and has additional effects on cell cycling, including induction of an RB-associated G (1) arrest in Rb+ AM and RIM cells, but not in Rb- cells. Our results also demonstrated reduced CDK4 and CDK6 expression as well as reduced E2F target gene expression (CCNA2 and CCNE2) with the combination therapy. MRI results in vivo demonstrated reduced tumor size at 5 weeks when treated with 14 days palbociclib (10 mg/kg) plus 6 Gy radiation compared to saline-treated tumors. Finally, no hepatic toxicity was found after treatments. CONCLUSION: A pre-clinical murine model provides preclinical evidence for use of palbociclib plus radiation as a therapeutic agent for Rb+ meningiomas.

Necrosis is a consistent factor to recurrence of meningiomas: should it be a stand-alone grading criterion for grade II meningioma?

The purpose of this study was to evaluate spontaneous necrosis as a possible isolated factor for progression and recurrence in grade I meningiomas classified according to the current World Health Organization (WHO) classification. Meningiomas are the most frequently reported primary intracranial tumours, accounting for more than 35%. The 2016 WHO classification of central nervous system tumors stratifies meningiomas in grades I (benign), II (atypical), and III (malignant), according to histopathological aspects and the risk of progression or recurrence. Among 110 patients with intracranial meningiomas, 70 were WHO grade I meningiomas with no findings of atypia (G1WON), 15 were WHO grade I with necrosis (G1WN), 21 were WHO grade II (G2), and 4 were WHO grade III (G3). The mean follow-up was 5.9 ± 0.2 years. High performance scale (KPS ≥ 80) was different (p < 0.001) between WHO grade I meningiomas without (81.4%) and with (60%) necrosis. The 5-year mortality rate was 1.4, 6.7 and 5.9% for G1WON, G1WN and G2, respectively, with significant difference (p = 0.011) related to the presence of necrosis. The risk of recurrence was 3.7 times higher in G1WN than in G1WON (p = 0.017), and 4.2 times in G2 (p = 0.010). Progression-free survival (PFS) was clearly higher in patients with G1WON compared to G1WN and G2 (p = 0.002 and p < 0.001, respectively). There was no significant difference in PFS between G1WN and G2 (p = 0.692). Retreatment was also superior in meningioma with necrosis. Our findings provide clear statistical data to consider that patients with benign meningiomas and histologic findings of spontaneous necrosis are at increased risk of progression and recurrence compared to those with benign lesion without atypical features. Statistical analysis curves also suggest that these lesions behave more similarly to those currently classified as WHO grade II meningioma.

Long-term Outcomes After Gamma Knife Radiosurgery for Meningiomas.

BACKGROUND: Gamma knife stereotactic radiosurgery (SRS) has become an important management strategy for patients with meningiomas. Although prior reports have studied early tumor control, neurological response, and associated morbidity, our purpose was to use clinical and imaging studies to determine whether long-term outcomes remain stable over time. MATERIALS AND METHODS: We studied 290 consecutive patients (92 men and 198 women) who underwent gamma knife SRS for a meningioma between 1987 and 1997. The median tumor margin dose was 15 Gy and the median tumor volume was 5.5 mL. Target definition was performed using contrast enhanced computed tomography in 72 patients and magnetic resonance imaging in 218 patients. The median patient age at radiosurgery was 61 years. Twenty patients had a history of fractionated radiation therapy, 136 patients had undergone a subtotal resection, and 22 patients had recurrences after initial gross total resection. RESULTS: The overall tumor control rate was 91%. Twenty-six patients (9%) had evidence of delayed local tumor growth and 44 (15%) had regional tumor progression, which occurred at a median of 38 months. The 10- and 20-year actuarial rates of freedom from tumor progression of the targeted tumor were 87.7%±2.5% and 87.2%±4.2%. Of 234 patients who had symptoms before SRS (n=62, 26%) improved, 126 (54%) had no change in symptoms and 46 (20%) gradually worsened. Thirty-two of 34 (94%) asymptomatic patients remained asymptomatic. We found no difference in long-term tumor control rates between patients who had undergone craniotomy before radiosurgery (89%) and patients who underwent primary radiosurgery (93.1%). Adverse radiation effects were detected in 3.1% of patients. Factors associated with worse progression-free survival included prior radiation therapy (P<0.0001) and higher grade meningioma (P<0.0001). At a median of 8.7 years after SRS, 137 patients were dead at a median age of 77 years. CONCLUSIONS: We found that gamma knife SRS provided durable tumor control with low morbidity in meningioma patients.

