Predictor factors for recurrence in atypical meningiomas.

BACKGROUND AND OBJECTIVES: Atypical meningiomas (AMs), World Health Organization (WHO) grade 2, are a group of tumors with uneven and unpredictable clinical behavior. Our aim was to analyze possible tumor recurrence predictors, and to identify factors that improve progression-free survival (PFS). PATIENTS, MATERIALS AND METHODS: Our retrospective study included 81 patients followed up in the Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iasi, Romania, between 1 January 2010 and 31 December 2020. The histopathological specimens were reviewed according to the WHO 2021 criteria. Analyses included clinical, imaging, pathological and surgical factors. RESULTS: The tumor recurred in 53.1% of the 81 cases within 60 months of surgery. Tumor location (p<0.000), tumor volume (p<0.010), extent of surgical resection (p<0.000) and dural sinus invasion (p<0.001) were predictive factors of recurrence. Gross total resection (Simpson grade I and II) was achieved in 59.2% of patients. Patients with the tumors located in the brain convexity and volume <26.4 cm³ had better survival rates up to recurrence. PFS showed a significant relationship between Simpson grade I-III and biopsy (p<0.000) and was statistically influenced by tumor volume and location, and dural sinus invasion. CONCLUSIONS: AMs are a heterogeneous group of tumors, and we identified posterior fossa location, volume ≥26.4 cm³, Simpson grade III and IV resection and dural sinus invasion as predictive factors for relapse and a shorter PFS. Whereas certain characteristics provide some prognostic value, future molecular characterizations of AMs are necessary, which will support the clinical decision-making process.

Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review.

BACKGROUND: Meningiomas are the most common primary neoplasms of the central nervous system in adults, arising from the arachnoid cap cells. Thus, grade 2 meningiomas are situated on the border between benignity and malignancy. Among the many prognostic factors that have been investigated in these tumors, bone invasion is one of them. OBJECTIVE: The aim of our study was to identify whether bone invasion influences tumor recurrence and progression-free survival (PFS) in patients with atypical meningiomas (AMs). PATIENTS, MATERIALS AND METHODS: Out of 81 patients with AMs followed over a period of five years, we identified nine patients with bone invasion. We analyzed their demographic, clinical, imaging, and pathological characteristics, such as age, gender, radiological aspects, morphological features, extent of resection, recurrence rate, and PFS over a follow-up period of 60 months. Bone invasion was determined based on preoperative, surgical, and pathological reports. RESULTS: Out of the nine patients with bone invasion, four had convexity meningiomas, four had parasagittal meningiomas and one had a falcine meningioma. Regarding tumor recurrence∕progression, most patients (n=6) recurred within the first 24 months after surgery. Our study showed that the early recurrence/progression of tumor (at 12 months) correlated with extensive presence of malignancy criteria, especially with the presence of 15-18 mitoses∕10 high-power fields, as well as with large foci of spontaneous necrosis, but also with tumor bone infiltration, extensive bone lamellae destruction, and tumor infiltration of adjacent muscle with its atrophy due to tumor compression. Patients with bone invasion had a PFS of 29.3 months, compared to patients without invasion who had a higher PFS (49.3 months). Significant statistical associations were observed between bone invasion and tumor recurrence (p=0.002) and PFS (p=0.004). CONCLUSIONS: Our study emphasizes the importance of a thorough histopathological examination of the surgical specimen, which can provide significant data for the assessment of the progression of an AM [World Health Organization (WHO) grade 2] with bone invasion. AM infiltration in adjacent bone and muscle increases the rate of tumor recurrence and decreases PFS over a follow-up period of 60 months.

Morphological aspects of the vasculogenesis and angiogenesis during prenatal edification of the circle of Willis: a review.

In the literature, there are many articles reporting anatomical variations of circle of Willis (CoW), defined as those changes that lead to the inability of this anastomotic structure to maintain adequate brain flow. Because there is such a wide variation in the configuration of the CoW, its anatomical variations affect the hemodynamics of blood flow, thus contributing to the development of aneurysms or stroke. As such, we consider that a good knowledge of the embryological development of the constituent arteries of the CoW can shed some light on the causes of the appearance of its anatomical variants. Reviewing literature, we will present the embryological development of the constituting arteries of the CoW and will begin with vasculogenesis and angiogenesis of the vascular system as a whole. Then, we will focus on the embryological development of the internal carotid artery (ICA) and its branches because, starting with the embryological day 24, these arteries are the first vessels that begin to develop to provide the necessary blood for the primitive brain. As the hindbrain increases its volume, a larger amount of nutrients is needed. Because a larger amount of blood is required to be provided by the primitive ICAs, there is a need for arterial capacity development and thus the posterior circulation begin to take shape. At this stage, the posterior circulation consists of a plexiform arterial network that receives blood from the carotid artery through the carotid-vertebrobasilar anastomoses. At the 5-8 mm embryonic stage, these anastomoses begin to regress, and the basilar artery and vertebral arteries become independent of the ICA. We are pointing out on the process of regression of these primitive vessels, emphasizing the fact that their persistence represents the starting point for the appearance of anatomic anomalies of the CoW, which are identified in the adult individuals. In this review, we also present and illustrate some developmental abnormalities of the anterior and posterior parts of the CoW.

