Treatment of unresectable skull base meningiomas with somatostatin analogs

2011 ◽  
Vol 30 (5) ◽  
pp. E11 ◽  
Author(s):  
Chris Schulz ◽  
René Mathieu ◽  
Ulrich Kunz ◽  
Uwe Max Mauer
Keyword(s):  
Surgical Treatment ◽  
Mr Imaging ◽  
Skull Base ◽  
Somatostatin Analogs ◽  
Cranial Nerves ◽  
Insurance Company ◽  
Mr Images ◽  
Study Results ◽  
Skull Base Meningiomas ◽  
Tumor Enlargement

Object The standard surgical treatment for meningiomas is total resection, but the complete removal of skull base meningiomas can be difficult for several reasons. Thus, the management of certain meningiomas of the skull base—for example, those involving basal vessels and cranial nerves—remains a challenge. In recent reports it has been suggested that somatostatin (SST) administration can cause growth inhibition of unresectable and recurrent meningiomas. The application of SST and its analogs is not routinely integrated into standard treatment strategies for meningiomas, and clinical studies proving growth-inhibiting effects do not exist. The authors report on their experience using octreotide in patients with recurrent or unresectable meningiomas of the skull base. Methods Between January 1996 and December 2010, 13 patients harboring a progressive residual meningioma (as indicated by MR imaging criteria) following operative therapy were treated with a monthly injection of the SST analog octreotide (Sandostatin LAR [long-acting repeatable] 30 mg, Novartis). Eight of 13 patients had a meningioma of the skull base and were analyzed in the present study. Postoperative tumor enlargement was documented in all patients on MR images obtained before the initiation of SST therapy. All tumors were benign. No patient received radiation or chemotherapy before treatment with SST. The growth of residual tumor was monitored by MR imaging every 12 months. Results Three of the 8 patients had undergone surgical treatment once; 3, 2 times; and 2, 3 times. The mean time after the last meningioma operation (before starting SST treatment) and tumor enlargement as indicated by MR imaging criteria was 24 months. A total of 643 monthly cycles of Sandostatin LAR were administered. Five of the 8 patients were on SST continuously and stabilized disease was documented on MR images obtained in these patients during treatment (median 115 months, range 48–180 months). Three of the 8 patients interrupted treatment: after 60 months in 1 case because of tumor progression, after 36 months in 1 case because of side effects, and after 36 months in 1 case because the health insurance company denied cost absorption. Conclusions Although no case of tumor regression was detected on MR imaging, the study results indicated that SST analogs can arrest the progression of unresectable or recurrent benign meningiomas of the skull base in some patients. It remains to be determined whether a controlled prospective clinical trial would be useful.

scholarly journals Image-Guided Multisession Radiosurgery of Skull Base Meningiomas

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3569
Author(s):  
Alfredo Conti ◽  
Antonio Pontoriero ◽  
Giuseppe Iatì ◽  
Salvatore M. Cardali ◽  
Anna Brogna ◽  
...  
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Cranial Nerves ◽  
Progression Free Survival ◽  
Motor Deficits ◽  
Intracranial Meningioma ◽  
Treatment Schedule ◽  
Fractionated Radiotherapy ◽  
Patient Reported ◽  
Skull Base Meningiomas

Background: The efficacy of single-session stereotactic radiosurgery (sSRS) for the treatment of intracranial meningioma is widely recognized. However, sSRS is not always feasible in cases of large tumors and those lying close to critically radiation-sensitive structures. When surgery is not recommended, multi-session stereotactic radiosurgery (mSRS) can be applied. Even so, the efficacy and best treatment schedule of mSRS are not yet established. The aim of this study is to validate the role of mSRS in the treatment of skull base meningiomas. Methods: A retrospective analysis of patients with skull base meningiomas treated with mSRS (two to five fractions) at the University of Messina, Italy, from 2008 to 2018, was conducted. Results: 156 patients met the inclusion criteria. The median follow-up period was 36.2 ± 29.3 months. Progression-free survival at 2-, 5-, and 10- years was 95%, 90%, and 80.8%, respectively. There were no new visual or motor deficits, nor cranial nerves impairments, excluding trigeminal neuralgia, which was reported by 5.7% of patients. One patient reported carotid occlusion and one developed brain edema. Conclusion: Multisession radiosurgery is an effective approach for skull base meningiomas. The long-term control is comparable to that obtained with conventionally-fractionated radiotherapy, while the toxicity rate is very limited.

scholarly journals Anterior skull base meningiomas: surgery related hypothalamic sequalae. How to avoid?