[Preoperative embolization with microspheres of giant supratentorial meningiomas: 5-year experience]. / Embolización preoperatoria con microesferas en meningiomas gigantes supratentoriales: experiencia de 5 años.

BACKGROUND: Preoperative embolization of hypervascular tumours such as meningiomas has proven to be a favorable factor for resection of the latter because it diminishes intraoperative bleeding and the need for blood transfusions. OBJECTIVES: Evaluation of surgical outcomes of preoperative embolization with microspheres of giant supratentorial meningiomas. METHODS: We retrospectively analyzed patient records from 2007 to 2012 with the diagnosis of giant supratentorial meningiomas (> 5 cm) (n= 27) and obtained two samples: those with preoperative embolization (n= 14) and patients without any properative embolization (n= 13). We evaluated and compared statistically significant surgical bleeding, surgical time and resection grade (via Simpson scale). Additionally, we evaluated internal/external vascularization rate and the histopathologic diagnosis. RESULTS: According to the Simpson scale, the mean resection grade was 1.21 for embolized meningiomas, whereas for non-embolized meningiomas it was 1.92 . No differences were found in surgical bleeding and operative time. We used microspheres whose diameters were 40-120 µm, and these were easily observed with common microscopy techniques. In all cases we observed predominance in extracranial vascularization. No morbidity and mortality were recorded with the endovascular procedure. CONCLUSIONS: Embolization with microspheres improves resection rate evaluated by the Simpson scale in patients with giant supratentorial meningiomas.

ANTECEDENTES: la embolización preoperatoria de tumores hipervascularizados, como los meningiomas, ha demostrado ser un factor favorable para su resección quirúrgica en términos de menor sangrado transquirúrgico y transfusiones sanguíneas. OBJETIVOS: evaluar el beneficio quirúrgico de la embolización preoperatoria con microesferas en meningiomas gigantes supratentoriales. MATERIAL Y MÉTODOS: estudio retrospectivo de los expedientes de pacientes postoperados entre 2007 y 2012 con diagnóstico de meningiomas gigantes supratentoriales (>5 cm) (n= 27). La muestra se dividió en dos grupos: pacientes embolizados antes de la intervención (n= 14), y pacientes a quienes no se realizó embolización (n= 13). Se comparó la cantidad de sangrado transoperatorio, el tiempo quirúrgico, y el grado de resección evaluado por la escala de Simpson. Además, se evaluó el tamaño tumoral, la tasa de vascularización de la carótida interna y externa y el diagnóstico histopatológico. RESULTADOS: el promedio de resección de acuerdo con la escala de Simpson para meningiomas embolizados fue de 1.21, mientras que para meningiomas no embolizados fue de 1.92 (t de Student, p= < 0.014). No encontramos diferencias significativas en tiempo quirúrgico o en el sangrado transoperatorio. En más de la mitad de los casos utilizamos microesferas de 40-120 µm de diámetro. Las microesferas se observaron fácilmente con los métodos usuales de microscopia y tinción, su existencia se correlacionó con áreas focales de necrosis. En todos los casos se encontró predominio de vascularización extracraneal, sin que el procedimiento endovascular se asociara con mortalidad. CONCLUSIONES: la embolización de meningiomas gigantes supratentoriales con microesferas mejora el grado de resección quirúrgica evaluada por la escala de Simpson.

Use of 111In-pentetreotide scan in a subject with treatment refractory atypical meningioma.