The Myth of Prometheus in metastatic meningioma to the liver: from craniotomy to hepatectomy.

Metastases from intracranial meningiomas are rare, and among them, meningiomas with hepatic dissemination are extremely rare. Therefore, there are currently no guidelines for staging and treatment of metastatic disease in meningioma, a disease that is a challenge for both the clinician and the pathologist. Our literature review revealed 24 cases of liver metastases originating from intracranial meningiomas. We used them to analyze the pathological patterns of dissemination and to assess the different management strategies available, the most efficient and beneficial being surgery and chemotherapy, especially in the case of meningiomas with hepatic and∕or systemic dissemination.

Protection measures against SARS-CoV-2 infection for cytopathology and histopathology laboratories personnel: practical recommendations.

In the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, healthcare workers are at high risk to be infected with this new coronavirus, particularly when they handle not only patients, but also their body fluids. In Romania, even though the protective measures to be used by medical staff in emergency departments, clinical departments, radiology departments, clinical laboratories and morgues services are well known, there is little information about the protection of medical staff in the laboratories of cytopathology and histopathology. In this article, we will discuss the transmission routes of the new coronavirus, the surfaces it could contaminate in a hospital, as well as the modalities of its inactivation. We will present some guidelines for preparing the pathology departments to face the pandemic situation like the present one. Also, we will point out some possible recommendations/suggestions for protective measures to be taken by laboratory staff during the cytological and histopathological procedures when they manipulate body fluids or surgical samples of patients with suspected or confirmed coronavirus disease 2019 (COVID-19). Laboratory personnel should be aware that any body fluid or surgical specimen that arrives in the laboratory may contain SARS-CoV-2 and, as such, they should act after new working procedures. We recommend restraint from performing extemporaneous examination (smear and frozen section) and cytopathological examination in laboratories that do not have adequate condition for handling and processing Hazard Group 3 (HG3) pathogens, as SARS-CoV-2. Also, laboratory personnel should pay attention to instruments, technical equipment, or environmental surfaces as these also can be contaminated with the new coronavirus.

The discovery of the circle of Willis as a result of using the scientific method in anatomical dissection.

There are numerous articles on the discovery of this arterial polygon, its history being quite long, beginning with the Antiquity and up to the Modern Era. Making an analysis of the primary and secondary sources on this topic, the purpose of this article is to identify the significant moments of the discovery of this arterial polygon, which is an anatomical structure with great importance for neurologists and neurosurgeons. We will present the contributions to this topic from Renaissance and early Modern Era anatomists, such as Andreas Vesalius, Jean Fernel, Gabriel Fallopius, Giulio Cesare Casseri, Adriaan van den Spiegel, Johann Vesling, and Johann Jakob Wepfer von Schaffhausen. We also pointed out that the contribution of the famous British anatomist Sir Thomas Willis (1621-1675) was the most important one. He published De Cerebri Anatome, in 1664, in which he described the vascular arrangement laying at the base of the brain, accompanying it by the exquisite drawings of Christopher Wren. Thus, he demonstrated to the medical world that he had reached the greatest understanding of the structure and function of the circular arterial anastomosis. For this excellent discovery, his followers honored him by giving his name to this arterial circle.

Tumor recurrence in parasagittal and falcine atypical meningiomas invading the superior sagittal sinus.