2018 ◽  
Vol 32 (1) ◽  
pp. 94-104
Author(s):  
Ashraf El Badry ◽  
Ahmed Nageeb Taha
Keyword(s):  
Surgical Technique ◽  
Skull Base ◽  
Cranial Nerves ◽  
Conformal Radiotherapy ◽  
Vascular Supply ◽  
Anterior Skull Base ◽  
Initial Surgery ◽  
Before And After ◽  
Hypothalamic Function ◽  
Skull Base Meningiomas

Abstract Introduction: Surgical: morbidities related to anterior skull base meningiomas are widely addressed in the literature and mostly related to tumor relations to cranial nerves and vascular structures in this challenging area. However; there is infrequent complications related to hypothalamic insult either from direct affection or via manipulation of vascular supply of this area. The aim of this study: is to address hypothalamic complications occurred after surgery for anterior skull base meningiomas, pitfalls in our surgical technique and the way to minimize such morbidities. Patients and methods: Retrospective study was conducted on all patients who did surgery for anterior skull base meningiomas in the neurosurgery department, Mansoura University during the period from 2011 to 2016. All the patients clinical and radiological data before and after surgery were analyzed. All patients who developed transient or permeant hypothalamic manifestation were included in this study and data regarding their tumor morphology, surgical technique and post-operative early and late imaging were assessed. Results: Among 93 patients who did surgery for anterior skull base meningiomas; 12 patients developed post-operative sequalae related to hypothalamic function. In 7 patients; tumor was recurrent and in 4 patients; conformal radiotherapy was given after the initial surgery. Complication was transient in 3 patients and permeant in 9 patients. 8 patients died from their hypothalamic sequalae. Early post-operative imaging showed hypothalamic infarction in 8 patients. Conclusion: Through reviewing these cases we can address the importance of many factors in the tumours especially size, morphology, recurrence who increase hypothalamic insults. Factors in surgery include preservation of arachnoid plain, perforators, meticulous dissection for minimize this complication.

Surgical Treatment of Skull Base Meningiomas: Risk Factors and Strategy of Treatment

Skull Base ◽  
2007 ◽  
Vol 16 (S 1) ◽  
Author(s):  
Yuri Aimi ◽  
Kiyoshi Saito ◽  
Takeshi Okada ◽  
Masahiro Ichikawa ◽  
Tetsuya Nagatani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Skull Base ◽  
Skull Base Meningiomas

Resection of a Posterior Fossa Endodermal Cyst With Exoscopic Assistance: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E173-E174
Author(s):  
Olena Kleshchova ◽  
Timothy Gerald White ◽  
Kevin Kwan ◽  
Amrit Chiluwal ◽  
Todd A Anderson ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Posterior Fossa ◽  
Cranial Nerves ◽  
Video Production ◽  
Neurenteric Cyst ◽  
Mr Images ◽  
Recommended Treatment ◽  
Facial Numbness ◽  
Endodermal Cyst ◽  
Upper Thoracic

Abstract Neurenteric cysts are rare benign congenital tumors of endodermal origin that most commonly occur in the cervical and upper thoracic spine, with only about 10% to 18% of the reported cases occurring intracranially.1 A definitive preoperative diagnosis is complicated by the variable appearance of neurenteric cysts on magnetic resonance (MR) imaging.2 The recommended treatment of neurenteric cysts is complete surgical resection when possible.3,4 We present a case of a posterior fossa neurenteric cyst. A 33-yr-old man without medical history presented with left-sided headache and mild left-sided facial numbness and weakness. Admission MR imaging revealed a nonenhancing mass, which was hyperintense on T1-weighted MR images, compressing the brainstem anteriorly. The lesion was isointense on T2 FLAIR images and hypointense on diffusion-weighted imaging, initially read as possible epidermoid cyst. The patient underwent a left-sided retrosigmoid craniotomy via far lateral transcondylar approach. The tumor was adjacent to both vertebral arteries, the left PICA, and cranial nerves (CN) VII-XII with superior extension to CN V. The cyst was encased in a thin capsule, and its contents were yellowish in color and ranged from thick liquid to colloidal and caseous consistency. The cyst also contained heavily calcified portions, which were excised using sharp dissection. Images of the cyst wall show that it is focally lined with ciliated columnar epithelium with intracellular mucin confirming an endodermal or neurenteric cyst. After the operation, the patient's symptoms resolved, and he was discharged on postoperative day 4. Postoperative MR images confirmed gross total resection. The patient consented to video production.

