scholarly journals Hydroxyurea for treatment of unresectable and recurrent meningiomas. II. Decrease in the size of meningiomas in patients treated with hydroxyurea

1997 ◽  
Vol 2 (4) ◽  
pp. E11
Author(s):  
Uwe M. H. Schrell ◽  
Michael G. Rittig ◽  
Marc Anders ◽  
Uwe H. Koch ◽  
Rolf Marschalek ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Cavernous Sinus ◽  
World Health ◽  
Tumor Growth Rate ◽  
Malignant Meningioma ◽  
Who Grade ◽  
Fourth Patient ◽  
Hydroxyurea Treatment ◽  
Long Term Treatment ◽  
The Right

In this paper the authors present the first evidence that meningiomas respond to treatment with hydroxyurea. Hydroxyurea was administered as an adjunct chemotherapeutic treatment in patients with recurrent and unresectable meningiomas. Hydroxyurea was used because experimental data demonstrated that it inhibits growth of cultured human meningioma cells and meningioma transplants in nude mice by inducing apoptosis. The authors therefore treated four selected patients with hydroxyurea. All patients had undergone multiple gross resections and all except one received radiotherapy. Three patients with recurrent Grade I meningiomas assessed according to World Health Organization (WHO) guidelines received hydroxyurea because of an increased tumor growth rate, documented by magnetic resonance (MR) imaging, within a 6- or 12-month interval. A fourth patient with a malignant meningioma (WHO Grade III) began a course of treatment with hydroxyurea immediately after his sixth palliative operation without waiting for another relapse to be demonstrated on MR imaging. Because of their location and invasive growth behavior none of the meningiomas could have been removed completely by surgical intervention. All patients received hydroxyurea at a dosage level of 1000 to 1500 mg/day (approximately 20 mg/kg/day). In a man with a large sphenoid wing meningioma invading the right cavernous sinus and the temporal base, the intracranial tumor mass was reduced by 60% during 6 months of treatment. A woman with a large ball-shaped meningioma of the right sphenoid wing invading the cavernous sinus exhibited a 74% decrease of the initial tumor volume in 10 months of treatment with oral hydroxyurea. Serial MR images obtained monthly revealed that the process of size reduction was continuous and proportionate. The shrinkage of the tumor was accompanied by a complete remission of symptomatic trigeminal neuralgia after 2 months and by improved abducent paresis after 5 months. The third patient had a slowly growing meningioma that exhibited a 15% reduction in mass when reassessed after 5 months of hydroxyurea treatment. The fourth patient with the malignant meningioma in the left cerebellopontine angle has had no recurrence for 24 months. Long-term treatment with hydroxyurea may result in full remission of tumors in meningioma patients. The preliminary data indicate that hydroxyurea provides true medical treatment in patients with unresectable and recurrent meningiomas, replacing palliative surgery and radiotherapy in the management of this disease.

Hydroxyurea for treatment of unresectable and recurrent meningiomas. II. Decrease in the size of meningiomas in patients treated with hydroxyurea

1997 ◽  
Vol 86 (5) ◽  
pp. 840-844 ◽  
Author(s):  
Uwe M. H. Schrell ◽  
Michael G. Rittig ◽  
Marc Anders ◽  
Uwe H. Koch ◽  
Rolf Marschalek ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Cavernous Sinus ◽  
World Health ◽  
Malignant Meningioma ◽  
Who Grade ◽  
Content Type ◽  
Fourth Patient ◽  
Long Term Treatment ◽  
The Right ◽  
Fine Print

