Peritumoral Edema/Tumor Volume Ratio: A Strong Survival Predictor for Posterior Fossa Metastases

The authors studied the pial and dural blood supplies in 74 intracranial meningiomas and quantified their associated peritumoral brain edema (PTBE). The extent and localization of pial blush in relation to the total tumor volume were determined angiographically. The amount of edema and tumor size were calculated using computerized tomography. The edema-tumor volume ratio was defined as Edema Index (EI). There were 49 meningiomas with PTBE; of those tumors, 46 were supplied by pial vessels, and three were supplied exclusively by dural vessels. Tumors without PTBE showed no pial blush. The mean EI in meningiomas with pial blush was significantly larger (EI = 3.0) than in meningiomas without pial supply (EI = 1.1; p < 0.0001). Meningiomas in which 10% of the whole tumor volume was supplied by pial vessels had only a small mean EI of 2.2, whereas tumors with pial blood supply greater than or equal to 20% had a mean EI of 3.3 (p < 0.026). In 69.9% of cases with pial blood supply, major portions of the edema were located adjacent to the tumor region supplied by pial vessels. Edema index differences among tumors of different subgroups, as defined by size or histology, were significantly related to the pial supply in each subset. Thus, pial blood supply may be causative for the development of PTBE in meningiomas.

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The importance of pial blood supply to the development of peritumoral brain edema in meningiomas

Journal of Neurosurgery ◽

10.3171/jns.1997.87.3.0368 ◽

1997 ◽

Vol 87 (3) ◽

pp. 368-373 ◽

Cited By ~ 61

Author(s):

Michael Bitzer ◽

Lars Wöckel ◽

Andreas R. Luft ◽

Ajay K. Wakhloo ◽

Dirk Petersen ◽

...

Keyword(s):

Brain Edema ◽

Blood Supply ◽

Tumor Volume ◽

Volume Ratio ◽

Content Type ◽

Total Tumor Volume ◽

Pial Vessels ◽

Peritumoral Brain Edema ◽

Tumor Region ◽

The Mean

✓ In a retrospective analysis, the authors studied the pial and dural blood supplies in 74 intracranial meningiomas and quantified their associated peritumoral brain edema (PTBE). The extent and localization of pial blush in relation to the total tumor volume were determined angiographically. The amount of edema and tumor size were calculated using computerized tomography. The edema—tumor volume ratio was defined as Edema Index (EI). There were 49 meningiomas with PTBE; of those tumors, 46 were supplied by pial vessels, and three were supplied exclusively by dural vessels. Tumors without PTBE showed no pial blush. The mean EI in meningiomas with pial blush was significantly larger (EI = 3) than in meningiomas without pial supply (EI = 1.1; p < 0.0001). Meningiomas with a smaller pial supply than dural supply had a significantly smaller mean EI than tumors with a pial supply equal to or greater than the dural supply (EI = 2.9 vs. EI = 3.7; p < 0.015). In 69.9% of cases with pial blood supply, major portions of the edema were located adjacent to the tumor region supplied by pial vessels. Edema index differences among tumors of different subgroups, as defined by size or histology, were significantly related to the pial supply in each subset. Thus, pial blood supply may be associated with the development of PTBE in meningiomas.

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How much tumor volume is responsible for development of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas?

10.21203/rs.3.rs-437289/v1 ◽

2021 ◽

Author(s):

Shuhei Yamada ◽

Noriyuki Kijima ◽

Tomoyoshi Nakagawa ◽

Ryuichi Hirayama ◽

Manabu Kinoshita ◽

...

Keyword(s):

