Extent of resection and survival outcomes in World Health Organization grade II meningiomas.

PURPOSE: WHO grade II meningiomas behave aggressively, with recurrence rates as high as 60%. Although complete resection in low-grade meningiomas is associated with a relatively low recurrence rate, the impact of complete resection for WHO grade II meningiomas is less clear. We studied the association of extent of resection with overall and progression-free survivals in patients with WHO grade II meningiomas. METHODS: A retrospective database review was performed to identify all patients who underwent surgical resection for intracranial WHO grade II meningiomas at our institution between 1995 and 2019. Kaplan-Meier analysis was used to compare overall and progression-free survivals between patients who underwent gross total resection (GTR) and those who underwent subtotal resection (STR). Multivariable Cox proportional-hazards analysis was used to identify independent predictors of tumor recurrence and mortality. RESULTS: Of 214 patients who underwent surgical resection for WHO grade II meningiomas (median follow-up 53.4 months), 158 had GTR and 56 had STR. In Kaplan-Meier analysis, patients who underwent GTR had significantly longer progression-free (p = 0.002) and overall (p = 0.006) survivals than those who underwent STR. In multivariable Cox proportional-hazards analysis, GTR independently predicted prolonged progression-free (HR 0.57, p = 0.038) and overall (HR 0.44, p = 0.017) survivals when controlling for age, tumor location, and adjuvant radiation. CONCLUSIONS: Extent of resection independently predicts progression-free and overall survivals in patients with WHO grade II meningiomas. In an era of increasing support for adjuvant treatment modalities in the management of meningiomas, our data support maximal safe resection as the primary goal in treatment of these patients.

Low-carbohydrate diet and the risk of metabolic syndrome in Korean adults.

BACKGROUND & AIMS: The association of low-carbohydrate diet with weight loss and the risk of cardiovascular diseases has recently been the focus of increasing research attention. However, studies on low-carbohydrate diet in the Asian population are limited. The present study was aimed to examine the association between low-carbohydrate diet and metabolic syndrome among Korean adults. METHODS AND RESULTS: A total of 16,349 participants aged 30 years or older who participated in a 24-h dietary recall survey of the fifth and sixth Korea National Health and Nutrition Examination Survey were included in this study. Low-carbohydrate diet was evaluated using the low-carbohydrate-diet score, which was calculated based on the percentage of energy from carbohydrate, protein, and fat by sex. The association between the low-carbohydrate-diet score and metabolic syndrome was analyzed using multiple logistic regression analysis. A low-carbohydrate diet was not associated with metabolic syndrome and its components such as waist circumference, blood pressure, and triglyceride levels. However, women in the highest decile of the animal- or plant-based low-carbohydrate-diet score showed a decreased risk of reduced high-density lipoprotein (HDL)-cholesterol levels, and men in the highest decile of the animal-based low-carbohydrate-diet score showed a decreased risk of reduced HDL-cholesterol levels than those in the lowest decile of the low-carbohydrate-diet score. CONCLUSION: These findings indicate that, in Korea, a low-carbohydrate diet did not increase the risk of metabolic syndrome among adults who typically consume a high-carbohydrate low-fat diet. However, it may moderately decrease the risk of reduced HDL-cholesterol levels.

Overlooked diagnosis of infected paratracheal air cysts in patients with respiratory symptoms: Case report.

RATIONALE: Infected paratracheal air cysts as the focus of respiratory symptoms can be overlooked in practice because of nonspecific symptoms and physician's scant knowledge for this entity. We report 2 cases of infected paratracheal air cyst diagnosed at chest computed tomography (CT) and bronchoscopy/endobronchial ultrasound. PATIENT CONCERN: Two patients visited our hospital with respiratory symptoms, including cough, sputum, and fever. DIAGNOSES: Chest CT showed paratracheal cystic lesions with air-fluid level in the thoracic inlet. In the first patient, endobronchial ultrasound revealed a right paratracheal hypoechoic mass corresponding to the lesion on CT scan. In the second patient, bronchoscopy revealed purulent discharge from a dimpling at posterolateral wall of trachea, which was the opening of communication between the trachea and infected paratracheal air cyst. INTERVENTIONS: Both patients received antibiotic treatment. OUTCOME: After medical treatment, the patients' symptoms were improved. Follow-up chest CT scans showed air-filled paratracheal air cysts without internal fluid or rim enhancement. LESSONS: A physician should pay attention to paratracheal air cyst in patients with respiratory symptoms when their lungs are clear on CT scan.

Milk-cereal and whole-grain dietary patterns protect against low bone mineral density among male adolescents and young adults.

BACKGROUND/OBJECTIVES: Evidence supporting the possible effect of dietary factors on adult bone health has emerged in recent decades. The purpose of this study was to ascertain the influence of different dietary patterns on bone mineral density (BMD) among Korean male youth. SUBJECTS/METHODS: Data were extracted from the Korean National Health and Nutrition Examination Survey (KNHANES) during 2008-2011. The subjects included 1351 male aged 10-25 years. We defined 'low BMD group' as subjects with a BMD Z-score of -2.0 or less. Dietary patterns were derived from 20 food groups via factor analysis. RESULTS: Three dietary patterns-meat and vegetable, white rice and kimchi, milk-cereal and whole grain-were derived. The 'milk-cereal and whole-grain' dietary pattern score showed positive association with energy, protein, fat, calcium, phosphorus, potassium, riboflavin and vitamin C intakes. Participants in the top tertile of the milk-cereal and whole-grain pattern were less likely to have low BMD, compared with subjects in the bottom tertile (odds ratio=0.36, 95% confidence interval=0.16-0.81, P=0.018). CONCLUSIONS: Our findings suggest that the milk-cereal and whole-grain dietary pattern may have a benign influence on bone health in the Korean male youth.

Identification of major dietary patterns in Korean adults and their association with cancer risk in the Cancer Screening Examination Cohort.

BACKGROUND/OBJECTIVES: Cancer is the primary cause of disease-related death in Korea. The purposes of this study were to confirm the major dietary patterns and to evaluate whether there were associations between these identified dietary patterns and the risk of cancer based on data from the Cancer Screening Examination Cohort (CSEC) 2004-2008 of the National Cancer Center (NCC) of Korea. SUBJECTS/METHODS: This study included 8 024 subjects who completed a written survey on demographics and lifestyles, as well as a 3-day dietary record. Dietary patterns were identified by factor analysis using the principal component analysis method. The associations between the identified dietary patterns and cancer risk were examined using Cox proportional hazards regression models. RESULTS: During a median follow-up period of 9.0 years, 425 cancer cases were newly diagnosed. We identified 4 major dietary patterns ('rice and kimchi', 'vegetables and fish', 'fruits and dairy', and 'meats and sweets'). There was a negative relation between 'rice and kimchi' pattern and the risk of non-gastrointestinal cancers only (highest vs. lowest tertile; multivariate-adjusted hazard ratio=0.60, 95% confidence interval=0.41, 0.88). The 'fruits and dairy' pattern tended to decrease the risk of cancer, and the preventive effect was noted only for gastrointestinal cancer risk. However, there was no association after adjusting for covariates. CONCLUSIONS: The traditional dietary pattern with high consumption of rice, kimchi, soybean paste and vegetables may decrease the cancer risk among Koreans, and strategies based on the dietary pattern may effectively reduce the cancer risk.

Dominant Occipital Sinus Complicating Surgery of a Fourth Ventricular Mass.

BACKGROUND: We describe a case of a fourth ventricular mass requiring a modified approach to its management owing to a rare variation of the occipital sinus (OS). CASE DESCRIPTION: A 32-year-old female presented with persistent headache and nausea. Magnetic resonance imaging revealed a fourth ventricular mass and hydrocephalus. Venous sinus anatomy appeared unusual, and thus magnetic resonance venography was performed, which identified the OS as the main drainage pathway for the entire brain, providing the sole drainage between the superior sagittal sinus and the jugular veins through the marginal sinus. Both the transverse and sigmoid sinuses were hypoplastic, and flow through the straight sinus was diminished. Thus, endoscopic third ventriculostomy and biopsy were performed as the first step. Postoperatively, the patient's nausea persisted and biopsy results were inconclusive, and thus a second surgery was planned. The dural opening was tailored so as not to damage the OS and marginal sinus, and the tumor was resected subtotally through the limited dural opening. Histopathological analysis identified a low-grade glioma. CONCLUSIONS: Rare variations of the venous/sinus anatomy may fundamentally change the surgical management plan, and recognizing such variations is crucial to minimizing the risk of potentially fatal complications.

