Meningiomas are known to express somatostatin receptor 2 (SSTR2). PET using the SSTR2 analog 68 Ga-DOTATATE has recently been introduced for imaging of meningiomas. However, a systematic correlation between 68 Ga-DOTATATE uptake, SSTR2 expression, and histology (including tumor-free scar tissue) is still lacking. For elucidation, we conducted this prospective study. Methods: Twenty-one adult patients with primary (n 5 12) or recurrent (n 5 9) meningiomas were prospectively enrolled. Preoperative MR imaging and 68 Ga-DOTATATE PET scans were fused and used for a spatially precise neuronavigated tissue-sampling procedure during tumor resection. Histopathologic diagnosis included immunohistochemical determination of SSTR2 expression. At each individual sampling site, the maximum standardized uptake value (SUV max ) of 68 Ga-DOTATATE was correlated with MR imaging findings, histology, and semiquantitative SSTR2 expression. Results: One hundred fifteen samples (81 tumor, 34 tumor-free) were obtained. There was a significant positive correlation between SUV max and SSTR2 expression. Receiver-operating characteristic analysis revealed a threshold of 2.3 for SUV max to discriminate between tumor and nontumoral tissue. Regarding the detection of tumor tissue, PET imaging showed a higher sensitivity (90% vs. 79%; P 5 0.049), with specificity and positive predictive values similar to MR imaging, for both de novo and recurrent tumors. Conclusion: 68 Ga-DOTATATE uptake correlates with SSTR2 expression and offers high diagnostic accuracy to delineate meningioma from tumor-free tissue even in recurrent tumors after previous therapy. Our findings substantiate an important role for 68 Ga-DOTATATE PET in meningioma management.

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IntracranIal dural arteriovenous fistulas (DAVFs) are pathological shunts between dural arteries and dural venous sinuses, meningeal veins, or cortical veins. DAVFs account for 10%-15% of intracranial arteriovenous malformations.9 The venous drainage pattern of a DAVF determines its severity and classification according to Borden et al. 1 and Cognard et al. 3 Both of these systems associate cortical venous drainage with increased risk of intracranial hemorrhage and neurological deficits. 2,4,6,7,13,15,16 During the past 2 decades, embolization has become the first-line treatment for DAVFs. In particular, the invention of highly compliant, inflatable occlusion balloons and the Onyx liquid embolic agent (ev3 Neurovascular) opened a new horizon in the endovascular treatment of DAVFs. By temporarily inflating a large-lumen compliant balloon in the diseased sinus compartment during the injection of Onyx into an arterial feeder, this combined sinus-preserving embolization (CSPE) approach is supposed to preserve the natural venous drainage pattern and allow a better penetration of the fistula network by the liquid embolic agent.Transvenous embolization (TVE) is performed by retrograde catheterization of the involved dural sinus or cortical vein, followed by deposition of coils and/or liquid abbreviations CCA = common carotid artery; CCF = carotid cavernous fistula; CSOE = combined sinus-occluding embolization; CSPE = combined sinus-preserving embolization; DAVF = dural arteriovenous fistula; DSA = digital subtraction angiography; ECA = external carotid artery; SO = sinus-occluding; SP = sinus-preserving; TAE = transarterial embolization; TVE = transvenous embolization. methods Clinical symptoms, complication rates, and Cognard grading prior to and after endovascular DAVF treatment using different technical approaches was retrospectively analyzed in 36 patients with lateral DAVF Cognard Types I-IIb. The long-term success rate was determined by a standardized questionnaire. results The SO approaches offered a higher rate of definitive fistula occlusion (93% SO vs 71% SP) but were accompanied by a significantly higher complication rate (33% or 20% SO vs 0% SP). The patients interviewed reported very high satisfaction with their health in long-term follow-up in both groups. conclusions A higher rate of definitive fistula occlusion in the SO group was attained at the price of a significantly higher complication rate. The SP approaches offered a good primary success rate in combination with a very low complication rate. Despite some limitations of the data (e.g., a small sample size) the authors thus recommend an SP variant as the primary therapeutic option for the endovascular treatment of low-and intermediate-grade DAVFs. The SO approaches should be restricted to cases in which SP treatment does not achieve a downgrading to no worse than Cognard Type IIa.http://thejns.org/doi/abs/10.3171/2016.2.JNS152081

Re-irradiation has been shown to be a meaningful option for recurrent high-grade glioma (HGG) patients. Furthermore, bevacizumab exerts certain activity in combination with chemotherapy/as monotherapy and was safely tested in combination with radiotherapy in several previous studies. To our knowledge, this is the largest cohort of patients treated with both re-irradiation and bevacizumab to date. After receiving standard radiotherapy (with or without TMZ) patients with recurrent HGG were treated with bevacizumab (10 mg/kg intravenously at d1 and d15) during re-irradiation. Median prescribed radiation dose during re-treatment was 36 Gy, conventionally fractionated. Datasets of 71 re-irradiated patients were retrospectively analyzed. Patients either received bevacizumab (N = 57) or not (N = 14; other substances (N = 4) and sole radiation (N = 10)). In patients receiving bevacizumab, both post-recurrence survival (PRS) (median 8.6 vs. 5.7 months; p = 0.003, log-rank test) and post-recurrence progression-free survival (PR-PFS, 5.6 vs. 2.5 months; p = 0.005, log-rank test; PFS-6 42.1 % for the bevacizumab group) were significantly increased which was confirmed by multivariate analysis. KPS, re-surgery, MGMT methylation status, sex, WHO grade, tumor volume and age were no significant predictors for neither PR-PFS nor PRS (univariate analysis). Re-irradiation with bevacizumab remains a feasible and highly effective treatment schedule. Studies on further salvage strategies and timing of sequential treatment options versus observation are warranted.