A 57-year-old man with a history of multiple recurrent atypical meningiomas (World Health Organization grade II) had several surgical resections including γ knife resection of the parafalcine meningioma, followed with a stereotactic radiosurgical ablation. Despite these treatments, an MRI scan performed 7 months later showed progression of the disease. The patient remained symptomatic with intermittent severe headaches associated with nausea, vomiting, and visual disturbance. He had a positive In-pentetreotide indicating the presence of somatostatin receptors. Therefore, he was placed on systemic Sandostatin (octreotide acetate) treatment, and at follow-up, he was clinically responsive to treatment.

Incidence and treatment of central nervous system tumors in Suriname.

OBJECTIVE: To estimate the incidence of central nervous system (CNS) tumors in Suriname. METHODS: A retrospective chart review was performed at the Academic Hospital Paramaribo and the State Health Insurance foundation. Patients receiving a diagnosis of CNS tumor in the period 2000-2010 were included in the study if a computed tomography scan or magnetic resonance imaging study was available. Demographic data and patient characteristics and disease variables were retrieved. RESULTS: The study comprised 251 patients who met the inclusion criteria. The incidence of treated CNS tumors was 5 per 100,000 per year. There was a peak incidence in the 41-50 age group and a male-to-female ratio of 1:1.46. Of CNS tumors, 21% were gliomas, 26.7% were meningiomas, 4.7% were schwannomas, and 12.0% were pituitary adenomas. Suriname has a low glioma incidence compared with globally (40%-60% of CNS tumors globally). The incidence of pituitary adenoma was higher than expected. There are indications for a higher glioma and meningioma incidence in Javanese and a higher metastases incidence in Creoles. CONCLUSIONS: The annual incidence of treated CNS tumors of 5 per 100,000 inhabitants in Suriname was in accordance with the expectation of an incidence of 3-6 per 100,000. Suriname is considered a country with a low cancer incidence. The differences found among various subgroups were too small to make definitive statements.

Pediatric meningiomas: a single-center experience with 15 consecutive cases and review of the literature.

OBJECTIVE: The goal of this study was to determine the epidemiology, clinical presentation, associated factors, pathological features, and treatment outcome of pediatric meningiomas in a single-center institution. METHODS: Clinical data of 15 patients under 18 years of age operated on for meningiomas from January 1994 to December 2010 were reviewed. RESULTS: The study group included nine males and six females (mean age of 13 years at surgery). The most common symptoms at presentation were headaches in 6 out of 15 (40 %), raised intracranial pressure in 3 out of 15 (20 %), and seizures in 3 out of 15 (20 %). Sole operated tumors were found in 12 out of 15 (80 %), whose location is as follows: parasagittal in 4 out of 12 (33.3 %), 2 in the convexity (16.6 %), 2 at the skull base (16.6 %), and 4 in other sites (33.3 %). Six children presented with radiation-induced (RT) meningiomas and five had evidence of neurofibromatosis type 2 (NF2). Three patients had multiple meningiomas (all of them had NF2). Simpson's grade I excision was achieved in 12 out of 15 (80 %). On histopathology, 11 out of 15 (73.3 %) were grade I and 4 out of 15 (26.6 %) were grade II (all of them atypical). Five tumors (33.3 %) recurred, four of which had RT or NF2. During the mean follow-up period of 5 years, 12 out of 15 (80 %) had a good outcome (GOS=5). CONCLUSIONS: Childhood meningiomas are uncommon lesions with a slight male predominance. Absence of large series with long follow-up precludes any definite conclusions on the clinical course and outcome of these tumors. Associated factors (such as RT and NF2), location, and extent of excision appear to be more important than histopathological grade in predicting outcome.

Meningioma angiomatoso selar tratado por radiocirurgia: relato de caso / Sellar angiomatous meningioma treated by radiosurgery: case report

Os meningiomas são os tumores cerebrais mesodermais,ocorrendo em 13 por cento a 19 por cento de todos os tumores cerebrais.Cerca de 40 por cento deles ocorrem na base do crânio,na região selar, e 10 por cento nas regiões parasselares, incluindo a região da asa do esfenóide,bulbo olfatório,tubérculo e diafragma selares. É relatado o caso de paciente com meningioma angiomatoso selar,submetido previamente à cirurgia transesfenoidal e, posteriormente, tratado por radiocirurgia estereotáxica. A evolução foi satisfatória, com remissão completa das crises de cefaléia e da ptose preexistente.