✓ In this paper the authors present the first evidence that meningiomas respond to treatment with hydroxyurea. Hydroxyurea was administered as an adjunct chemotherapeutic treatment in patients with recurrent and unresectable meningiomas. Hydroxyurea was used because experimental data demonstrated that it inhibits growth of cultured human meningioma cells and meningioma transplants in nude mice by inducing apoptosis. The authors therefore treated four selected patients with hydroxyurea. All patients had undergone multiple gross resections and all except one received radio-therapy. Three patients with recurrent Grade I meningiomas assessed according to World Health Organization (WHO) guidelines received hydroxyurea because of an increased tumor growth rate, documented by magnetic resonance (MR) imaging, within a 6- or 12-month interval. A fourth patient with a malignant meningioma (WHO Grade III) began a course of treatment with hydroxyurea immediately after his sixth palliative operation without waiting for another relapse to be demonstrated on MR imaging. Because of their location and invasive growth behavior none of the meningiomas could have been removed completely by surgical intervention. All patients received hydroxyurea at a dosage level of 1000 to 1500 mg/day (approximately 20 mg/kg/day). In a man with a large sphenoid wing meningioma invading the right cavernous sinus and the temporal base, the intracranial tumor mass was reduced by 60% during 6 months of treatment. A woman with a large ball-shaped meningioma of the right sphenoid wing invading the cavernous sinus exhibited a 74% decrease of the initial tumor volume in 10 months of treatment with oral hydroxyurea. Serial MR images obtained monthly revealed that the process of size reduction was continuous and proportionate. The shrinkage of the tumor was accompanied by a complete remission of symptomatic trigeminal neuralgia after 2 months and by improved abducent paresis after 5 months. The third patient had a slowly growing meningioma that exhibited a 15% reduction in mass when reassessed after 5 months of hydroxyurea treatment. The fourth patient with the malignant meningioma in the left cerebellopontine angle has had no recurrence for 24 months. Long-term treatment with hydroxyurea may result in full remission of tumors in meningioma patients. The preliminary data indicate that hydroxyurea provides true medical treatment in patients with unresectable and recurrent meningiomas, replacing palliative surgery and radiotherapy in the management of this disease.

scholarly journals Transcavernous Resection of an Upper Clival Chondrosarcoma: “Cavernous Sinus as a Route”: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Walid Ibn Essayed ◽  
Michael A Mooney ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
World Health ◽  
Petrous Apex ◽  
Who Grade ◽  
Interpeduncular Cistern ◽  
Health Organization ◽  
Multimodality Image ◽  
The Right ◽  
Total Tumor Removal

Abstract Complete resection of skull base chondrosarcomas offers the potential for a durable, or even lifelong, cure and is best achieved at the first surgery.1,2 When a skull base chondrosarcoma is located at the upper clivus and in the interpeduncular cistern and invading laterally toward the petrous apex and cavernous sinus, the traditional approaches, ie, endonasal endoscopic or middle fossa approaches, are not adequate for the exposure and resection. The transcavernous sinus approach has been utilized to remove tumor from the cavernous sinus and as a corridor to the interpeduncular cistern and upper clivus, originally described for the clipping of basilar apex aneurysms.  We present a case of a chondrosarcoma centered in the upper clivus and eroding the right posterior clinoid, analogous to the location of a giant basilar apex aneurysm. Detailed study of the tumor extension, bony invasion, and relationship with neuroanatomy dictated the most effective surgical approach.3,4  Neuronavigation and intraoperative magnetic resonance imaging (MRI) facilitated the gross total resection of the tumor in the Advanced Multimodality Image-Guided Operating (AMIGO) suite. Achieving a gross total tumor removal of this World Health Organization (WHO) grade I chondrosarcoma, adjuvant irradiation can be withheld1 and the patient monitored with serial imaging. The patient did well after the surgery. The patient consented for surgery and the use of photography.

scholarly journals Extracerebral Pterional Metastasis from Malignant Meningioma: A Case Report

2021 ◽  
Author(s):  
Edmundo Luís Rodrigues Pereira ◽  
Diego Arthur Castro Cabral ◽  
Fernanda Myllena Sousa Campos
Keyword(s):  
Distant Metastases ◽  
World Health ◽  
Malignant Meningioma ◽  
Benign Meningioma ◽  
Who Grade ◽  
History Of ◽  
Health Organization ◽  
The Right ◽  
Who Grade Iii ◽  
Grade Iii

AbstractAnaplastic or malignant meningiomas that are classified as World Health Organization (WHO) grade III account for less than 1% of all meningiomas diagnosed. Despite the aggressive course, distant metastases are a rarity, occurring in only 0.1% to 0.2% of cases. We report the case of a 56-year-old woman who presented with parasagittal benign meningioma that underwent malignant transformation along with metastasis into the right orbitosphenoid region. The clinical, radiological, and histopathological aspects are highlighted, with an emphasis on the natural history of meningiomas.

scholarly journals Role of Extradural Clinoidectomy and Optic Unroofing in Resection of an Anterior Clinoidal Meningioma with Encasement of the Internal Carotid Artery and Its Branches

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Zhaoliang Sun ◽  
Emel Avci ◽  
Mustafa K. Başkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Vision Loss ◽  
Internal Carotid ◽  
Extent Of Resection ◽  
World Health ◽  
Who Grade ◽  
The Right ◽  
Supraclinoid Internal Carotid Artery

AbstractAnterior clinoidal meningiomas (ACMs) remain a major neurosurgical challenge. The skull base techniques, including extradural clinoidectomy and optic unroofing performed at the early stage of surgery, provide advantages for improving the extent of resection, and thereby enhancing overall outcome, and particularly visual function. Additionally, when the anterior clinoidal meningiomas encase neurovascular structures, particularly the supraclinoid internal carotid artery and its branches, this further increases morbidity and decreases the extent of resection. Although it might be possible to remove the tumor from the artery wall despite complete encasement or narrowing, the decision of whether the tumor can be safely separated from the arterial wall ultimately must be made intraoperatively.The patient is a 75-year-old woman with right-sided progressive vision loss. In the neurological examination, she only had light perception in the right eye without any visual acuity or peripheral loss in the left eye. MRI showed a homogeneously enhancing right-sided anterior clinoidal mass with encasing and narrowing of the supraclinoid internal carotid artery (ICA). Computed tomography (CT) angiography showed a mild narrowing of the right supraclinoid ICA with associated a 360-degree encasement. The decision was made to proceed using a pterional approach with extradural anterior clinoidectomy and optic unroofing. The surgery and postoperative course were uneventful. MRI confirmed gross total resection (Figs. 1 and 2). The histopathology was a meningothelial meningioma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence and has shown improved vision at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/vt3o1c2o8Z0

scholarly journals Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Emel Avci ◽  
Burak Ozaydin ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Mass Effect ◽  
World Health ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Total Resection ◽  
Who Grade ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare nerve sheet tumors that represent the second most common intracranial site of occurrence after vestibular nerve origins. Microsurgical resection of giant dumbbell-shaped trigeminal schwannomas often requires complex skull base approaches. The extradural transcavernous approach is effective for the resection of these giant tumors involving the cavernous sinus.The patient is a 72-year-old man with headache, dizziness, imbalance, and cognitive decline. Neurological examination revealed left-sided sixth nerve palsy, a diminished corneal reflex, and wasting of temporalis muscle. Magnetic resonance imaging (MRI) showed a giant homogeneously enhancing dumbbell-shaped extra-axial mass centered within the left cavernous sinus, Meckel's cave, and the petrous apex, with extension to the cerebellopontine angle. There was a significant mass effect on the brain stem causing hydrocephalus. Computed tomography (CT) scan showed erosion of the petrous apex resulting in partial anterior autopetrosectomy (Figs. 1 and 2).The decision was made to proceed with tumor resection using a transcavernous approach. Gross total resection was achieved. The surgery and postoperative course were uneventful, and the patient woke up the same as in the preoperative period. MRI confirmed gross total resection of the tumor. The histopathology was a trigeminal schwannoma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/TMK5363836M

scholarly journals Imaging and Histopathologic Nuances of Epithelioid Glioblastoma

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Brian H. Le ◽  
Richard A. Close
Keyword(s):  
Mass Effect ◽  
Clonic Seizure ◽  
Cystic Mass ◽  
Braf V600e ◽  
World Health ◽  
Significant Past Medical History ◽  
Who Grade ◽  
Epithelioid Glioblastoma ◽  
Health Organization ◽  
The Right

A 27-year-old male without significant past medical history presented following collapse resulting from a syncopal episode at work. There was an episode of vomiting, and one of tonic-clonic seizure activity, which was spontaneously resolved after approximately one minute. His neurologic exam was nonfocal, with full strength in the bilateral upper and lower extremities, and no sensory deficits were elicited. MRI studies demonstrated a 4.7 cm rim-enhancing cystic mass in the right temporal-parietal region, with resultant mass effect and edema. At surgery, intraoperative pathologic consultation favoured a primary glial neoplasm. Subsequent complete histologic examination on permanent sections confirmed the presence of glioblastoma, with a morphologic pattern and immunohistochemical profile most consistent with epithelioid glioblastoma (WHO grade IV). Epithelioid glioblastoma is a rare, especially aggressive variant of IDH-wildtype glioblastoma, recognized in the 2016 World Health Organization classification. Approximately 50% of such tumors harbour the BRAF V600E mutation, which has also been observed in some melanomas where selective inhibitors have demonstrated a therapeutic role. The especially aggressive behaviour and poor clinical outcome typically observed for this variant of glioblastoma demonstrate the importance of emerging areas relevant to neurooncology, specifically those of proteomic characterization and therapeutic nanomedicine.

