BACKGROUND: Tumor consistency is considered to be a critical factor for the surgical removal of meningiomas and its preoperative assessment is intensively studied. A significant drawback in the research of predictive methods is the lack of a clear shared definition of tumor consistency, with most authors resorting to subjective binary classification labeling the samples as "soft" and "hard." This classification is highly observer-dependent and its discrete nature fails to capture the fine nuances in tumor consistency. To compensate for these shortcomings, we examined the utility of texture analysis to provide an objective observer-independent continuous measure of meningioma consistency. METHODS: A total of 169 texturometric measurements were conducted using the Brookfield CT3 Texture Analyzer on meningioma samples from five patients immediately after the removal and on the first, second, and seventh postoperative day. The relationship between measured stiffness and time from sample extraction, subjectively assessed consistency grade and histopathological features (amount of collagen and reticulin fibers, presence of psammoma bodies, predominant microscopic morphology) was analyzed. RESULTS: The stiffness measurements exhibited significantly lower variance within a sample than among samples (p = 0.0225) and significant increase with a higher objectively assessed consistency grade (p = 0.0161, p = 0.0055). A significant negative correlation was found between the measured stiffness and the time from sample extraction (p < 0.01). A significant monotonic relationship was revealed between stiffness values and amount of collagen I and reticulin fibers; there were no statistically significant differences between histological phenotypes in regard to presence of psammoma bodies and predominant microscopic morphology. CONCLUSIONS: We conclude that the values yielded by texture analysis are highly representative of an intrinsic consistency-related quality of the sample despite the influence of intra-sample heterogeneity and that our proposed method can be used to conduct quantitative studies on the role of meningioma consistency.

• MeSH
• kolagen MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• meningeální nádory * chirurgie   patologie   MeSH
• meningeom * diagnostické zobrazování   chirurgie   patologie   MeSH
• retikulin MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Neurochirugie je zásadní pro získání histologických vzorků, provádění správných chirurgických výkonů, pro indikace k výkonům a následné pooperační sledování. V posledních letech došlo jak ke zpřesnění indikací neurochirurgických intervencí, tak ke snížení komplikací. Zásadní je použití moderních zobrazovacích, navigačních a elektrofyziologických technik. Péče o pacienty s nádory je však multioborová, proto je nezbytná kooperace s dalšími odbornostmi.

Neurosurgery plays a crutial role in obtaining histological samples, in performance of adequate surgical procedures, in decision about surgical procedures and postoperative follow-up. Indications of neurosurgical procedures has been refined as well as the rate of complications has been reduced. Modern imaging, navigation and eletrophysiological techniques are of utmost importance. Care has to be multidisciplinar, thus cooperation between key care givers is vital.

• MeSH
• astrocytom chirurgie   diagnóza   patologie   MeSH
• chemoradioterapie metody   MeSH
• ependymom chirurgie   diagnóza   patologie   MeSH
• glioblastom diagnóza   patologie   terapie   MeSH
• gliom diagnóza   klasifikace   terapie   MeSH
• kraniofaryngeom chirurgie   diagnóza   MeSH
• lidé MeSH
• lymfom diagnóza   patologie   terapie   MeSH
• meningeom chirurgie   diagnóza   patologie   MeSH
• metastázy nádorů diagnóza   terapie   MeSH
• nádory centrálního nervového systému * diagnóza   klasifikace   terapie   MeSH
• nádory hypofýzy chirurgie   diagnóza   patologie   MeSH
• nádory míchy diagnóza   terapie   MeSH
• neurochirurgické výkony metody   MeSH
• stupeň nádoru MeSH
• vestibulární schwannom chirurgie   diagnóza   MeSH
• Check Tag
• lidé MeSH

BACKGROUND AND OBJECTIVES: Meningiomas in children are uncommon, with distinct characteristics that set them apart from their adult counterparts. The existing evidence for stereotactic radiosurgery (SRS) in this patient population is limited to only case series. The objective of this study was to evaluate the safety and efficacy of SRS in managing pediatric meningiomas. METHODS: Children and adolescents who had been treated for meningioma with single-fraction SRS were included in this retrospective, multicenter study. The assessment included local tumor control, any complications related to the tumor or SRS, and the emergence of new neurological deficits after SRS. RESULTS: The cohort included 57 patients (male-to-female ratio 1.6:1) with a mean age of 14.4 years who were managed with single-fraction SRS for 78 meningiomas. The median radiological and clinical follow-up periods were 69 months (range, 6-268) and 71 months (range, 6-268), respectively. At the last follow-up, tumor control (tumor stability and regression) was achieved in 69 (85.9%) tumors. Post-SRS, new neurological deficits occurred in 2 (3.5%) patients. Adverse radiation effects occurred in 5 (8.8%) patients. A de novo aneurysm was observed in a patient 69 months after SRS. CONCLUSION: SRS seems to be a safe and effective up-front or adjuvant treatment option for surgically inaccessible, recurrent, or residual pediatric meningiomas.