Intracranial meningiomas in children: ten-year experience.

Meningiomas are central nervous system neoplasms derived from arachnoid cap cells. They are the second most common brain tumors after gliomas, but are rare in children. Furthermore, meningiomas exhibit different behavior in this age group. From 1997-2007, 7 children with brain meningiomas were treated at the Department of Neurosurgery, Brazilian National Cancer Institute, Rio de Janeiro, Brazil. They represented 2.7% of all brain meningiomas, and 2.1% of all brain tumors, in children followed during this period at our institution. There were 4 boys, and the mean age at diagnosis was 7.3 years. Headaches, seizures, and motor deficits were the most frequent signs at presentation. All patients underwent surgery, and total resection was achieved in 6 of 7 patients. Most lesions were World Health Organization class I meningiomas. There were no deaths, and patients were asymptomatic or demonstrated mild motor or sensory signs at follow-up. In conclusion, meningiomas are rare in the pediatric population. Most of the lesions are low-grade, and the prognosis in this setting is good.

Estudio clínico-patológico comparativo de los meningiomas con referencia a su grado histológico y riesgo de recidivas

El grado histológico de la Organización Mundial de la Salud y la extensión de la resección quirúrgica inicial han sido considerados factores pronósticos determinantes en meningiomas. Sin embargo, una tasa de recidiva cercana al 20 por ciento en meningiomas benignos totalmente resecados plantea la necesidad de considerar nuevos factores pronósticos. Para estimar la importancia del grado histológico y determinar la influencia de factores clínicos y morfológicos sobre el riesgo de recidivas en meningiomas, se realizó un estudio clínico-patológico comparativo sobre una casuística de 580 tumores (pertenecientes a 532 pacientes). Con la progresión del grado histológico, se evidenció un aumento significativo en el porcentaje de pacientes del sexo masculino, una mayor propiedad invasiva del tumor a estructuras adyacentes y mayor porcentaje de tumores recidivantes,en tanto que la edad del paciente, la localización y tamaño del tumor, la extensión de la resección quirúrgica inicial y el intervalo libre de recidivas no variaron con el grado histológico. No se observaron diferencias significativas al comparar meningiomas no recidivantes y recidivantes con respecto al sexo y edad de los pacientes, grado histológico, localización y tamaño del tumor, extensión de la resección quirúrgica inicial e invasión tumoral de estructuras adyacentes. Si bien el grado histológico de los meningiomas resulta importante para predecir su comportamiento biológico, no existen parámetros clínicos ni morfológicos confiables que permitan determinar el pronóstico para un grado histológico en particular (especialmente en el grupo de meningiomas benignos)

The histological grade of the Wordl Health Organization and the extension of the initial surgical resection have been considered determining prognostic factors inmeningiomas. Nevertheless, a recurrence rate close to 20% in benign meningiomas completely resected arises the need of considering new prognostic factors. In orderto estimate the importance of the histological grade and to determine the influence of clinical and morphological factors upon the risk of recurrences in meningiomas, a comparative clinical-pathological study was carried out on 580 tumors (belonging to 532 patients). Progression of the histological grade was evident in a significant percentage of male patients in addition to a major invasive quality of the tumor to adjacent structures and a higher percentage of recurrent tumors, while the age of the patient, the localization and size of the tumor, the extension of the initial surgical resection and the interval free from recurrencies, did not vary with the histological grade. No significant differences were observed when comparing non recurrent meningiomas and recurrent meningiomas with respect to the gender and age of the patients, histological grade, localization and size of the tumor, extension of the initial surgical resection and tumorous invasion of adjacent structures. While the histological grade of the meningiomas is important to predict their biological behaviour, there are no reliable clinical or morphological parameters able to determine the prognosis for a particular histological grade (especially within the group of benign meningiomas)