scholarly journals Combined Transcavernous and Kawase's Approach for Gross Total Resection of a Cavernous Sinus Meningioma

2021 ◽  
Author(s):  
Walid Elshamy ◽  
Burak Ozaydin ◽  
G. Mark Pyle ◽  
Mustafa K. Baskaya
Keyword(s):  
Cavernous Sinus ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
World Health ◽  
Gross Total Resection ◽  
Surgical Removal ◽  
Total Resection ◽  
Meckel’S Cave ◽  
Who Grade ◽  
Meckel's Cave

AbstractMicrosurgery of cavernous sinus (CS) lesions is generally considered to be associated with a high rate of morbidity and cranial nerve deficits. The success for surgical removal of CS meningiomas is debatable and achieving a good functional outcome with preservation of the cranial nerves is the goal. Surgery of these lesions is challenging, recurrence rates are high, and therapeutic strategies remain controversial. In this video, we present a case of a CS meningioma that extended to Meckel's cave and the posterior fossa in a 46-year-old woman with history of a left-sided cerebellopontine angle World Health Organization (WHO) grade-I meningioma with extension to the left CS. Seven years ago, she had a microsurgical resection of a Cerebellopontine angle (CPA) meningioma. She later received radiotherapy for the slowly growing meningioma of the posterior CS. The patient presented with newly onset headache and facial pain. Magnetic resonance imaging (MRI) showed a meningioma of the left CS and Meckel's cave extending into the ambient cistern, with a mild mass effect on the pons, and a size increase compared with prior imaging. Since this area previously received radiotherapy, and the patient was symptomatic from trigeminal compression, the decision was made to proceed with surgical resection of the tumor via combined transcavernous and anterior petrosectomy. Postoperatively, the patient woke up with the same neurological status. MRI confirmed gross total resection of the tumor. The histopathology was a WHO grade-II chordoid meningioma. The patient is currently receiving radiotherapy. This video demonstrates the surgical approach and the resection steps of this pathology.The link to the video can be found at: https://youtu.be/HrU1VOzUGWU.

scholarly journals Transcranial magnetic stimulation language mapping analysis revisited: Machine learning classification of 90 patients reveals distinct reorganization pattern in aphasic patients

2020 ◽  
Author(s):  
Ziqian Wang ◽  
Lucius Fekonja ◽  
Felix Dreyer ◽  
Peter Vajkoczy ◽  
Thomas Picht
Keyword(s):  
Machine Learning ◽  
Inferior Frontal Gyrus ◽  
Univariate Analysis ◽  
World Health ◽  
Support Vector ◽  
Who Grade ◽  
Machine Learning Classification ◽  
Svm Model ◽  
The Right ◽  
Language Network

AbstractRepetitive TMS (rTMS) allows to non-invasively and transiently disrupt local neuronal functioning. Its potential for mapping of language function is currently explored. Given the inter-individual heterogeneity of tumor impact on the language network and resulting rTMS derived functional mapping, we propose to use machine learning strategies to classify potential patterns of functional reorganization. We retrospectively included 90 patients with left perisylvian glioma tumors, world health organization (WHO) grade II-IV, affecting the language network. All patients underwent navigated rTMS language mappings. The severity of aphasia was assessed preoperatively using the Berlin Aphasia Score (BAS), which is adapted to the Aachener Aphasia Test (AAT). After spatial normalization to MNI 152 of all rTMS spots, we calculated the error rate (ER) in each cortical area by automated anatomical labeling parcellation (AAL) and used support vector machine (SVM) as a classifier for significant areas in relation to aphasia. 29 of 90 (32.2%) patients suffered from aphasia. Univariate analysis revealed 11 perisylvian AVOIs’ ERs (eight left, three right hemispheric) that were significantly higher in the aphasic than non-aphasic group (p < 0.05), depicting a broad, bihemispheric language network. After feeding the significant AVOIs into the SVM model, it showed that additional to age (w = 2.95), the ERs of right Frontal_Inf_Tri (w = 2.06) and left SupraMarginal (w = 2.05) and Parietal_Inf (w= 1.80) contributed more than other features to the model. The model’s sensitivity was 89.7%, the specificity was 82.0%, the overall accuracy was 81.1% and AUC was 88.7%. Our results demonstrate an increased vulnerability of the right inferior frontal gyrus to rTMS in patients suffering from aphasia due to left perisylvian gliomas. This confirms a functional relevant involvement of the right frontal area in relation to aphasia. While age as a feature improved our SVM model the most, the tumor location feature didn’t affect the SVM model. This finding indicates that general tumor induced network disconnection is relevant to aphasia and not necessarily related to specific lesion locations. Additionally, our results emphasize the decreasing potential for neuroplasticity with age.

