Atypical meningioma-is it time to standardize surgical sampling techniques?
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ABSTRACT:
SUBMITTER: Jenkinson MD
PROVIDER: S-EPMC5464334 | biostudies-literature | 2017 Mar
REPOSITORIES: biostudies-literature
Publications
Atypical meningioma-is it time to standardize surgical sampling techniques?
Jenkinson Michael D MD Santarius Thomas T Zadeh Gelareh G Aldape Kenneth D KD
Neuro-oncology 20170301 3
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Project description:BackgroundTentorial meningiomas (TM) are complex entities with distinguished clinical, radiological and surgical considerations. They comprise approximately 3 - 6% of all intracranial meningiomas1. TM have been classified in 5 subgroups according to the modified Yasargil's classification, based on their location 2 and 3. Those located at the free margin of the tentorium are still challenging for neurosurgeons, with high morbidity and mortality. Atypical trigeminal neuralgia (ATN) is a type of trigeminal neuralgia that is identified by the constancy of symptoms. They experience less intense pain, but a constant dull aching or burning pain, and it is frequently misdiagnosed. Although it is well known that typical trigeminal (TN) neuralgia responds very well to medical treatment and are related with posterior fossa tumors, ATN is less likely. In this video we demonstrate the microsurgical resection of group 1 tentorial meningioma in the treatment of atypical trigeminal neuralgia.Case descriptionA previously healthy 63-year-old female came to our service complaining of long lasting, intermittent, right facial pain for two years. On neurological examination, the patient had hypoesthesia in the territory of maxillae (V2) branch of the right trigeminal nerve. She had no other complaints on the physical examination. Initial treatment with carbamazepine and pregabalin was performed, however, it could not be further increased because of the maximal doses and side effects. Radiological investigation was carried out with cranial computed tomography (CT) and magnetic resonance image (MRI), which showed a high signal density mass lesion in the free margin of the tentorium, with extension to the right cerebello pontine angle (CPA), compressing the trigeminal nerve, that exhibited homogeneous contrast enhancement, suggestive of tentorial meningioma. Given the size, the location of the mass, and no response to the medical treatment, microsurgical resection was performed.ConclusionThe postoperative period was excellent, without any neurological deficit. The patient consented with publication of her images and videos.
| S-EPMC9805598 | biostudies-literature
Project description:Comparison of vaginal microbiota sampling techniques: cytobrush versus swab
| PRJEB19346 | ENA
Project description:INTRODUCTION: We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A 58-year-old woman presented with an 18-month history of progressive dysphagia, chronic cough and 30-pound weight loss. Prior gastroenterologic and laryngologic workup was unrevealing. RESULTS: Her neurologic examination revealed an absent gag reflex, decreased sensation to light touch on bilateral distal extremities, hyperreflexia, and tandem gait instability. Repeat esophagogastroduodenoscopy was normal, whereas laryngoscopy and video fluoroscopy revealed marked hypopharyngeal dysfunction. Brain magnetic resonance imaging demonstrated a 3.1 x 2.7 x 2.9 cm foramen magnum mass consistent with meningioma. The patient underwent neurosurgical resection of her mass with near complete resolution of her neurologic symptoms. Pathology confirmed diagnosis of a WHO grade I meningothelial meningioma. CONCLUSION: CNS pathology is an uncommon but impressive cause of dysphagia. Our case demonstrates the importance of a thorough neurologic survey when evaluating such a patient.
| S-EPMC2359174 | biostudies-other
Project description:PurposeWhile adjuvant radiation therapy (RT) may prolong progression-free survival in resected atypical meningiomas, whether such progression-free survival benefit outweighs potential treatment toxicities remains controversial. Here, we compare the acute and late toxicity outcomes of atypical meningiomas managed with upfront adjuvant RT versus surveillance.Methods and materialsIn our prior single-institution retrospective study of 230 patients with resected atypical meningiomas between 2000 and 2015, adjuvant RT was associated with a significantly lower risk of progression/recurrence compared with surveillance (hazard ratio, 0.21; P < .01), with 36% of surveillance patients eventually requiring salvage RT. In this study, the acute (≤6 months) and late (>6 months) RT toxicities from the same patient cohort for those who received adjuvant (n = 51) versus salvage RT (n = 64) were compared. Additionally, treatment toxicity at the last follow-up was compared between the adjuvant RT (n = 51) and the surveillance (n = 179) groups. Toxicities were graded per the Common Terminology Criteria for Adverse Events v5.0.ResultsRT in the adjuvant compared with the salvage setting was generally associated with greater RT toxicities both in the acute (90% vs 69%, P < .01) and late (57% vs 33%, P = .01) setting. While there was no significant difference in grade 3 to 4 acute toxicities, late grade 3 to 4 toxicities were present in 14% of the adjuvant group versus 3% of the salvage RT group (P = .04). Radionecrosis was present in 18% of adjuvant RT versus 8% of salvage RT group (P = .11). Between the adjuvant RT and surveillance groups, any treatment-related toxicity at the last follow-up was greater in the adjuvant RT group (31% vs 15%, P < .01), with a trend toward greater grade 3 to 4 toxicities (8% vs 3%, P = .10). There was no difference in the rate of cerebrovascular accident (4% vs 4%, P = .99).ConclusionsAdjuvant RT may be associated with greater acute and late treatment toxicities, which can significantly impact the quality of life of patients with atypical meningioma. Potential RT toxicity should be carefully weighed against tumor control benefits in deciding the optimal use and timing of RT.
| S-EPMC11872651 | biostudies-literature
Project description:We report the exceptional occurrence of murine double minute clone 2 amplification in an atypical meningioma and its recurrent anaplastic meningioma arising in the right frontal lobe of a 75-year-old man. Murine double minute clone 2 amplification was shown by array comparative genomic hybridization and confirmed by fluorescence in situ hybridization. This is a rare finding with only one similar report in the literature. Awareness of this finding is indicated and should not lead to misdiagnosis of other entities that more commonly show this feature.
| S-EPMC5985599 | biostudies-literature
Project description:BACKGROUND:Meningiomas are the most common primary tumors of the central nervous system. In patients with WHO grade I meningiomas no adjuvant therapy is recommended after resection. In case of anaplastic meningiomas (WHO grade III), adjuvant fractionated radiotherapy is generally recommended, regardless of the extent of surgical resection. For atypical meningiomas (WHO grade II) optimal postoperative management has not been clearly defined yet. METHODS:We conducted a retrospective analysis of patients treated for intracranial atypical meningioma at Charité Universitätsmedizin Berlin from March 1999 to October 2018. Considering the individual circumstances (risk of recurrence, anatomical location, etc.), patients were either advised to follow a wait-and-see approach or to undergo adjuvant radiotherapy. Primary endpoint was progression-free survival (PFS). RESULTS:This analysis included 99 patients with atypical meningioma (WHO grade II). Nineteen patients received adjuvant RT after primary tumor resection (intervention group). The remaining 80 patients did not receive any further adjuvant therapy after surgical resection (control group). Median follow-up was 37?months. Median PFS after primary resection was significantly longer in the intervention group than in the control group (64?m vs. 37?m, p?=?0.009, HR?=?0.204, 95% CI?=?0.062-0.668). The influence of adjuvant RT was confirmed in multivariable analysis (p?=?0.041, HR?=?0.192, 95% CI?=?0.039-0.932). CONCLUSIONS:Our study adds to the evidence that RT can improve PFS in patients with atypical meningioma.
| S-EPMC6719347 | biostudies-literature
Project description:ObjectivesThe objectives of this study were to evaluate existing nomenclature used for outpatient referrals triage and propose a system, which meets the needs of McMaster Children's Hospital and can be modified for use in other hospitals.MethodsWe reviewed triage practices in the Department of Pediatrics, McMaster Children Hospital, Hamilton, Ontario and conducted a literature search to assess terminology used for outpatient referrals triage at other institutions.ResultsThere is lack of unified terminology for triaging outpatient referrals. Existing systems are not widely accepted, lack uniformity, and often miss recording the true acuity of the referral. We developed a system that covers most outpatient triage scenarios, allocates either flexible or precise visit timelines to referrals and plans for logistics of the patient's visit. Triage categories are iMMediate (MM), Acute (A) (1 to 14 days), Semi-Acute (S) (1 to 3 months), Timetabled (T) (next available appointment slot), Evaluated (E) (used for either forwarding to another provider or requesting additional information), and Rejected (R) categories-McMASTER triage system. Several numbered subcategories are used in each category to define precise timelines, if needed. Visit logistics categories are the following: Hub (H) (place to see the patient), How to notify patient and referring provider (HP) and (HD), need to Start with tests prior to appointment (S), and need to Complete (C) other relevant local processes-HHSC logistics system. Both these systems may be adapted for local use in other institutions.ConclusionThis is the first publication that proposes terminology standardization in triaging outpatient referrals for specialist paediatric services.
| S-EPMC9394629 | biostudies-literature
Project description:BackgroundMeningiomas of the optic sheath have been traditionally treated with radiotherapy, among other reasons, because of the poor results in terms of visual preservation of the open surgical approaches.Case descriptionTwo cases of optic nerve meningioma were operated through an endoscopic endonasal expanded approach due to rapidly progressing visual deterioration and doubtful diagnosis. In the first case an exclusively bone decompression was performed. In the second one a partial resection of the intradural portion and complete opening of the dural sheath was undertaken. In both cases visual acuity remained stable without further treatment for the 2 years follow up.ConclusionsEndoscopic endonasal decompression of the optic nerve by removal of the optic canal and opening of the optic sheath is safe. This approach is feasible for optic sheath meningioma. This treatment might be considered as an option in patients with rapidly deteriorating visual acuity.
| S-EPMC9623684 | biostudies-literature
Project description:PurposeThe gold-standard for reconstruction of large mandibular defects is the use of free flaps of vascularized autologous bone with the fibula as the preferred donor site. The use of "custom cutting guides" for this indication is becoming increasingly prevalent. But cost of the procedure averages around 2,500 dollars per patient excluding treatment and entails selection criteria. We think it is possible to standardize mandibular reconstructions from an anatomical mean. The objective of this study was to perform a mandibular morphometric analysis in order to obtain a set of "mean" measurements, which can be used by all surgeons interested in mandibular reconstruction.MethodsWe performed a morphometric analysis consisting of three-dimensional mandibular reconstructions of 30 men and 30 women. Several reference points were set and defined to evaluate specific lengths and angles of interest. We conducted an intra and inter-sexual descriptive analysis of measurements obtained.ResultsWe did not identify any major intra-sexual differences within each group. The gonial angle is more open in women and the measurements characterizing the basilar contour are more prominent in men. We did not identify any differences in alveolar region parameters.ConclusionThe results of this study constitute a morphological tool for surgeons, from bone graft to free flap. These results also confirm us that the use of «custom cutting guides» for mandibular reconstruction may be excessive. It is pertinent to examine the value of "custom made" mandibular reconstructions since the differences observed are of the order of millimeters.
| S-EPMC7647103 | biostudies-literature
Project description:Surgical resections of meningiomas, the most common intracranial tumor in adults, can only be curative if radical resection is achieved. Potentially, the extent of resection could be improved, especially in complex and/or high-grade meningiomas by fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA), indocyanine green (ICG), or fluorescein. This review aims to summarize and evaluate these fluorescence-guided meningioma surgery techniques. PubMed and Embase were searched for relevant articles. Additionally, we checked reference lists for further studies. Forty-eight articles were included in the final analysis. 5-ALA fluoresced with varying sensitivity and selectivity in meningiomas and in invaded bone and dura mater. Although ICG was mainly applied for video angiography, one report shows tumor fluorescence 18-28 h post-ICG injection. Lastly, the use of fluorescein could aid in the identification of tumor remnants; however, detection of dural tail is highly questionable. Fluorescence-guided meningioma surgery should be a reliable, highly specific, and sensitive technique. Despite numerous studies reporting the use of fluorescent dyes, currently, there is no evidence that these tools improve the radical resection rate and long-term recurrence-free outcome in meningioma surgery without neurological deficits. Evidence regarding the effectiveness and increased safety of resection after the application of these fluorophores is currently lacking. Future research should focus on the development of a meningioma-targeted, highly sensitive, and specific fluorophore.
| S-EPMC6821664 | biostudies-literature