Evaluation of surgical outcome of giant intracranial meningiomas (original) (raw)
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Cureus, 2021
This study aims to examine the possible demographic, clinical, and surgical differences between giant and smaller meningiomas. Materials and Methods Forty-eight meningioma patients who were operated on in our clinic between 2016-2020 were included in our study. Fourteen meningiomas larger than 5 cm in diameter were defined as giant meningiomas and placed in group 1. Thirty-four remaining meningiomas, with sizes less than 5 cm, were placed in group 2. These patients were evaluated regarding age, sex, localization, symptoms and neurological findings, surgical results, histopathology, and postoperative results. Results The most common localization in group 1 was falcine-parasagittal, whereas in group 2 it was convexity. Simpson's grade I resection rate in group 1 was 35.71%, while in group 2 this rate was 67.65%. In histopathological examination, transitional type meningiomas (35.71%) were the most common in group 1, whereas fibrous type meningiomas (32.35%) were seen the most in group 2. Group 1 Karnofsky Performance Scale score average was 75.71 preoperatively and 85.71 postoperatively. In group 2, the preoperative and postoperative average was 97.35 and 96.76, respectively. The comparative statistical analysis reflects that: A) Resection rates were significantly lower in the giant meningioma group. B) Similarly, Karnofsky Performance Scale scores were also lower than group 2. C) When statistical comparisons were made according to sex, age, localization, histopathological results, postoperative complications, and recurrence rates, no significant differences were observed. Conclusion The term "Giant Meningioma" is a type of distinction that is frequently made in the literature. However, the single major difference we see in our study was the surgical results. The general condition of patients before and after surgery may be more critical than others in giant meningiomas. Although surgical resection is the main form of treatment in giant meningiomas, the risks arising from the size of the tumor should be taken into account, and necessary plans should be made for a successful surgical intervention.
Surgical Management of Intracranial Meningiomas
The Professional Medical Journal, 2007
Objective: To study the surgical management and outcome of patients having intracranial meningiomas. Design: A retrospective study. Setting: The Department of Neurosurgery Punjab Medical College & Allied Hospital, Faisalabad. Duration From April 2004 to October 2005. Materials & Methods:Thirty patients suffering from intracranial meningiomas diagnosed on CT-scan and managed surgically were included in this study. Simpson grade I removal was possible in 21 patients. Grade II removal was done in Three patients while grade 111 removal was possible in four patients, grade IV removal was done in one patient and grade V in one patient. Post operative XRT was given in cases having grades II, 111, IV and V removal. Follow up was done at six monthly intervals. Outcome was assessed as Good .Fair, and poor depending upon clinical and radiological examinations. RESULTS: Out of 30 patients only one had recurrence after one year of follow up which was removed surgically and postoperative XRT was ...
Indian Journal of Neurosurgery, 2021
Intracranial meningiomas are the most common extra-axial tumors, representing 15% of all brain tumors. Arising from the arachnoid cells, and common in middle-aged women, 90% meningiomas are benign. We conducted a 10-year study on 183 cases of intracranial meningiomas and observed a lower and decreasing trend; the mean age was 43.3 years but there was also a significant incidence in young females. Parasagittal/falx (29%), sphenoid ridge, convexity meningiomas and middle cranial fossa locations were more common. Histopathologically, meningothelial meningioma was the most common. Benign (WHO I) tumors were found in above 90%, atypical (WHO II) in 5% cases, and malignant (WHO III) in < 4% patients. Most patients underwent Simpsons Grade I excision (35.6%) with dural reconstruction because of late presentations. Posterior fossa meningiomas were mostly benign, while intraventricular ones were mostly malignant with highest postoperation mortality. Mortality in operated patients was 9.8%...
Clinicopathological characteristics of intracranial meningiomas
Nepal Journal of Neuroscience, 2020
Background: Meningioma comprises 25-30% of total central nervous system tumors detected. Ninety percent of meningiomas are benign, 6% are atypical, and 2% are malignant. Complete resection is often curative. Objectives: The objective of this study is to give ideas about the descriptive epidemiology, clinical presentation and histopathology of current scenario at National Neurosurgical Referral Center, Nepal. Methods: This is a prospective study from the period of January 2015 to September 2019 in the department of neurosurgery, National Academy of Medical Science, Bir Hospital. Inclusion criteria consists of all the histopathological proven cases of meningioma during the study period. Result: A total of 150 meningioma cases were operated during the study period. The average age of presentation was 42 years. Male to female ratio was 1:2. Most common affected age group was 30-50 years. The most common clinical symptoms for intracranial meningioma were headache followed by vomiting and...
Problems in the Management of Intracranial Meningiomas
Meningiomas account for approximately 15–20% of all brain tumors, and are the most common benign intracranial tumor. These neoplasms develop from cap cells in the arachnoidea; thus, they can be found anywhere that dura mater exists. Meningiomas are usually diagnosed in middle age, and are significantly more frequent in females than in males. Atypical and anaplastic malignant forms also exist. Some types of meningiomas are difficult to manage and require special considerations. The first-line therapy for meningioma is surgery aimed at total excision; however, limitations of surgery must be fully evaluated in order to achieve better results. Conventional radiotherapy and gamma-knife radiosurgery can be used as adjuvant therapeutic modalities under certain conditions. The issues that we consider important in the management of intracranial meningiomas can be discussed under the headings of diagnosis, surgery, multiplicity, pathology, and recurrence. DIAGNOSIS In cases of meningioma, plain radiographs may reveal hyperostosis, bone erosion, enlarged vascular channels, calcification of the tumor tissue , and pneumosinus dilatans. On cranial computerized tomography (CT), these tumors appear as well-defined masses with smooth, sharp margins. On noncontrast images, 75% of meningiomas are hyperdense and the other 25% appear either hypo-or isodense to the surrounding tissue. The advent of contemporary neuroimaging techniques, such as CT and magnetic resonance imaging (MRI), has dramatically increased the specificity of radiological diagnosis of intracranial meningiomas. We previously reported 97.6% preoperative correct diagnosis of meningiomas with CT or MRI [1]. Examples of cases that we have encountered difficulty diagnosing are intraparenchymal meningioma [2], ectopic scalp meningioma [3], and some atypical meningiomas.
Management of intracranial meningiomas in Enugu, Nigeria
Surgical Neurology International, 2012
Background: Meningiomas may range on presentation from incidentally identified small lesions to large symptomatic tumors in eloquent areas of the brain. Management options correspondingly vary and include careful observation, surgical excision, and palliative application of very limited therapeutic maneuvers in select cases. This paper discusses the options and difficulties in the management of meningiomas in a developing country. Methods: This study is a retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2006 and September 2011 at Memfys Hospital for Neurosurgery, Enugu. Radiographic diagnosis of meningioma was based on computed tomography (CT) and or magnetic resonance imaging (MRI) criteria in all cases, but only patients who had surgery and a histological diagnosis were analyzed. Results: Seventy-four patients were radiographically diagnosed with intracranial meningioma over the period under review. Fifty-five patients were operated upon and 52 (70.3%) with histological diagnosis of meningioma were further analyzed. Histological diagnosis was complete in 42 (56.8%) patients and in 10 (13.5%) patients the subtype of meningioma was not determined. The male to female ratio was 1:1.08. The peak age range for females was in the 6th decade and for males in the 5th decade. The locations were olfactory groove (26.9%), convexity (21.2%), parasagittal/falx (19.2%), sphenoid ridge (15.4%), tuberculum sellae (7.7%), tentorial (3.8%), and posterior fossa (5.8%). The most common clinical presentation was headaches in 67.3% followed by seizures (40.4%) and visual impairment (38.5%). Histology was benign (World Health Organization [WHO] grade 1) in 39 patients. One patient harbored an atypical and two had anaplastic tumors. Gross total resection of the tumor was achieved in 41 patients. Surgical mortality was 3.9%. Conclusion: Effective management of meningioma depends largely on adequate and complete surgical resection and results in good outcomes. Adequate preoperative assessment, including visual assessment, and hormonal assessment in olfactory groove and sphenoid region meningiomas, is necessary.
Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria
Journal of Neurosciences in Rural Practice, 2012
Introduction: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. Materials and Methods: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. Results: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. ...
THE NATURAL COURSE OF INCIDENTAL INTRACRANIAL MENINGIOMAS: SYSTEMATIC REVIEW AND META-ANALYSIS.
Background: With the increasing availability of radiological imaging, detection of incidental intracranial meningiomas in asymptomatic patients has increased dramatically. The best management of incidentally found meningiomas is not as clear. A systematic review and meta-analysis of the studies currently available allows for a better understanding of the natural course of asymptomatic meningiomas, a platform for more research, and a foundation on which a standardized guideline for following these tumors may be built. Methods: A systematic review of the English language literature published before October 2017 with no lower date limit was carried out. Data collected from the articles included years of the study, study location, study design, number of patients with asymptomatic meningiomas with follow-up, number of meningiomas, inclusion of NF2 patients, mean age, gender, whether tumor was defined as growing or not, tumor location, MRI characteristics, initial size of the tumors, growth rates, and outcome of follow-up. Meta-analysis of the collected data was carried out. Results: Twenty studies were identified and included in the meta-analysis (1108 patients, 1175 meningiomas). Meta-analysis results revealed an inverse relationship between age of patients and tumor growth (P<0.001). There was no significant correlation between tumor growth and gender (P=0.15). The presence of calcification was associated with significant reduced risk of growth (P<0.001). Meanwhile, growth was associated with the presence of edema (P=0.005) and T2 hyperintensity (P<0.001). Also, the tumor growth was associated with initial tumor size P=0.01. The outcome of follow up for 1154 tumors in all included studies revealed that 551 (47.7%) had grown, 283(51.4%) of them grown asymptomatically and 153 (27.8%) underwent surgery. 149 out of 1093 patients in the whole analysis developed symptoms during their follow-up (13.6%). The mean follow-up duration for the whole analysis was 60.7 months. Conclusion: Regarding incidentally discovered meningiomas, an initial follow-up within 3-6 months of initial diagnosis with both clinical and radiological exam followed by another exam at 9-12 months. After the initial observation period, annual radiological exams may be sufficient with special consideration between years 5-10 post-diagnosis.
Journal of Neuro-Oncology, 2019
Background Incidental discovery accounts for 30% of newly-diagnosed intracranial meningiomas. There is no consensus on their optimal management. This review aimed to evaluate the outcomes of different management strategies for these tumors. Methods Using established systematic review methods, six databases were scanned up to September 2017. Pooled event proportions were estimated using a random effects model. Meta-regression of prognostic factors was performed using individual patient data. Results Twenty studies (2130 patients) were included. Initial management strategies at diagnosis were: surgery (27.3%), stereotactic radiosurgery (22.0%) and active monitoring (50.7%) with a weighted mean follow-up of 49.5 months (SD = 29.3). The definition of meningioma growth and monitoring regimens varied widely impeding relevant meta-analysis. The pooled risk of symptom development in patients actively monitored was 8.1% (95% CI 2.7-16.1). Associated factors were peritumoral edema (OR 8.72 [95% CI 0.35-14.90]) and meningioma diameter ≥ 3 cm (OR 34.90 [95% CI 5.17-160.40]). The pooled proportion of intervention after a duration of active monitoring was 24.8% (95% CI 7.5-48.0). Weighted mean timeto-intervention was 24.8 months (SD = 18.2). The pooled risks of morbidity following surgery and radiosurgery, accounting for cross-over, were 11.8% (95% CI 3.7-23.5) and 32.0% (95% CI 10.6-70.5) respectively. The pooled proportion of operated meningioma being WHO grade I was 94.0% (95% CI 88.2-97.9). Conclusion The management of incidental meningioma varies widely. Most patients who clinically or radiologically progressed did so within 5 years of diagnosis. Intervention at diagnosis may lead to unnecessary overtreatment. Prospective data is needed to develop a risk calculator to better inform management strategies.