Preoperative identification of meningiomas that are highly likely to recur

Nakasu, Satoshi; Nakasu, Yoko; Nakajima, Masayuki; Matsuda, Masayuki; Handa, Jyoji

doi:10.3171/jns.1999.90.3.0455

Cited by 134 publications

(111 citation statements)

References 33 publications

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“…9,13,17,18,28 In clinical practice, the coexistence of several radiological features within 1 meningioma is not uncommon. Confusion frequently occurs because we do not know which finding is important and which is not.…”

Section: Discussionmentioning

confidence: 99%

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Correlation between magnetic resonance imaging grading and pathological grading in meningioma

Lin

Chou

Kao³

et al. 2014

JNS

100

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Object This study investigated the specific preoperative MRI features of patients with intracranial meningiomas that correlate with pathological grade and provide appropriate preoperative planning. Methods From 2006 to 2012, 120 patients (36 men and 84 women, age range 20–89 years) with newly diagnosed symptomatic intracranial meningiomas undergoing resection were retrospectively analyzed in terms of radiological features of preoperative MRI. There were 90 WHO Grade I and 30 WHO Grade II or III meningiomas. The relationships between MRI features and WHO histopathological grade were analyzed and scored quantitatively. Results According to the results of multivariate logistic regression analysis, age ≥ 75 years, indistinct tumorbrain interface, positive capsular enhancement, and heterogeneous tumor enhancement were identified factors in the prediction of advanced histopathological grade. The prediction model was quantified as a scoring scale: 2 × (age) + 5 × (tumor-brain interface) + 3 × (capsular enhancement) + 2 × (tumor enhancement). The calculated score correlated positively with the probability of high-grade meningioma. Conclusions This scoring approach may be useful for clinicians in determining therapeutic strategy and in surgical planning for patients with intracranial meningiomas.

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Section: Discussionmentioning

confidence: 99%

“…9,13,17,18,28 In clinical practice, various combinations of radiological features usually appear within one meningioma. Thus, it is reasonable to make an exclusive and comprehensive assessment of all related clinical and radiological features Correlation between magnetic resonance imaging grading and pathological grading in meningioma for each patient.…”

mentioning

confidence: 99%

Correlation between magnetic resonance imaging grading and pathological grading in meningioma

Lin

Chou

Kao³

et al. 2014

JNS

100

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“…The most recent paper on meningioma recurrence by Nakasu and associates [27] focuses on a CT scanning-era series of 146 patients with a mean follow-up time of 9.6 years. The MIB-1 index, tumor size, near sinus location, calcification, edema, hyperostosis, lobulated or mushroom shape, and indistinct brain-tumor interface reached significance for recurrence on univariate analysis, whereas only lobulated and mushroom shapes were significant on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Predicting the probability of meningioma recurrence based on the quantity of peritumoral brain edema on computerized tomography scanning

Mantle¹,

Lach²,

Delgado³

et al. 1999

FOC

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Object The goal of this study was to determine whether the quantity of peritumoral brain edema displayed on computerized tomography (CT) scanning could be correlated with brain invasion and subsequent recurrence of meningiomas. Methods One hundred thirty-five patients who underwent resection of intracranial meningiomas at the Ottawa Civic Hospital were followed during the period 1980 to 1998. A complete resection was defined as one in which tumor, invaded bone, and involved dura were removed. Tumors were examined microscopically for evidence of brain invasion. The mean follow-up period was 9 years (± 4 years, standard deviation [SD]) and the mean time to recurrence was 5 years (± 4 years, SD). The authors used a simple grading system based on the average thickness (in centimeters) of edema seen on an axial CT slice showing the most tumor. Edema grade was linearly related to edema volume determined by digitizing the scans (r = 0.96; 29 cases). The chance of brain invasion increased by 20% for each centimeter of edema (rs = 1, p < 0.0001; 124 cases). The presence of brain invasion was predictive of recurrence after complete resection with an accuracy of 83%, a sensitivity of 89%, and a specificity of 82%. The chance of recurrence within 10 years after complete resection was given by the equation: percentage chance of recurrence = (centimeter of edema)3 X 0.7, which can be used to predict the chance of recurrence based on findings on CT scans (rs = 1.00, p < 0.0001; 86 patients). Statistical significance was confirmed using Kaplan-Meier and univariate and multivariate analyses. Completeness of resection was the most powerful predictor of recurrence (p < 0.00001, r = 0.6), followed by edema grade and brain invasion (both p = 0.02, r = 0.1). Patient age and gender and tumor location, size, and histological subtype were nonsignificant factors. Conclusions Brain invasion causes peritumoral edema. Invaded brain tissue is also the source of residual cells in cases of tumor recurrence after gross-total resection.

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“…At the same time, no statistically significant effect on the overall survival rate was identified. Nevertheless, this technology has attracted an increased attention of neurosurgeons resulting in more reports on FN, as well as the application of this method for other central nervous system tumors [4,[7][8][9][10][11][12][13][14][15][16] including intracranial meningiomas [16][17][18][19][20]. However, the assessment of FN's sensitivity and specificity was not demonstrated clearly and in particular, no comparison was made between the data obtained from visible fluorescence, and the data obtained from laser biospectroscopy in meningiomas of different World Health Organization (WHO) grades.…”

Section: Introductionmentioning

confidence: 99%

Laser biospectroscopy and 5-ALA fluorescence navigation as a helpful tool in the meningioma resection

et al. 2016

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5-aminolevulinic acid (5-ALA) is a natural precursor of protoporphyrin IX (PP IX), which possesses fluorescent properties and is more intensively accumulated in tumor cells than in normal tissue. Therefore, the use of 5-ALA in the surgical treatment of intracranial tumors, particularly gliomas, has gained popularity in the last years, whereas its use in other intracranial pathological entities including meningiomas has been reported occasionally. This study describes a series of 28 patients with intracranial meningiomas, who were administered 5-ALA for a better visualization of tumor boundaries. Twelve patients underwent also laser spectroscopic analysis in order to confirm the visual impression of tumor tissue visualization. Bone infiltration was readily demonstrated. In one case, the tumor recurrence could have been prevented by removal of a tumor remnant, which would possibly have been better recognized if spectroscopic analysis had been used. Fluorescent navigation (FN) is a useful method for maximizing the radicality of meningioma surgery, particularly if the tumor infiltrates the bone, the skull base, and/or the surrounding structures

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Preoperative identification of meningiomas that are highly likely to recur

Abstract: Meningiomas with mushrooming or lobulated shapes should be treated more aggressively with a wider dural excision. This is not usually necessary for round tumors, although it may be beneficial in younger patients.

Cited by 134 publications

References 33 publications

Correlation between magnetic resonance imaging grading and pathological grading in meningioma

Correlation between magnetic resonance imaging grading and pathological grading in meningioma

Predicting the probability of meningioma recurrence based on the quantity of peritumoral brain edema on computerized tomography scanning

Laser biospectroscopy and 5-ALA fluorescence navigation as a helpful tool in the meningioma resection

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