• MeSH
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• meningeální nádory * radioterapie   chirurgie   MeSH
• meningeom * radioterapie   chirurgie   MeSH
• mladiství MeSH
• následné studie MeSH
• radiochirurgie * škodlivé účinky   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Východiska: Meningeomy jsou častými primární nádory mozku s roční incidencí 3–8 případů na 100 000 obyvatel. Přestože se většinou jedná o benigní onemocnění, zhoršuje často svým charakterem a lokalizací svému nositeli kvalitu života. Základními léčebnými metodami jsou neurochirurgická exstirpace nebo stereotaktické ozáření. Obě metody dosahují velmi dobrých léčebných výsledků, přesto část pacientů trpí recidivou onemocnění vyžadující další intervenci s rizikem vzniku nebo zhoršení neurologického deficitu. Nevelké meningeomy bez růstové tendence a s absencí symptomatologie bývají často sledovány. Na druhou stranu se nelze spokojit s dlouhodobými výsledky léčby meningeomů s agresivnějším biologickým chováním. Známým rizikem recidivy meningeomů je vyšší grade, často je však obtížné identifikovat podskupiny, které vykazují prospěch z kombinované neurochirurgické operace a radioterapie, resp. u kterých je vhodné hledat cesty k další eskalaci léčby, a to i za cenu jistých vedlejších účinků. Pro rozvoj personalizované medicíny se perspektivně jeví analýza hormonální, cytogenetické i epigenetické výbavy nádorů. Cíl: Cílem práce je shrnout poznatky o epidemiologii, léčebných algoritmech a prognóze meningeomů mozku a navrhnout perspektivní prognostické a prediktivní faktory pro maximálně individualizovanou terapii.

Background: Common primary brain tumors are meningiomas with year incidence 3–8 cases per 100 000 people. Even though we mainly speak about benign disease, with its character and localization, it worsens the life quality to its bearer. The main therapeutic methods are neurosurgery extirpation and stereotactic radiosurgery. Despite reaching very good therapeutic results with both methods, some of the patients suffer with recurrence of the disease requiring other interventions with the risk of creating or worsening a neurological deficit. Small meningiomas without growing tendency and with the absence of symptomatology are observed. On the other hand, we cannot be satisfied with long-term results of the therapy of meningiomas with more aggressive biological behavior. A higher grade is a known risk of meningioma recurrence; however, it is often difficult to identify subgroups that show advantage of a combination of neurosurgery and radiosurgery, respectfully at which it is appropriate to look for ways to treatment escalation, and that is with the risk of side effects. The analysis of hormonal, cytogenetics and epigenetics tumor equipment seems to be the most promising for the development of personalized treatment. Purpose: The aim of this work is to sum up the facts about epidemiology, treatment algorithms and the prognosis of brain meningiomas and to suggest perspective prognostic and predictive factors for maximally individualized therapy.