OBJECTIVE: Parasagittal and falcine meningiomas are still a challenge in terms of surgical resection. Although maximal safe resection is the main therapeutic approach, numerous postoperative complications can still occur depending on the locations of these tumors. Moreover, previous studies have reported that parasagittal meningiomas have a higher recurrence rate than meningiomas with other locations. PATIENTS, MATERIALS AND METHODS: We retrospectively reviewed 21 patients with parasagittal and falcine atypical meningiomas [World Health Organization (WHO) grade II], nine of whom had their superior sagittal sinus (SSS) invaded by the tumor. We reviewed the demographic information, operative notes, pathological reports, and clinical and imagistic follow-up reports of each patient over a 5-year time span. RESULTS: All the patients were surgically treated, and the tumor removal was grade II according to Simpson's grading system in 47.6% and grade III in 19% of the cases. The SSS was invaded in 42.9% of the patients. No immediate mortality or morbidity was revealed by our study. Tumor recurrence/progression documented on postoperative imaging amounted to 14.3% and 19%, 12 and 24 months after surgery, respectively. Furthermore, 36, 48 and 60 months after the surgery, the recurrence rate remained the same, namely in 9.5% of the cases. The recurrence was higher in patients with SSS invasion than in patients with no SSS invasion. The tumor recurrence was slightly more predominant in women, i.e., 6% higher than in the male group. CONCLUSIONS: In our group of patients with parasagittal and falcine meningiomas, we report a 47.6% Simpson II resection rate and 19% Simpson III resection rate associated with a very low complication rate and no immediately postoperative morbidity and mortality, compared to more aggressive techniques. The recurrence of parasagittal meningiomas predominated after grade III and IV Simpson resection and dural sinus invasion was a negative predictive factor for recurrence. Therefore, the surgery of parasagittal and falcine meningiomas is beneficial, both for tumor control, but also for improving neurological outcome. Aggressive meningioma resection should be balanced with the increased neurosurgical risk.

The History of Arachne Through Historic Descriptions of Meningiomas with Hyperostosis: From Prehistory to the Present.

BACKGROUND: Intracranial meningiomas are brain tumors that have probably been known the longest, largely because of the occasional production of grotesque cranial deformities that have attracted the attention and interest of humankind. Because of the tendency of some intracranial meningiomas to cause skull deformation and thickening, these tumors have given rise to various speculations and theories related to their origin, starting in prehistoric times up to the present. METHODS: From the Steinheim skull and "pharaonic meningiomas" to the first meningioma monograph and the first explanations of Harvey Cushing regarding the mechanism of hyperostosis, this review aims to weave again the story of Arachne. We identify the main contributors who have tried to understand and explain the tendency of some of these tumors to cause hyperostosis or other skull bone involvements. CONCLUSIONS: The contribution of neurosurgeons or pathologists over the centuries is of undeniable importance and is the basis for understanding future molecular mechanisms.

The Anatomy of Papal Tiara: A Story About Popes' Contribution and Protection of Anatomists.

Beginning with the thirteenth century, the papacy has exerted an important role in the development of anatomy and medical sciences through the protection and support provided to anatomists, who were in most cases the personal physicians of the popes as well. The work is intended to be a lesson of anatomy of Papal tiara, presenting the most important contributing popes, the anatomists-physicians whom they supported and protected and the relations between papacy and medical sciences.

The "polymorphous" history of a polymorphous skull bone: the sphenoid.

For a long time, because of its location at the skull base level, the sphenoid bone was rather mysterious as it was too difficult for anatomists to reach and to elucidate its true configuration. The configuration of the sphenoid bone led to confusion regarding its sutures with the other skull bones, its shape, its detailed anatomy, and the vascular and nervous structures that cross it. This article takes the reader on a journey through time and space, charting the evolution of anatomists' comprehension of sphenoid bone morphology from antiquity to its conception as a bone structure in the eighteenth century, and ranging from ancient Greece to modern Italy and France. The journey illustrates that many anatomists have attempted to name and to best describe the structural elements of this polymorphous bone.

Through Clinical Observation: The History of Priapism After Spinal Cord Injuries.

Since ancient times, physicians of antiquity noted the occurrence of priapism in some spinal cord injuries. Although priests saw it as a consequence of curses and witchcraft, after clinical observations of the Middle Ages and Renaissance, the first medical hypotheses emerged in the 17th-19th centuries completed and argued by neuroscience and neurology developed in the European laboratories and hospitals. This study aims to present a short overview of the history of clinical observations of posttraumatic male priapism after spinal cord injuries since antiquity until the beginning of the 20th century.

Inflammatory juvenile compound conjunctival nevi. A clinicopathological study and literature review.

AIM: The conjunctival nevus affecting children and adolescents is a rare condition and the literature showed only few reports on this issue. The aim of this article is to determine the histopathological features for the correct diagnosis of an inflammatory juvenile compound nevus of the conjunctiva (IJCNC) in order to make the difference between this tumor and other lesions, like conjunctival melanoma or lymphoma, very similar from a gross point of view. This article is a clinical pathological study of two cases of IJCNC with particular histopathological characteristics, who were admitted at the 2nd Ophthalmology Clinic, "Prof. Dr. Nicolae Oblu" Emergency Clinical Hospital, Iasi, Romania, over a period of five years (from July 1, 2012 to June 30, 2017). Both patients were adolescents, a boy (13-year-old) and a girl (12-year-old). Both lesions were bulbar juxtalimbal located and grew in size over one year. Seen at slit-lamp biomicroscopy, the first one presented as a non-pigmented lesion, while the second was a pigmented nevus, but their dimensions did not exceed 10 mm in diameter. From a histopathological point of view, both of them showed a nested junctional growth pattern, along with intra- and subepithelial location, of the nevomelanocytes. Tumoral cells demonstrated different degrees of atypical cytology, but in the second case, it was more obvious. Microscopic examination also revealed epithelial cystic inclusions, and prominent inflammation in the stroma of these two nevi. One of the cases presented heavy inflammation that took the form of lymphoid follicles and sheets of eosinophils, but the other showed only diffuse inflammation with lymphocytes plasma cells, and eosinophils within its stroma. The immunohistochemical characterization (anti-melan A, anti-S100 protein and anti-cytokeratin AE1÷AE3 antibodies) of the tumoral cells helped to the diagnosis. CONCLUSIONS: IJCNC represent a small group of nevi that develop in adolescents and have some particular histopathological features. The pathological diagnosis is difficult as the microscopic features are very similar to a conjunctival melanoma, but a detailed microscopic examination, immunohistochemical stainings and the young age of the patient could help in establishing the benign nature of these lesions.

The history of optic chiasm from antiquity to the twentieth century.

PURPOSE: The optic chiasm is an essential structure located at the skull base that stirred over time the curiosity of anatomists, who became more and more interested in its structure and function. Through centuries, the optic chiasm was viewed as a vessel crossing, a way of transporting tears secreted by the brain to the eye, integrating images, or responsible for coordinated eye movements. The paper aims to overview the history of understanding the optic chiasm from the beginnings of antiquity to the twentieth century. METHODS: We reviewed the literature and studied all the historical sources on optic chiasm and eyes in the works of ancient, medieval, Renaissance authors, and the seventeenth to nineteenth century works. RESULTS: The optic chiasm is a structure that fascinated ancient anatomists and made them develop various theories on its function. In terms of function, the optic chiasm had a history based more on speculation, the seventeenth century bringing its first understanding and reaching the peak in the nineteenth century with the understanding of the anatomical structure of the chiasm and its role in the visual process. CONCLUSION: The history of the optic chiasm is a fascinating time travel displaying the conceptual transformations that have been made in anatomy and medicine by our forerunners.

An unwritten anatomy lesson: The influence of Roman clothing on neuroanatomical terminology: In memoriam Albert L. Rhoton, Jr. (1932-2016).

Throughout the centuries, anatomists attempting to denominate the new structures they discovered have found inspiration in the civilization of ancient Rome and the clothing worn by its citizens. This aricle presents the origins of seven neuroanatomical terms, fimbria, velum, funiculus, lemniscus, corona, splenium, and cingulum, inspired by the clothing and jewellery of Roman women and the military attire of Roman soldiers. Thus, through their apparel, the Romans influenced the Terminologia Anatomica and "clothed" the structures of the brain and spinal cord, making them immortal. Clin. Anat. 29:685-690, 2016. © 2016 Wiley Periodicals, Inc.

A review of analogies between some neuroanatomical terms and roman household objects.

Wishing to contribute to an easier remembrance of the name, shape, location and function of some neuroanatomical structures, this paper aims to identify the origin of eight Latin terms (pulvinar, capsula, infundibulum, operculum, flocculus, forceps, falx, habenula). Therefore, we analyzed the etymology of these Latin neuroanatomical terms in brief, and searched the possible correlations between the shape of different household objects used in Roman Antiquity and the shape of neuroanatomical structures bearing those names. We also perused the literature to identify the first anatomist who made such an analogy when searching to give a name to the anatomical structure he had discovered at dissection, as well as the time context of his discovery. We found knowledge of few neuroanatomical structures tracing their origin to Antiquity, but most of the nervous structures we have studied were discovered in the 19th century, when the German school of anatomy played a distinctive part. However, the multitude of Latin words designating neuroanatomical structures by analogy is an undeniable proof of neuroanatomists' amazing imagination.