Tumor Volume ◽

Clinical Symptoms ◽

Characteristic Curve ◽

Univariate Analysis ◽

Area Under The Curve ◽

Volumetric Analysis ◽

Tumor Diameter ◽

Peritumoral Edema ◽

Asymptomatic Group ◽

Maximum Tumor Diameter

Abstract Purpose Meningiomas are the most common primary intracranial neoplasms. Their volume and location are important factors related to the appearance of clinical symptoms. This study aimed to identify factors that influence clinical symptoms and to determine a specific threshold tumor volume for the prediction of symptomatic progression in patients with convexity, parasagittal, and falx meningiomas. Methods We retrospectively studied patients with radiologically suspected convexity, parasagittal, or falx meningiomas at our institution. Results The data of three hundred thirty-three patients were analyzed. We further divided patients into two groups based on clinical symptoms: as asymptomatic group (250 cases) and a symptomatic group (83 cases). Univariate analysis revealed significant differences between the groups in terms of sex (p = 0.002), age at the time of volumetric analysis (p < 0.001), hyperintense lesions on T2-weighted images (p = 0.029), peritumoral edema (p < 0.001), maximum tumor diameter (p < 0.001), and tumor volume (p < 0.001). Further multivariate analysis revealed significant differences between the groups in terms of age at the time of volumetric analysis (p = 0.002), peritumoral edema (p < 0.001), and tumor volume (p < 0.001). Receiver operating characteristic curve revealed a threshold tumor volume of 21.1 ml for predicting whether a patient would develop symptoms (sensitivity 0.843, specificity 0.880, an area under the curve 0.919 [95% confidence interval: 0.887–0.951]). Conclusion We identified factors predictive of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas and determined the first-ever threshold tumor volume for predicting symptomatic progression in such patients.

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Imaging features and classification of peritumoral edema in vestibular schwannoma

The Neuroradiology Journal ◽

10.1177/1971400919896253 ◽

2019 ◽

Vol 33 (2) ◽

pp. 169-173

Author(s):

Mario Giordano ◽

Venelin Gerganov ◽

Hussam Metwali ◽

Massimo Gallieni ◽

Madjid Samii ◽

...

Keyword(s):

Tumor Growth ◽

Tumor Volume ◽

Major Axis ◽

Imaging Features ◽

Peritumoral Edema ◽

Brainstem Tumor ◽

Fluid Attenuated Inversion Recovery ◽

The Difference ◽

Skull Base Meningiomas

Background Peritumoral edema (PTE) is rarely present in patients with vestibular schwannomas (VS). We studied the correlation between radiological tumor characteristics and the presence of edema, describe its magnetic resonance imaging features and classify the different edema patterns. Methods We analysed 605 consecutive patients treated for VS at our Institute. PTE was found in 30 patients, studied on fluid attenuated inversion recovery sequences and categorised as involving the brachium pontis, cerebellum and/or brainstem. Tumor volume, shape, surface, internal structure and axis of growth were evaluated and compared to a matched series of 30 patients without PTE. Results In our population of patients, 5% showed PTE. Edema involved the brachium pontis in 22 cases (88%), cerebellum in 15 (60%) and brainstem in 3 (12%). PTE was classified as mild (one region involved), moderate (two regions) and severe (three regions). Edema was present not only perpendicular to the major tumor growth axis but also parallel to it (91%). The difference between the two groups in regards to tumor shape and surface was not significant. We found no correlation between tumor and edema volumes. Conclusions VS can cause PTE, but its incidence is less frequent than in skull base meningiomas. PTE involves most frequently the brachium pontis, followed by the cerebellum and brainstem. Its occurrence correlates with tumor size but not with other radiological VS features. PTE is not always located perpendicular to the major axis of tumor growth, which indicated that the compressive theory proposed for meningiomas is not plausible explanation for its manifestation.

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Long-term tumor control and cranial nerve outcomes following Gamma Knife surgery for larger-volume vestibular schwannomas

Journal of Neurosurgery ◽

10.3171/2011.11.jns11811 ◽

2012 ◽

Vol 116 (3) ◽

pp. 598-604 ◽

Cited By ~ 56

Author(s):

Brian D. Milligan ◽

Bruce E. Pollock ◽

Robert L. Foote ◽

Michael J. Link

Keyword(s):