Suprascapular neuropathy in massive rotator cuff tears with severe fatty degeneration in the infraspinatus muscle.

AIMS: Our aim was to describe the atypical pattern of increased fatty degeneration in the infraspinatus muscle compared with the supraspinatus in patients with a massive rotator cuff tear. We also wished to describe the nerve conduction and electromyography findings in these patients. PATIENTS AND METHODS: A cohort of patients undergoing surgery for a massive rotator cuff tear was identified and their clinical records obtained. Their MRI images were reviewed to ascertain the degree of retraction of the torn infraspinatus and supraspinatus muscles, and the degree of fatty degeneration in both muscles was recorded. Nerve conduction studies were also performed in those patients who showed more degeneration in the infraspinatus than in the supraspinatus. RESULTS: Out of a total of 396 patients who underwent surgery for a massive rotator cuff tear between 2006 and 2015, 35 who had more severe fatty degeneration in the infraspinatus than in the supraspinatus were identified. There were 13 men and 22 women. Their mean age was 67.2 years (56 to 81). A total of 20 (57%) had grade 4 fatty degeneration as classified by Fuchs et al, in the infraspinatus. Patte grade 3 muscle retraction was seen in 25 patients (71%). In all, eight patients (23%) had abnormal nerve conduction studies. The mean retraction of the infraspinatus was 3.6 cm (2.1 to 4.8) in patients with more severe fatty degeneration in the infraspinatus, versus 3.0 cm (1.7 to 5.5) in those with more severe degeneration in the supraspinatus (p = 0.003). The retraction ratios were 0.98 (0.61 to 1.57) and 0.77 (0.38 to 1.92), respectively (p < 0.001). CONCLUSION: Fatty degeneration affecting the infraspinatus more than the supraspinatus may be, in the context of a massive rotator cuff tear, due to entrapment of the suprascapular nerve at the spinoglenoid notch. Cite this article: Bone Joint J 2016;98-B:1505-9.

Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery.

OBJECTIVE: Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. METHODS: We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. RESULTS: Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). CONCLUSION: When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

OBJECTIVE: Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. METHODS: We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. RESULTS: Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). CONCLUSION: When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

A fruit, milk and whole grain dietary pattern is positively associated with bone mineral density in Korean healthy adults.

BACKGROUND/OBJECTIVES: Osteoporosis is a major health problem that will grow in burden with ageing of the global population. Modifiable risk factors for osteoporosis, including diet, have significant implications for disease prevention. We examined associations between dietary patterns and bone mineral density (BMD) in a Korean adult population. SUBJECTS/METHODS: In total, 1828 individuals from the Healthy Twin Cohort were included as subjects. Information on general characteristics, lifestyles and health status was obtained through a health examination, and BMD was assessed using DEXA. Dietary intake was assessed using a 3-day food record, and dietary patterns were examined by factor analysis. Associations between dietary patterns and BMD were examined using mixed linear regression, adjusting for family and twin structure as well as other potential risk factors for bone health. RESULTS: Four dietary patterns were identified (Rice and kimchi; eggs, meat and flour; Fruit, milk and whole grains; and Fast food and soda). The 'Fruit, milk and whole grains' pattern was associated with a reduced risk of having low BMD in men (odds ratio (OR)=0.38; 95% confidence interval (CI)=0.22-0.67) and women (OR=0.45; 95% CI=0.28-0.72) and was positively associated with BMD at multiple sites. The 'rice and kimchi' pattern had a positive association with only whole-arm BMD in men and women. CONCLUSIONS: Our results suggest that a dietary pattern with high intake of dairy products, fruits and whole grains may contribute positively to bone health in a Korean adult population, and dietary pattern-based strategies could have potential in promoting bone health.

Microvascular decompression for trigeminal neuralgia.

The microvascular decompression procedure has proven to be a safe and effective option in the surgical management of neurovascular compression syndromes in general and trigeminal neuralgia in particular. This article aims to serve as an overview of the decision-making process, application of the surgical technique, and clinical outcome pertaining to this procedure.

The influence of age on the histological grading of meningiomas.

This study was undertaken to assess the relationship between the age of patients at the time of their surgery and histological grading of meningiomas. A retrospective review was conducted for 1,083 consecutive patients with meningiomas who had surgical removal between January 1991 and December 2006. Histological grading for each tumor was done utilizing the WHO classification for meningiomas. The incidence of WHO grade II or III tumors between the elderly and the non-elderly groups was compared. The mean age at diagnosis for the WHO grade I, II, and III tumors was 55.1 (±14.79), 59.0 (±15.54), and 64.3 years (±13.28) (p value = 0.007), respectively. We found that 11.9 % of meningiomas diagnosed after the age of 60 years was WHO grade II or III, while this value was only 6.9 % for patients 60 years or younger (p = 0.0006). Our study showed that the combined incidence of WHO grade II and III meningiomas increases as age advances. We believe that this constitutes an important piece of information requiring neurosurgeons to carefully and continuously observe the elderly patients harboring meningiomas.

Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis.

BACKGROUND: Trigeminal neuralgia (TN) is relatively frequent in multiple sclerosis (MS) patients and can be extremely disabling. Surgical interventions are less effective for the treatment of MS-related TN compared with classic TN, and higher recurrence rates are observed. OBJECTIVE: To evaluate initial pain-free response (IPFR), duration of pain-free intervals (PFIs), and factors predictive of outcome in different surgical modalities used to treat MS-related TN. METHODS: A total of 96 MS patients underwent 277 procedures (range, 1-11 procedures per patient) to treat TN at our institution from 1995 to 2011. Of these, 89 percutaneous retrogasserian glycerol rhizotomies, 82 balloon compressions, 52 stereotactic radiosurgeries, 28 peripheral neurectomies, 15 percutaneous radiofrequency rhizotomies, and 10 microvascular decompressions were performed as upfront or repeat treatments. RESULTS: Bilateral pain was observed in 10% of patients during the course of disease. During the follow-up period (median, 5.7 years), recurrence of symptoms was seen in 66% of patients, and 181 procedures were performed for symptom recurrence. As an initial procedure, balloon compression had the highest IPFR (95%; P = .006) and median PFI (28 months; P = .05), followed by percutaneous retrogasserian glycerol rhizotomy (IPFR, 74%, P = .04; median PFI, 9 months; P = .05). In general, repeat procedures had lower effectiveness compared with initial procedures, with no statistically significant difference seen across the various treatment modalities. CONCLUSION: Treatment failure occurs in most of the MS-related TN patients independently of the type of treatment. However, balloon compression had the highest rate of IPFR and PFI compared with other modalities in the initial treatment of MS-related TN.

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications.

Interest in studying the anatomy of the abducent nerve arose from early clinical experience with abducent palsy seen in middle ear infection. Primo Dorello, an Italian anatomist working in Rome in the early 1900s, studied the anatomy of the petroclival region to formulate his own explanation of this pathological entity. His work led to his being credited with the discovery of the canal that bears his name, although this structure had been described 50 years previously by Wenzel Leopold Gruber. Renewed interest in the anatomy of this region arose due to advances in surgical approaches to tumors of the petroclival region and the need to explain the abducent palsies seen in trauma, intracranial hypotension, and aneurysms. The advent of the surgical microscope has allowed more detailed anatomical studies, and numerous articles have been published in the last 2 decades. The current article highlights the historical development of the study of the Dorello canal. A review of the anatomical studies of this structure is provided, followed by a brief overview of clinical considerations.

Expression analysis of human ß-secretase in transgenic tomato fruits.

An emerging strategy in biomanufacturing involves using transgenic plants to express recombinant pharmaceutical and industrial proteins in large quantities. ß-Site APP cleaving enzyme 1 (ß-secretase 1, BACE1) is an enzyme involved in the abnormal production of Aß42, the major component of senile plaques in Alzheimer's disease (AD). Thus, BACE1 represents a key target protein in the development of new potential drugs to treat Alzheimer's disease. We aimed to develop a tomato-derived recombinant BACE1 (rBACE1) protein to serve as a vaccine antigen that would promote an immune response. We utilized a plant expression cassette, pE8BACE, to optimize BACE1 expression in tomato fruits. Polyemerase chain reaction and Southern blot analyses verified integration of the BACE1 gene into the plant genome. Northern and Western blot analyses demonstrated successful mRNA and protein expression of rBACE1, respectively; the Sensizyme assay kit estimated the expression level of rBACE1 protein at 136 ± 7 ng mg⁻¹ total soluble protein. The tomato-derived rBACE1 retains its activity for a long storage period at cool or room temperature, and is highly resistant to degradation in conditions such as low acidity. Tomato-derived rBACE1 was severely degraded by heat or boiling. The proteolytic activity of tomato-derived rBACE1, confirmed by fluorescence resonance transfer assay, was similar to that of a commercial sample of Escherichia coli-derived BACE1.

Minimally invasive endoscopic endonasal management of skull base cholesterol granulomas.

BACKGROUND: Skull base cholesterol granulomas (SBCGs) are rare lesions that have traditionally been managed via middle fossa or transtemporal approaches. Despite the relative paucity in the literature, the endoscopic endonasal approach may serve as a potential alternative surgical route. In this study, we report our experience with the management of SBCG using this minimally invasive approach. METHODS: The charts and imaging studies of three patients were reviewed retrospectively. The mean age was 36 years (range 30-42). The male/female ratio was 2:1. The epicenter of the lesion was petrous apex in two patients and clivus in one. One patient had undergone surgery via a middle fossa approach 3 years before the endoscopic procedure. The SBCG was drained using an endoscopic endonasal approach in all patients. A stent was left in place in 2 cases. RESULTS: All patients presented with headaches and ipsilateral retroorbital pain. One patient also had diplopia, ipsilateral blepharospasm, and hearing loss. Average lesion size was 31 mm (22-37 mm). Pain and associated neurologic symptoms completely resolved in one patient, and the headache significantly improved in the other two. These two patients underwent revision surgeries for symptomatic reaccumulation and stenosis of cavity opening at 5 and 7 months, respectively. Both patients improved subsequently, and have been stable since that time. One patient developed chronic sphenoid sinusitis. Average hospital stay was 1 day per procedure. All patients had functional patency of the SBCG with average follow-up of 25 months (10-36 months). CONCLUSIONS: Endoscopic endonasal approach may serve as a technically feasible and minimally invasive alternative to traditional surgical approaches for the management of SBCG in carefully selected patients.

A traditional Korean dietary pattern and metabolic syndrome abnormalities.

BACKGROUND AND AIMS: Using national data, we explored the relationship between dietary patterns and metabolic abnormalities to address how the traditional Korean diet, high in carbohydrate and low in animal fat with plenty of plant foods, has influenced metabolic abnormalities in the adult population. METHODS AND RESULTS: We examined cross-sectional associations between dietary patterns and the risk of metabolic abnormalities in 4,730 subjects aged 20 years or more using both health and dietary data from the 2005 Korean National Health and Nutrition Examination survey. Three evident dietary patterns were derived by cluster analysis: 'Traditional' (50.3% of total population), 'Meat and Alcohol, (15.8%) and 'Korean Healthy' (33.9%). The 'Traditional' group was characterised by high consumptions of rice and kimchi, while the 'Korean healthy' group ate a modified Korean-style diet with various foods such as noodles, bread, eggs and milk, and the 'Meat and Alcohol' group had high consumptions of processed meat and alcohol. Compared with the 'Traditional' pattern, the 'Meat and Alcohol' pattern was associated with a 33% increased risk of having elevated blood glucose, a 21% increased risk of having elevated serum triglycerides and a 21% increased risk of having elevated blood pressure. However, the 'Traditional' pattern showed a 23% increased risk of having low high density lipoprotein (HDL)-cholesterol compared with the other two patterns by logistics analysis. CONCLUSIONS: Fifty percent of the Korean adult population continues to follow a traditional dietary pattern, having beneficial effects with respect to some metabolic abnormalities. However, the high prevalence of low HDL-cholesterol, attributable to a high-carbohydrate diet, should be considered.

Ret finger protein inhibits muscle differentiation by modulating serum response factor and enhancer of polycomb1.

Skeletal myogenesis is precisely regulated by multiple transcription factors. Previously, we demonstrated that enhancer of polycomb 1 (Epc1) induces skeletal muscle differentiation by potentiating serum response factor (SRF)-dependent muscle gene activation. Here, we report that an interacting partner of Epc1, ret finger protein (RFP), blocks skeletal muscle differentiation. Our findings show that RFP was highly expressed in skeletal muscles and was downregulated during myoblast differentiation. Forced expression of RFP delayed myoblast differentiation, whereas knockdown enhanced it. Epc1-induced enhancements of SRF-dependent multinucleation, transactivation of the skeletal α-actin promoter, binding of SRF to the serum response element, and muscle-specific gene induction were blocked by RFP. RFP interfered with the physical interaction between Epc1 and SRF. Muscles from rfp knockout mice (Rfp(-/-)) mice were bigger than those from wild-type mice, and the expression of SRF-dependent muscle-specific genes was upregulated. Myotube formation and myoblast differentiation were enhanced in Rfp(-/-) mice. Taken together, our findings highlight RFP as a novel regulator of muscle differentiation that acts by modulating the expression of SRF-dependent skeletal muscle-specific genes.

A tentorial venous hemangioma presenting as an extra-axial mass in the ambient cistern: a case report.

Although venous hemangiomas are one of the most common soft-tissue tumors, venous hemangiomas in the central nervous system are extremely rare. We present an unusual case of venous hemangioma originating from the interdural space of the tentorium. A 32-year-old woman was incidentally found to have extra-axial mass occupying the left ambient cistern. This tumor was observed for the first 4 years as it was completely asymptomatic. Surgical resection was later recommended when the tumor grew. The mass originated from between the two layers of the anteromedial tentorial incisura. There were no findings indicative of previous hemorrhage inside the mass. The matrix of the mass was firm and vascular, resembling a fibrous meningioma. Gross total resection was achieved without any neurological deficit. Pathological examination revealed a dense fibrous connective tissue with a proliferation of vessels marked by thickened walls. A spindle cell proliferation in the vessel walls did not stain with the antibody to S-100 protein. Movat stain demonstrated the venous character of the vessels. These results were histologically compatible with a venous hemangioma. Albeit extremely rare, a venous hemangioma, a distinct clinical and pathological entity from a venous angioma, can present an intracranial mass lesion.

Benefits and limitations of diameter measurement in the conservative management of meningiomas.

BACKGROUND: Meningiomas are the most common benign brain tumors that are frequently followed-up by neurologists, general practitioners, and neurosurgeons. Some recent studies advocate the accurate volumetric method (VM) over measuring the linear maximum diameter although its clinical significance still remains unknown. The aim of this study is to directly compare the linear method (LM) and VM to delineate the characteristics of both measurements. METHODS: Between 2003 and 2010, growth analysis using magnetic resonance imaging DICOM files was performed for 189 meningiomas in 161 patients at the Cleveland Clinic. In LM, a minimum increase of 2 mm in maximum diameter was defined as tumor growth. The absolute volume growth (VG, in cm(3)) was calculated for each tumor. RESULTS: Linear growth (LG) was seen in 71 tumors (37.6%) within the median follow-up of 2.0 years. These tumors with LG showed a mean VG of 2.80 cm(3). Some large LG-positive tumors can be larger than estimated from LG. In addition, the skull base location was correlated to greater VG. On the other hand, 118 tumors without LG demonstrated the minimal actual volume increase, i.e., mean VG of 0.16 cm(3). Although a small subset of these LG-negative tumors might have slightly high VG when they were large, the location of tumor had no correlation to VG. CONCLUSIONS: Our data demonstrated some important precautions in measuring the tumor growth. We believe that it is mandatory in the conservative management of meningiomas to correctly understand benefits and potential limitations of different measurement methods utilized.