Sphenoid wing meningiomas: surgical results

Objetivo: Analisar o resultado do tratamento cirúrgico dos meningiomas esfenoidais.Método:Estudo retrospectivo de 32 pacientes com meningiomas da asa do esfenóide, operados de janeiro de 2000 a janeiro de 2004 na Clínica Neurocirúrgica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.Resultados:A média etária dos pacientes foi de 43 anos, sendo 26 do sexo feminino e 6 do sexo masculino.Crises convulsivas foram a primeira manifestação clínica de 16 pacientes. Quanto à localização, 3 pacientes apresentavam meningiomas em placa, 8 localizados no terço interno, 14 no terço médio e 7 no terço externo.Ressecção Simpson I foi obtida em 9 pacientes, Simpson II em 15,Simpson III em 6,e Simpson IV em 2.Quanto aos resultados do tratamento cirúrgico,observamos 22 resultados excelentes,7 bons,2 ruins e 1 óbito.Conclusão:O tratamento cirúrgico é o tratamento de escolha para meningiomas da asa do esfenóide, com bons resultados e reduzidas complicações.

Meningioma gigante en edad pediátrica: caso clínico y revisión de la literatura / Giant meningioma in pediatric age: clinical case and literature review

Se presenta el caso clínico de una menor de menos de tres años portadora de un meningioma gigante que invadía la región temporal, fose pterigomaxilar y órbita a izquierda. Se describe el manejo clínico quirúrgico y la evolución muy favorable del caso. Se revisa la literatura y se discute la poca frecuencia de este tipo de tumores en la edad pediátrica.

Anaplastic meningioma: case report.

Intracranial meningiomas continue to challenge our best clinical efforts to eliminate them once discovered and deemed appropriate for treatment. Malignant meningiomas constitute 10% to 15% of all meningiomas and limited information exists regarding adjuvant treatment. The external whole brain irradiation is recommended. Traditional chemotherapy has proven ineffective; thus, new chemotherapeutic agents and new methods of delivery should be developed. Immunotherapy may be considered for patients with malignant meningiomas when all others previous treatment have failed. We report a case of anaplastic papillary meningioma. A 67-year-old man presented with partial complex seizures, headache and aggressiveness. A computerized tomography and magnetic resonance image demonstrated a large left temporo-occipital mass with diffuse contrast enhancement and extensive surrounding edema. A left temporo-occipital flap was performed. The tumor and the infiltrated dura were radically removed. Postoperatively, the patient remained neurologically intact. The treatment was complemented by external whole brain radiation.

La terapéutica endovascular preoperatoria en los meningiomas intracraneanos: evaluación y resultados quirúrgicos / Preoperative endovascular therapy in intracranial meningiomas: evaluation and surgical results

Los meningiomas son tumores benignos y por lo tanto potencialmente curables. Requieren para su tratamiento definitivo una resección quirúrgica completa. Al ser tumores vascularizados son propensos a las hemorragias durante la resección quirúrgica, las que muchas veces pueden ser importantes, elemento este determinante en la evolución final del paciente. Esta es una de las razones que llevaron a sostener que la embolización preoperatoria de sus pedículos, podría facilitar la cirugía al disminuir el sangrado. A nivel mundial hay una vasta experiencia en esta técnica, con excelentes resultados. Los autores presentan su experiencia que se inició con dos pacientes portadores de meningiomas gigantes, que fueron operados sin embolización, y que debido a la intensa hemorragia debió limitarse la cirugía a una resección parcial y que en una segunda etapa con embolización preoperatoria, se logró en ambos casos, una resección quirúrgica completa sin incidentes. En total se estudiaron 8 casos, con buena evolución. Actualmente los autores utilizan este procedimiento en forma rutinaria, destacándose la escasa o nula hemorragia intraoperatoria, la resección más fácil, debido a los cambios inducidos en el tumor por la embolización y la excelente evolución posterior a estos pacientes. Se realiza una revisión de la bibliografía existente y se comparan los resultados de las diferentes series con los datos obtenidos por los autores(AU)