Posterior Fossa ◽

Gamma Knife ◽

Cranial Nerve ◽

Tumor Volume ◽

Gamma Knife Surgery ◽

Tumor Control ◽

Tumor Diameter ◽

Tumor Margin ◽

Median Maximum

Object Gamma Knife surgery (GKS) for vestibular schwannoma (VS) is an accepted treatment for small- to medium-sized tumors, generally smaller than 2.5 cm in the maximum posterior fossa dimension. The purpose of this study was to evaluate the efficacy and toxicity of GKS for larger tumors. Methods Prospectively collected data were analyzed for 22 patients who had undergone GKS for VSs larger than 2.5 cm in the posterior fossa diameter between 1997 and 2006. No patient had symptomatic brainstem compression at the time of GKS. The median treated tumor volume was 9.4 cm3 (range 5.3–19.1 cm3). The median maximum posterior fossa diameter was 2.8 cm (range 2.5–3.8 cm). The median tumor margin dose was 12 Gy (range 12–14 Gy). Serial imaging, audiometry (10 patients with serviceable hearing pre-GKS), and clinical follow-up were available for a median of 66 months (range 26–121 months). Tumor control failure was defined as either a progressive increase in tumor diameter of at least 2 mm in any dimension or a later resection. Results Four patients met the criteria for GKS failure, including 1 patient who demonstrated sarcomatous degeneration more than 7 years after GKS and died 3 months after microsurgical debulking. An enlarging cystic component was the surgical indication in 1 of the 2 patients who required resection, although 27% of tumors (6 lesions) were cystic before GKS. The 3-year actuarial rate of tumor control, freedom from new facial neuropathy, and preservation of functional hearing were 86%, 92%, and 47%, respectively. At 5 years post-GKS, these rates decreased to 82%, 85%, and 28%, respectively. At the most recent follow-up, 91% of tumors were smaller than at the time of GKS and the median maximum posterior fossa diameter reduction was 26%. On multivariate analysis, none of the following factors was associated with GKS failure, new facial weakness, new trigeminal neuropathy, or loss of serviceable hearing: patient age, tumor volume, tumor margin dose, and preoperative cranial nerve dysfunction. Conclusions Single-session radiosurgery is a successful treatment for the majority of patients with larger VSs. Although tumor control rates are lower than those for smaller VSs managed with GKS, the cranial nerve morbidity of GKS is significantly lower than that typically achieved via resection of larger VSs.

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Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa

Journal of Neurosurgery ◽

10.3171/jns.1997.86.1.0040 ◽

1997 ◽

Vol 86 (1) ◽

pp. 40-47 ◽

Cited By ~ 367

Author(s):

Misao Nishikawa ◽

Hiroaki Sakamoto ◽

Akira Hakuba ◽

Naruhiko Nakanishi ◽

Yuichi Inoue

Keyword(s):

Posterior Fossa ◽

Medulla Oblongata ◽

Chiari Malformation ◽

Volume Ratio ◽

Basilar Invagination ◽

Posterior Cranial Fossa ◽

Control Group ◽

Adult Type ◽

Content Type ◽

Cranial Fossa

✓ To investigate overcrowding in the posterior cranial fossa as the pathogenesis of adult-type Chiari malformation, the authors studied the morphology of the brainstem and cerebellum within the posterior cranial fossa (neural structures consisting of the midbrain, pons, cerebellum, and medulla oblongata) as well as the base of the skull while taking into consideration their embryological development. Thirty patients with Chiari malformation and 50 normal control subjects were prospectively studied using neuroimaging. To estimate overcrowding, the authors used a “volume ratio” in which volume of the posterior fossa brain (consisting of the midbrain, pons, cerebellum, and medulla oblongata within the posterior cranial fossa) was placed in a ratio with the volume of the posterior fossa cranium encircled by bony and tentorial structures. Compared to the control group, in the Chiari group there was a significantly larger volume ratio, the two occipital enchondral parts (the exocciput and supraocciput) were significantly smaller, and the tentorium was pronouncedly steeper. There was no significant difference in the posterior fossa brain volume or in the axial lengths of the hindbrain (the brainstem and cerebellum). In six patients with basilar invagination the medulla oblongata was herniated, all three occipital enchondral parts (the basiocciput, exocciput, and supraocciput) were significantly smaller than in the control group, and the volume ratio was significantly larger than that in the Chiari group without basilar invagination. These results suggest that in adult-type Chiari malformation an underdeveloped occipital bone, possibly due to underdevelopment of the occipital somite originating from the paraxial mesoderm, induces overcrowding in the posterior cranial fossa, which contains the normally developed hindbrain. Basilar invagination is associated with a more severe downward herniation of the hindbrain due to the more severely underdeveloped occipital enchondrium, which further exacerbates overcrowding of the posterior cranial fossa.

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