• MeSH
• cytogenetika MeSH
• lidé MeSH
• meningeom * chirurgie   genetika   radioterapie   MeSH
• prognóza MeSH
• radiochirurgie metody   MeSH
• stereotaktické techniky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: The initial management of asymptomatic, incidentally discovered, cavernous sinus (CS) meningiomas remains incompletely defined. This study evaluated the safety and efficacy of stereotactic radiosurgery (SRS) for patients presenting with an asymptomatic CS meningioma. METHODS: This is an international, retrospective study included patients treated with upfront SRS for an asymptomatic CS meningioma. Local tumor control, tumor and SRS-related complications, and the development of new neurologic deficits after SRS were evaluated. RESULTS: A total of 37 patients (29 men; mean ± SD age: 55.05 ± 11.56 years) treated with upfront SRS for an asymptomatic, CS meningioma were included in the study. The mean ± SD margin dose was 12.27 ± 2.3 Gy. The median clinical and radiological follow-up periods were 66 (IQR 84) and 72 (IQR 84) months, respectively. At the last follow-up, tumor regression and stability were noted in 19 (51.35%) and 18 (48.65%) of CS meningiomas, respectively. SRS-related complications occurred in 2 patients (5.4%) and were managed conservatively. CONCLUSIONS: Upfront SRS is a safe and effective treatment option for asymptomatic CS meningiomas. SRS may be considered at the time of initial diagnosis of a CS meningioma. If observation is the initial management chosen, SRS should be recommended when CS meningioma growth is documented on follow-up imaging.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• meningeální nádory * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• meningeom * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• nádory baze lební * chirurgie   MeSH
• následné studie MeSH
• radiochirurgie * metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• sinus cavernosus * diagnostické zobrazování   patologie   chirurgie   MeSH
• supratentoriální nádory * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

BACKGROUND: The optimal management of asymptomatic, petroclival meningiomas remains incompletely defined. The purpose of this study was to evaluate the safety and efficacy of upfront stereotactic radiosurgery (SRS) for patients with asymptomatic, petroclival region meningiomas. METHODS: This retrospective, international, multicenter study involved patients treated with SRS for an asymptomatic, petroclival region meningioma. Study endpoints included local tumor control rate, procedural complications, and the emergence of new neurological deficits. RESULTS: There were 72 patients (22 males, mean age 59.53 years (SD ± 11.9)) with an asymptomatic meningioma located in the petroclival region who were treated with upfront SRS. Mean margin dose and maximum dose were 13.26 (SD ± 2.72) Gy and 26.14 (SD ± 6.75) Gy respectively. Median radiological and clinical follow-up periods post-SRS were 52.5 (IQR 61.75) and 47.5 months (IQR 69.75) respectively. At last follow-up, tumor control was achieved in all patients. SRS-related complications occurred in 6 (8.33%) patients, with 3 of them (4.17%) exhibiting new neurological deficits. CONCLUSIONS: Upfront SRS for asymptomatic, petroclival region meningiomas affords excellent local tumor control and does so with a relatively low risk of SRS-related complications. SRS can be considered at diagnosis of an asymptomatic petroclival region meningioma. If active surveillance is initially chosen, SRS should be recommended when growth is noted during radiological follow-up.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• meningeální nádory * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• meningeom * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• následné studie MeSH
• radiochirurgie * škodlivé účinky   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

OBJECTIVE: Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus. METHODS: The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression. RESULTS: SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9-1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0-1.02, adjusted p = 0.02). CONCLUSIONS: In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.

• MeSH
• lidé MeSH
• meningeální nádory * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• meningeom * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• následné studie MeSH
• radiochirurgie * škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

INTRODUCTION: The clinical management of parasellar meningiomas (PM) is challenging due to their intimate association with critical neurovascular structures. Consensus regarding the recommended treatment protocol is lacking. This study will evaluate patients' visual outcomes following endoscopic transnasal optic nerve decompression (ETOND) and will investigate the possibility of reducing the rate of complications associated with stereotactic radiosurgery (SRS). METHODS: Retrospective analysis was conducted on all patients who underwent ETOND for PM between 2013 and 2020. The study comprised 12 patients (7 women and 5 men aged 36-75 years; mean, 55.2 years; median, 57.6 years) in which 14 optic nerve decompression procedures were carried out. Patients were followed up for 6 to 86 months (mean, 29.3 months; median, 25 months). There were five cases of spheno-orbital meningioma, four cases of cavernous sinus meningioma, and one case each of petro-clival meningioma, optic nerve sheath meningioma, and planum sphenoidale/tuberculum sellae meningioma. Visual outcome was evaluated and any postoperative complications noted. RESULTS: Improvements in visual acuity were noted in 10 of 14 eyes (71.4%) 3 to 6 months postoperation. Visual acuity remained stable in the remaining four eyes. No deterioration of visual acuity was noted during the follow-up period. In total, 9 of the 12 patients underwent SRS. No tumor growth was determined, while reduction in tumor volume was noted in five patients following SRS. No complications associated with SRS or the surgical procedure were noted. CONCLUSIONS: ETOND appears to be a promising technique for increasing rates of improved visual function, while reducing the risk of post SRS-related complications. In combination with subsequent SRS, it is an ideal treatment modality in the management of parasellar meningiomas. Confirmation of our findings would require a larger, prospective multicenter study.

