Peritumoral Brain Edema and Surgical Outcome in Secretory Meningiomas: A Matched-Cohort Analysis

Trivedi, Megh M.; Worley, Sarah; Raghavan, Alankrita; Das, Paramita; Recinos, Pablo F.; Barnett, Gene H.; Kshettry, Varun R.

doi:10.1016/j.wneu.2020.09.151

Cited by 7 publications

(2 citation statements)

References 22 publications

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“…SBMs mainly show the meningothelial histotype, and compared to non-skull based ones, they have a lower incidence of grade II/III histology (8.6–20% vs. 40%) and of NF2 alterations (20% vs. 46%), and a higher incidence of secretory histotype (63% vs. 37%) [ 60 , 62 , 63 ], a rare grade I variant, characterized by peritumoral edema [ 71 ]. Then, SBMs can be further categorized, as those localized at the lateral and posterior skull base mainly feature NF2 impairment [ 72 , 73 ], while those at the anterior and middle skull base are NF2 wild type and may have mutations in other genes, including AKT1 , PIK3CA, SMO, TRAF7, KLF4 and POLR2A [ 69 , 72 , 73 , 74 ].…”

Section: Histopathological Featuresmentioning

confidence: 99%

Advances in Multidisciplinary Management of Skull Base Meningiomas

Ius

Tel

Minniti

et al. 2021

Cancers

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The surgical management of Skull Base Meningiomas (SBMs) has radically changed over the last two decades. Extensive surgery for patients with SBMs represents the mainstream treatment; however, it is often challenging due to narrow surgical corridors and proximity to critical neurovascular structures. Novel surgical technologies, including three-dimensional (3D) preoperative imaging, neuromonitoring, and surgical instruments, have gradually facilitated the surgical resectability of SBMs, reducing postoperative morbidity. Total removal is not always feasible considering a risky tumor location and invasion of surrounding structures and brain parenchyma. In recent years, the use of primary or adjuvant stereotactic radiosurgery (SRS) has progressively increased due to its safety and efficacy in the control of grade I and II meningiomas, especially for small to moderate size lesions. Patients with WHO grade SBMs receiving subtotal surgery can be monitored over time with surveillance imaging. Postoperative management remains highly controversial for grade II meningiomas, and depends on the presence of residual disease, with optional upfront adjuvant radiation therapy or close surveillance imaging in cases with total resection. Adjuvant radiation is strongly recommended in patients with grade III tumors. Although the currently available chemotherapy or targeted therapies available have a low efficacy, the molecular profiling of SBMs has shown genetic alterations that could be potentially targeted with novel tailored treatments. This multidisciplinary review provides an update on the advances in surgical technology, postoperative management and molecular profile of SBMs.

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Section: Histopathological Featuresmentioning

confidence: 99%

Advances in Multidisciplinary Management of Skull Base Meningiomas

Ius

Tel

Minniti

et al. 2021

Cancers

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“…Significant PTE is rare but commonly seen in association with higher grade meningiomas and secretory meningiomas. 1 Seizures are one of the most clinically significant symptoms caused by meningiomas, occurring in roughly 30% of patients. 2 Meningiomas compressing cortical areas, as well as larger meningiomas, have a greater propensity to cause either focal or generalized seizures.…”

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confidence: 99%

Clinical management of seizures in patients with meningiomas: Efficacy of surgical resection for seizure control and patient-tailored postoperative anti-epileptic drug management

Peart

Melnick

Cibula

et al. 2023

Neuro-Oncology Advances

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Meningiomas are the most common primary intracranial tumor. They are slow growing and often incidentally found tumors that arise from the arachnoid villi. As they grow, they have a greater likelihood of becoming symptomatic with seizures being one of the most clinically significant symptoms. Seizures are more likely to present as a symptom of larger meningiomas and meningiomas that compress cortical areas particularly those in non-skull base locations. These seizures are often managed medically, utilizing the same anti-seizure medications that are used to treat other causes of epilepsy. We discuss common anti-seizure medications used including valproate, phenobarbital, carbamazepine, phenytoin, lacosamide, lamotrigine, levetiracetam and topiramate and their common adverse effects. The goal of pharmacotherapy for seizure control is to maximize seizure control while minimizing the adverse effects of the medication. The decision to provide medical management is dependent on individual seizure history and plans for surgical treatment. Patients who did not require seizure prophylaxis before surgery are commonly prescribed seizure prophylaxis postoperatively. Symptomatic meningiomas not controlled by medical management alone are commonly evaluated for surgical resection. The efficacy of surgical resection in providing seizure freedom is dependent on several features of the tumor including tumor size, the extent of the peritumoral edema, the number of tumors, sinus infiltration and the degree of resection.

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Peritumoral T2/FLAIR hyperintense MRI findings of meningiomas are not necessarily edema and may persist permanently: a systematic review

Laajava,

Korja

2023

Neurosurg Rev

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The current knowledge regarding the prevalence and persistence of edematous changes postmeningioma surgery is limited. Our hypothesis was that peritumoral edema is frequently irreversible gliosis, potentially influencing long-term postoperative epilepsy. We conducted a systematic literature search in PubMed, Cochrane Library, and Scopus databases. We included studies with adult patients undergoing first supratentorial meningioma surgery, which reported pre- and postoperative peritumoral brain edema (T2WI and FLAIR hyperintensity on MRI). Risk of bias was assessed based on detailed reporting of five domains: (1) meningioma characteristics, (2) extent of resection, (3) postoperative radiation therapy, (4) neurological outcome, and (5) used MRI sequence. Our loose search strategy yielded 1714 articles, of which 164 were reviewed and seven met inclusion criteria. Persistent edema rates ranged from 39% to 83% with final follow-up occurring between 0, 14, and 157 months. Among patient cohorts exhibiting persistent edema, a smaller portion achieved seizure resolution compared to a cohort without persistent edema. Relatively reliable assessment of persistent T2/FLAIR hyperintensity changes can be made earliest at one year following surgery. All studies were classified as low quality of evidence, and therefore, quantitative analyses were not conducted. Persistent T2/FLAIR hyperintensity changes are frequently observed in MRI imaging following meningioma surgery. The term “edema,” which is reversible, does not fully capture pre- and postoperative T2WI and FLAIR hyperintensity changes. Future studies focusing on peritumoral meningioma-related edema, its etiology, its persistence, and its impact on postoperative epilepsy are needed.

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Peritumoral Brain Edema and Surgical Outcome in Secretory Meningiomas: A Matched-Cohort Analysis

Cited by 7 publications

References 22 publications

Advances in Multidisciplinary Management of Skull Base Meningiomas

Advances in Multidisciplinary Management of Skull Base Meningiomas

Clinical management of seizures in patients with meningiomas: Efficacy of surgical resection for seizure control and patient-tailored postoperative anti-epileptic drug management

Peritumoral T2/FLAIR hyperintense MRI findings of meningiomas are not necessarily edema and may persist permanently: a systematic review

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