scholarly journals Chondrosarcoma of Cranial Vault: Case Report and Review of Literature

2021 ◽  
Vol 7 (2) ◽  
pp. 119-124
Author(s):  
Keshav Mishra ◽  
◽  
Somnath Sharma ◽  
Devendra K. Purohit ◽  
Arpita Jindal ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
Primary Treatment ◽  
Cranial Vault ◽  
World Health ◽  
Unusual Site ◽  
Who Grade ◽  
Skull Vault ◽  
Well Differentiated ◽  
Health Organization ◽  
The Right

Background and Importance: Chondrosarcoma is a rare malignant cartilage forming tumor, usually arising from long bones and rarely observed in the cranium. In the cranium, it commonly arises from the skull base with the skull vault being a highly unusual site. Case Presentation: We present the case of a 30-year female presenting with complaints of headache for 6 months. The patient was found to have large chondrosarcoma in the right frontoparietal region, which is an extremely rare location. The final diagnosis was based on histological examination, suggestive of well-differentiated chondrosarcoma [the World Health Organization (WHO); grade I]. Conclusion: Cranial vault chondrosarcoma is an uncommon histological diagnosis with surgery as the primary treatment option; however, adjuvant radiotherapy plays a definitive role, especially in aggressive or incomplete removed cases.

scholarly journals Imaging growth as a predictor of grade of malignancy and aggressiveness of IDH-mutant and 1p/19q-codeleted oligodendrogliomas in adults

2020 ◽  
Vol 22 (7) ◽  
pp. 993-1005 ◽  
Author(s):  
Alexandre Roux ◽  
Arnault Tauziede-Espariat ◽  
Marc Zanello ◽  
Sophie Peeters ◽  
Gilles Zah-Bi ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Growth Rates ◽  
Progression Free Survival ◽  
World Health ◽  
Tumor Growth Rate ◽  
Who Grade ◽  
Spontaneous Tumor ◽  
Grade Ii ◽  
Grade Iii

Abstract Background We quantified the spontaneous imaging growth rate of oligodendrogliomas. We assessed whether (i) it discriminates between World Health Organization (WHO) grade II and grade III oligodendrogliomas, and (ii) grade III oligodendrogliomas with neo-angiogenesis are associated with more fast growth rates (≥8 mm/y). Methods This work employed a retrospective bicentric cohort study (2010–2016) of adult patients harboring a newly diagnosed supratentorial oligodendroglioma, isocitrate dehydrogenase (IDH) mutant and 1p/19q codeleted (WHO 2016 classification), with a minimum of 2 available MRIs before any treatment (minimum 6-week interval) to measure the spontaneous tumor growth rate. Results We included 108 patients (age 44.7 ± 14.1 y, 60 males). The tumor growth rate was higher in grade III oligodendrogliomas with neo-angiogenesis (n = 37, median 10.4 mm/y, mean 10.0 ± 6.9) than in grade III oligodendrogliomas with increased mitosis count only (cutoff ≥6 mitoses, n = 18, median 3.9 mm/y, mean 4.5 ± 3.2; P = 0.004), and higher than in grade II oligodendrogliomas (n = 53, median 2.3 mm/y, mean 2.8 ± 2.2; P &lt; 0.001). There was increased prevalence of fast tumor growth rates in grade III oligodendrogliomas with neo-angiogenesis (54.1%) compared with grade III oligodendrogliomas with increased mitosis count only (11.1%; P &lt; 0.001), and in grade II oligodendrogliomas (0.0%; P &lt; 0.001). The tumor growth rate trends did not differ between centers (P = 0.121). Neo-angiogenesis (P &lt; 0.001) and mitosis count at ≥9 (P = 0.013) were independently associated with tumor growth rates ≥8 mm/year. A tumor growth rate ≥8 mm/year was the only predictor independently associated with shorter progression-free survival (P = 0.041). Conclusions The spontaneous tumor growth rate recapitulates oligodendroglioma aggressiveness, permits identification of grade III oligodendrogliomas preoperatively when ≥8 mm/year, and questions the grading by mitosis count.

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