ABC Surgical Risk Scale for skull base meningioma: a new scoring system for predicting the extent of tumor removal and neurological outcome

2009 ◽  
Vol 111 (5) ◽  
pp. 1053-1061 ◽  
Author(s):  
Kazuhide Adachi ◽  
Takeshi Kawase ◽  
Kazunari Yoshida ◽  
Takahito Yazaki ◽  
Satoshi Onozuka
Keyword(s):  
Surgical Treatment ◽  
Skull Base ◽  
Scoring System ◽  
Predictive Accuracy ◽  
Cranial Nerves ◽  
Tumor Removal ◽  
Surgical Risk ◽  
Predictive Variables ◽  
Relative Risks ◽  
Risk Scale

Object Surgery for skull base meningiomas (SBMs) can lead to complications because these lesions are difficult to approach and can involve cranial nerves and arteries. The authors propose a scoring system to evaluate the relative risks and benefits of surgical treatment of SBMs. Methods The authors used a 2-step process to construct their scale. First, they derived significant predictive variables from retrospective data on 132 SBM cases treated surgically (primary surgeries only) between May 2000 and December 2005. Next, they validated the predictive accuracy of their scoring system in 60 consecutive cases treated surgically between January 1995 and April 2000, including both primary and repeated surgeries. Finally, they investigated the effect of the surgery on the patients' preoperative symptoms for consecutive cases treated surgically between January 1995 and December 2005, including both primary surgeries and retreatments. Results Five items that predicted surgical risk were identified: 1) tumor attachment size; 2) arterial involvement; 3) brainstem contact; 4) central cavity location; and 5) cranial nerve group involvement. The authors named their scoring system the ABC Surgical Risk Scale, after the initial letters of these items. Each factor was assigned a score of 0–2 points, and an additional point was added for previous surgical treatment or for radiation, giving a possible total score of 12 points. On average, the scoring system allocated 2 points for gross-total resections, 6.1 points for near-total resections, and 9 points for subtotal resections, with significant differences between groups. For cases scoring ≥ 8 points, the percentage of cases showing neurological deterioration postoperatively exceeded the percentage showing improvement. Conclusions The authors conclude that this scoring system can be used to predict the extent of tumor removal and that the scores reflect the surgical risk.

scholarly journals Introduction: surgical management of skull base meningiomas

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. Intro ◽  
Author(s):  
Gabriel Zada ◽  
Mustafa K Başkaya ◽  
Mitesh V. Shah
Keyword(s):  
Skull Base ◽  
Wide Spectrum ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Surgical Approaches ◽  
Cerebrospinal Fluid Leakage ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae ◽  
Skull Base Meningiomas

Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients. Skull base meningiomas represent some of the most challenging pathology encountered by neurosurgeons, on account of their depth, invasion, vascularity, texture/consistency, and their relationship to bony anatomy, cranial nerves, and blood vessels. Resection of complex skull base meningiomas often mandates adequate bony removal to achieve sufficient exposure of the tumor and surrounding region, in order to minimize brain retraction and optimally identify, protect, control, and manipulate sensitive neurovascular structures. A variety of traditional skull base approaches has evolved to address complex skull base tumors, of which meningiomas are considered the paragon in terms of both complexity and frequency.In this supplemental video issue of Neurosurgical Focus, contributing authors from around the world provide instructional narratives demonstrating resection of a variety of skull base meningiomas arising from traditionally challenging origins, including the clinoid processes, tuberculum sellae, dorsum sellae, petroclival region, falco-tentorial region, cerebellopontine angle, and foramen magnum. In addition, two cases of extended endoscopic endonasal approaches for tuberculum sellae and dorsum sellae meningiomas are presented, representing the latest evolution in accessing the skull base for selected tumors. Along with key pearls for safe tumor resection, an equally important component of open and endoscopic skull base operations for meningiomas addressed by the contributing authors is the reconstruction aspect, which must be performed meticulously to prevent delayed cerebrospinal fluid leakage and/or infections. This curated assortment of instructional videos represents the authors’ optimal treatment paradigms pertaining to the selection of approach, setup, exposure, and principles to guide tumor resection for a wide spectrum of complex meningiomas.

scholarly journals Skull base meningiomas: development of treatment methods

2021 ◽  
Vol 23 (3) ◽  
pp. 93-103
Author(s):  
S. E. Zuev ◽  
A. S. Tokarev
Keyword(s):  
Targeted Therapy ◽  
Surgical Treatment ◽  
Skull Base ◽  
Proton Therapy ◽  
Robotic Systems ◽  
Treatment Methods ◽  
Significant Events ◽  
Skull Base Meningiomas

The review describes the treatment methods for skull base meningiomas and promising modern trends in this area. The most significant events in the development of meningiomas’ surgical treatment are described. The current research and scientific approaches to the skull base meningiomas’ treatment are presented: medical robotic systems, targeted therapy, radiosurgery, and proton therapy.

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