• MeSH
• dekomprese MeSH
• lidé MeSH
• meningeální nádory * komplikace   radioterapie   chirurgie   MeSH
• meningeom * komplikace   radioterapie   chirurgie   MeSH
• nádory baze lební * komplikace   patologie   chirurgie   MeSH
• nervus opticus chirurgie   MeSH
• prospektivní studie MeSH
• radiochirurgie * škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

OBJECTIVE: The management of neurofibromatosis type 2 (NF2)-associated meningiomas is challenging. The role of Gamma Knife radiosurgery (GKRS) in the treatment of these tumors remains to be fully defined. In this study, the authors aimed to examine the role of GKRS in the treatment of NF2-associated meningiomas and to evaluate the outcomes and complications after treatment. METHODS: Seven international medical centers contributed data for this retrospective cohort. Tumor progression was defined as a ≥ 20% increase from the baseline value. The clinical features, treatment details, outcomes, and complications were studied. The median follow-up was 8.5 years (range 0.6-25.5 years) from the time of initial GKRS. Shared frailty Cox regression was used for analysis. RESULTS: A total of 204 meningiomas in 39 patients treated with GKRS were analyzed. Cox regression analysis showed that increasing the maximum dose (p = 0.02; HR 12.2, 95% CI 1.287-116.7) and a lower number of meningiomas at presentation (p = 0.03; HR 0.9, 95% CI 0.821-0.990) were predictive of better tumor control in both univariable and multivariable settings. Age at onset, sex, margin dose, location, and presence of neurological deficit were not predictive of tumor progression. The cumulative 10-year progression-free survival was 94.8%. Radiation-induced adverse effects were noted in 4 patients (10%); these were transient and managed medically. No post-GKRS malignant transformation was noted in 287 person-years of follow-up. CONCLUSIONS: GKRS achieved effective tumor control with a low and generally acceptable rate of complications in NF2-associated meningiomas. There did not appear to be an appreciable risk of post-GKRS-induced malignancy in patients with NF2-treated meningiomas.

• MeSH
• dítě MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• meningeom etiologie   chirurgie   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory mozku etiologie   chirurgie   MeSH
• následné studie MeSH
• nemoci nervového systému etiologie   MeSH
• neurofibromatóza 2 komplikace   MeSH
• progrese nemoci MeSH
• radiochirurgie škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• věk při počátku nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

INTRODUCTION: Gamma Knife radiosurgery (GKR) can be a valuable treatment option for posterior cranial fossa meningiomas (PCFM). We retrospectively analyzed outcomes of GKR for PCFM. METHODS: Were included forty-six patients with 47 PCFM. Primary endpoint was tumor control. Secondary endpoint was clinical improvement. Biologically effective dose (BED) was evaluated in relationship to primary and secondary outcomes. Mean marginal dose was 12.4 Gy (median 12, 12-14). Mean BED was 63.6 Gy (median 65, 49.1-88.3). Mean target volume (TV) was 2.21 cc (range 0.3-8.9 cc). RESULTS: Overall tumor control rate was 93.6% (44/47) after mean follow-up of 47.8 months ± 28.46 months (median 45.5, range 6-108). Radiological progression-free survival at 5 years was 94%. Higher pretherapeutic TVs were predictive for higher likelihood of tumor progression (Odds ratio, OR 1.448, 95% confidence interval - CI 1.001-2.093, p = 0.049). At last clinical follow-up, 28 patients (71.8%) remained stable, 10 (25.6%) improved and 1 patient (2.6%) worsened. Using logistic regression, the relationship between BED and clinical improvement was assessed (OR 0.903, standard error 0.59, coefficient 0.79-1.027, CI -0.10; 0.01; p = 0.14). The highest probability of clinical improvement corresponded to a range of BED values between 56 and 61 Gy. CONCLUSION: Primary GKR for PCFM is safe and effective. Higher pretherapeutic TV was predictor of volumetric progression. Highest probability of clinical improvement might correspond to a range of BED values between 56 and 61 Gy, although this was not statistically significant. The importance of BED should be further validated in larger cohorts, other anatomical locations and other pathologies.

• MeSH
• lidé MeSH
• meningeální nádory * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• meningeom * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• následné studie MeSH
• radiochirurgie * MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH