BACKGROUND: Convexity meningiomas are common tumors requiring treatment in patients with neurofibromatosis type 2 (NF2). Although different therapeutic options are described for sporadic convexity meningioma, much less is known about these lesions in patients with NF2 despite their distinct biology and need for multiple treatments. We analyzed the value of Gamma Knife radiosurgery (GKRS) as definitive treatment for convexity meningiomas in patients with NF2. METHODS: This international multicenter retrospective study was approved by the International Radiosurgery Research Foundation. Patients with NF2 with at least 1 convexity meningioma and 6-month follow-up after primary GKRS were included. RESULTS: Inclusion criteria were met by 18 patients with NF2. A total of 120 convexity meningiomas (median treatment volume, 0.66 cm3 [range, 0.10-21.20 cm3]) were analyzed. Median follow-up after initial GKRS was 15.6 years (range, 0.6-25.5 years). Median age at GKRS was 32.5 years (range, 16-53 years). Median number of meningiomas per patient was 13 (range, 1-27), and median number of convexity lesions receiving GKRS per patient was 3.5 (range, 1-27). One case of tumor progression was reported 24 years after GKRS, leading to actuarial progression-free survival rates of 100% at 2, 5, and 10 years. No malignant transformation or death due to meningioma or radiosurgery was recorded. CONCLUSIONS: GKRS is safe and effective as definitive treatment of small to medium-sized convexity meningiomas in patients with NF2. Despite concerns about the particular mutational burden of these tumors, no malignant transformation manifested after treatment. GKRS represents a minimally invasive option that offers long-term tumor control to this specific group of patients.
- MeSH
- Progression-Free Survival MeSH
- Adult MeSH
- Brain Edema etiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Meningeal Neoplasms complications pathology radiotherapy MeSH
- Meningioma complications pathology radiotherapy MeSH
- Adolescent MeSH
- Young Adult MeSH
- Neoplasms, Multiple Primary complications radiotherapy MeSH
- Neurofibromatosis 2 complications MeSH
- Radiosurgery adverse effects methods MeSH
- Retrospective Studies MeSH
- Tumor Burden MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Techniques to quantify postural stability usually rely on the evaluation of only two variables, that is, two coordinates of COP. However, by using three variables, that is, three components of acceleration vector, it is possible to describe human movement more precisely. For this purpose, a single three-axis accelerometer was used, making it possible to evaluate 3D movement by use of a novel method, convex polyhedron (CP), together with a traditional method, based on area of the confidence ellipse (ACE). Ten patients (Pts) with cerebellar ataxia and eleven healthy individuals of control group (CG) participated in the study. The results show a significant increase of volume of the CP (CPV) in Pts or CG standing on foam surface with eyes open (EO) and eyes closed (EC) after the EC phase. Significant difference between Pts and CG was found in all cases as well. Correlation coefficient indicates strong correlation between the CPV and ACE in most cases of patient examinations, thus confirming the possibility of quantification of postural instability by the introduced method of CPV.
- MeSH
- Accelerometry methods MeSH
- Adult MeSH
- Humans MeSH
- Posture physiology MeSH
- Postural Balance physiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Chordoid meningioma is a rare variant of meningioma with histological features resembling those of chordoma. This tumour should have a greater risk of recurrence and aggressive growth (WHO grade II). So far, 92 such tumours have been described in the literature. We report two cases of chordoid meningioma occurring in adult female patients. In our two patients (aged 28 and 60 years with chordoid meningioma of the convexity and left-sided outer sphenoid wing, respectively) we centred on some rarely discussed aspects of the tumour. MRI scans showed no edema in the vicinity of either of the two meningiomas, whereas selective angiography of ACI and ACE revealed a dural type of vascular supply to the two neoplasms. In both cases, the tumour was removed by radical surgery (Simpson grade I resection) with a normal post-operative course. Both women (one 2 years post-surgery and one 4 years post-surgery) are now free from any signs of relapse on MRI and with normal neurological findings. The vascular endothelial growth factor (VEGF) expression was low in either case (5 and 40%, respectively). We regard the factors under consideration in our study (i.e. absence of edema, dural supply, low VEGF expression and radical Simpson grade I resection) as an important contribution to the discussion of the biological behaviour of chordoid meningioma.
- MeSH
- Biopsy MeSH
- Adult MeSH
- Echo-Planar Imaging MeSH
- Glial Fibrillary Acidic Protein metabolism MeSH
- Immunohistochemistry MeSH
- Middle Aged MeSH
- Humans MeSH
- Meningioma surgery blood supply pathology MeSH
- Cerebrovascular Circulation MeSH
- Neurosurgical Procedures MeSH
- Vimentin metabolism MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
BACKGROUND: The resection of convexity meningiomas should harbour a low rate of morbidity. Functional preservation should be the main goal of surgery and have higher priority over radicality. Involvement of the primary motor cortex (PMC) increases surgical risk. The goal of this study was to evaluate the effect of cortical mapping on surgical morbidity after rolandic area meningioma treatment. METHODS: From January 2005 to March 2011, 42 patients were operated on for rolandic meningioma involving or compressing the PMC. The cohort consisted of 25 (59.5%) convexity, 10 (23.8%) parasagittal and 7 (16.7%) falcine meningiomas. Four patients were treated for recurrent disease and 25 (59.5%). Intraoperative cortical mapping was used to identify location of PMC. The threshold stimulation current was set at every site of cortical monopolar anodal stimulation around the tumour and at the tumour-cortex junction repeatedly during the meningioma dissection. RESULTS: Radical resection (Simpson 1 and 2) was achieved in 30 patients (71.4%) and partial resection (Simpson 4) in 12 (28.6%). New permanent deficit occurred in three patients (7.1%). All patients had moderate preoperative deficit (muscle strength ≤ 3). WHO-I was in 28 cases (66.7%), WHO-II in 14 cases (33.3%). Average follow-up was 33.2 months. Five patients (11.9%) suffered from recurrence after an average of 23.8 months. CONCLUSIONS: Rolandic area meningiomas should be classified as a higher risk group. Intraoperative cortical mapping is in our experience useful in a situation when the cleavage plane at the PMC is lost. In such a scenario, resection outside the PMC is radical and only at the PMC is a thin remnant left without cortical damage, which helps to be safer with a better long-term prognosis.
- MeSH
- Adult MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Brain Mapping MeSH
- Meningeal Neoplasms pathology surgery MeSH
- Meningioma pathology surgery MeSH
- Motor Cortex pathology MeSH
- Follow-Up Studies MeSH
- Monitoring, Intraoperative MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
