EVALUATION OF RADIOLOGICAL FEATURES AND TUMOUR CHARACTERISTICS AND THEIR SIGNIFICANCE IN OUTOME OF INTRACRANIAL MENINGIOMAS

2021 ◽  
pp. 14-17
Author(s):  
Wajid Nazir Wani ◽  
Heena Samad ◽  
Shaam Bodeliwala
Keyword(s):  
Preoperative Evaluation ◽  
Intracranial Meningioma ◽  
Main Mode ◽  
Radiological Features ◽  
Good Outcome ◽  
Time To Recurrence ◽  
Transitional Type ◽  
Histological Variant ◽  
Tumour Characteristics ◽  
Neurosurgical Techniques

Meningioma is one of the most common intracranial tumours. Several advancements have been made for establishing the etiopathogenesis of meningiomas, including gene mutation and DNA methylation. Many factors have been found to be associated with tumour grade, time to recurrence, overall survival and prognosis. Today, with the availability of detailed radiological assessment and better micro neurosurgical techniques, the outcome has improved signicantly. This study is aimed at evaluating detailed radiological features of meningiomas along with its characteristics like vascularity, adhesiveness and edema and to determine their signicance in outcome. SUMMARY: Meningioma is amongst the most common brain tumours. Several factors have been found to be associated with its origin, growth, grade, time to recurrence, outcome and overall prognosis. This prospective evaluation of 68 consecutive patients of intracranial meningioma was aimed at evaluating their detailed radiological features along with tumour characteristics like vascularity, adhesiveness and edema and to determine their signicance in outcome. Our study showed MRI was most useful tool for preoperative evaluation of tumour characteristics like edema, vascularity and adhesiveness which guide surgical outcome. Less vascular and adhesive tumours had good outcome as compared to highly vascular and strongly adhesive tumours. Size of tumour too was associated with outcome. In our study, all patients (100%) of grade 0 tumour removal had good outcome which was statistically highly signicant (p<0.01). Most common histological variant was transitional type. We advocate aggressive surgical therapy as the primary and main mode of treatment in relation to the preoperative characteristics and features from imaging studies.

Radiation Therapy in the Treatment of Partially Resected Meningiomas

Neurosurgery ◽  
1987 ◽  
Vol 20 (4) ◽  
pp. 525-528 ◽  
Author(s):  
Nicholas M. Barbaro ◽  
Philip H. Gutin ◽  
Charles B. Wilson ◽  
Glenn E. Sheline ◽  
Edwin B. Boldrey ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
San Francisco ◽  
Tumor Location ◽  
Convincing Evidence ◽  
Subtotal Resection ◽  
Intracranial Meningioma ◽  
Total Resection ◽  
Female Ratio ◽  
Time To Recurrence ◽  
Male Female Ratio

Abstract To address the question of whether radiation therapy is beneficial in the management of partially resected meningiomas, we reviewed the records of all patients admitted to the University of California, San Francisco, between 1968 and 1978 who had a diagnosis of intracranial meningioma. The patients were divided into three groups: 51 patients had gross total resection and did not receive radiation therapy, 30 patients had subtotal resection and no radiation therapy, and 54 patients had subtotal resection followed by radiation therapy. The subtotal resection groups were similar in average age, male: female ratio, and tumor location, which allowed a valid comparison of the effects of irradiation. The recurrence rate in the total resection group was 4% (2 of 51 patients). Among patients in the subtotal resection groups, 60% of nonirradiated patients had a recurrence, compared with only 32% of the irradiated patients. The median time to recurrence was significantly longer in the irradiated group than in the nonirradiated group (125 vs. 66 months, P &lt; 0.05). There was no complication related to irradiation. These results provide convincing evidence that radiation therapy is beneficial in the treatment of partially resected meningiomas.

The Ki-67 Proliferation Index as a Marker of Time to Recurrence in Intracranial Meningioma

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S58-S58
Author(s):  
Christian Mirian ◽  
Simon Skyrman ◽  
Jiri Bartek ◽  
Lasse Rehné Jensen ◽  
Lars Kihlström ◽  
...  
Keyword(s):  
Proliferation Index ◽  
Intracranial Meningioma ◽  
Ki 67 ◽  
Time To Recurrence

scholarly journals Meningioma MRI radiomics and machine learning: systematic review, quality score assessment, and meta-analysis

2021 ◽  
Author(s):  
Lorenzo Ugga ◽  
Teresa Perillo ◽  
Renato Cuocolo ◽  
Arnaldo Stanzione ◽  
Valeria Romeo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Preoperative Evaluation ◽  
Brain Mri ◽  
Quality Score ◽  
Intracranial Meningioma ◽  
Machine Learning Applications ◽  
Year 2000

Abstract Purpose To systematically review and evaluate the methodological quality of studies using radiomics for diagnostic and predictive purposes in patients with intracranial meningioma. To perform a meta-analysis of machine learning studies for the prediction of intracranial meningioma grading from pre-operative brain MRI. Methods Articles published from the year 2000 on radiomics and machine learning applications in brain imaging of meningioma patients were included. Their methodological quality was assessed by three readers with the radiomics quality score, using the intra-class correlation coefficient (ICC) to evaluate inter-reader reproducibility. A meta-analysis of machine learning studies for the preoperative evaluation of meningioma grading was performed and their risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool. Results In all, 23 studies were included in the systematic review, 8 of which were suitable for the meta-analysis. Total (possible range, −8 to 36) and percentage radiomics quality scores were respectively 6.96 ± 4.86 and 19 ± 13% with a moderate to good inter-reader reproducibility (ICC = 0.75, 95% confidence intervals, 95%CI = 0.54–0.88). The meta-analysis showed an overall AUC of 0.88 (95%CI = 0.84–0.93) with a standard error of 0.02. Conclusions Machine learning and radiomics have been proposed for multiple applications in the imaging of meningiomas, with promising results for preoperative lesion grading. However, future studies with adequate standardization and higher methodological quality are required prior to their introduction in clinical practice.

Patterns of recurrence in patients receiving conformal radiation for intracranial meningioma: a single-institution experience

2020 ◽  
pp. 1-7
Author(s):  
B. Rajkrishna ◽  
Balakrishnan Rajesh ◽  
Sebastian Patricia ◽  
B. Selvamani
Keyword(s):  
Conformal Radiotherapy ◽  
Target Volume ◽  
Tumour Resection ◽  
Subtotal Resection ◽  
Intracranial Meningioma ◽  
Who Grade ◽  
Time To Recurrence ◽  
Grade 3 ◽  
Patterns Of Recurrence

Abstract Aim: To evaluate the patterns of recurrence following postoperative conformal radiotherapy (RT) for intracranial meningioma. Materials and methods: Eighty-six patients who received conformal RT for intracranial meningiomas from 2014 to 2017 were retrospectively analysed. For documented recurrences, recurrence imaging was deformably co-registered to planning CT scan. In-field recurrence was defined as recurrence within the 90% isodose line, and out-of-field recurrences were those that occurred outside the 90% isodose line. We present the demographic details, surgical and RT details, outcomes and patterns of recurrence. Results: The median age was 46 years (range 17–72); 82·6% underwent surgery [46·5% had subtotal resection (STR), 43·7% gross tumour resection (GTR), 5·6% biopsy] and 17·4% had no surgery. Among these, 53·5% were WHO grade 2; 27·9% grade 1; and 1·2% grade 3 meningioma. Fifty per cent received stereotactic RT (SRT), 46·5% 3D conformal RT (3DCRT) and 3·5% intensity-modulated RT (IMRT). The mean clinical target volume (CTV) and planning target volume (PTV) margins were 4·5 mm (range 0–15) and 3·9 mm (range 1–5), respectively. The doses ranged from 54 to 59·4 Gy. The median follow-up after RT was 1·7 years (range 0·2–4·7). 17·4% were lost to follow-up, 5·4% had recurrence, and the median time to recurrence after completion of RT was 2 years (range 0·7–2·9). The 3-year recurrence-free rate was 81·5%. Three patients had in-field and two had in-field and out-of-field recurrence. Among the cases with recurrence, three received SRT, one 3DCRT and one IMRT. Four were grade 2 and one was grade 3 tumour, and the CTV margin ranged from 0 to 5 mm, and the PTV margin ranged from 3 to 5 mm. Conclusion: Local recurrence was seen in grade 2 and 3 meningiomas. SRT probably had more recurrence as they had lesser CTV margin. Increased CTV margin, escalated dose up to 59·4 Gy and 3DCRT/IMRT may be helpful in preventing local recurrences in grade 2 and grade 3 meningiomas.

The Ki-67 Proliferation Index as a Marker of Time to Recurrence in Intracranial Meningioma

Neurosurgery ◽  
2020 ◽  
Author(s):  
Christian Mirian ◽  
Simon Skyrman ◽  
Jiri Bartek ◽  
Lasse Rehné Jensen ◽  
Lars Kihlström ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
De Novo ◽  
Proliferation Index ◽  
Intracranial Meningioma ◽  
Recurrence Rates ◽  
Ki 67 ◽  
Who Grade ◽  
Risk Of Recurrence ◽  
Time To Recurrence ◽  
Significant Difference

Abstract BACKGROUND There are examples of incongruence between the WHO grade and clinical course in meningioma patients. This incongruence between WHO grade and recurrence has led to search for other prognostic histological markers. OBJECTIVE To study the correlation between the Ki-67 proliferative index (PI), risk of recurrence, and recurrence rates in meningioma patients. METHODS We prospectively collected pathological diagnosis of de novo consecutive meningiomas. In total, we followed 159 patients with clinical controls until recurrence, death, or emigration. We estimated the correlation between risk of recurrence and Ki-67 PI when adjusted for age at diagnosis, sex, WHO grade, extent of surgical resection, and tumor location. We estimated the cumulative incidence of recurrence when considering death without recurrence a competing risk. We report recurrence rates per 100 person-years. RESULTS A 1%-point increase of Ki-67 PI yielded a hazard ratio of 1.12 (95% CI: 1.01-1.24) in a multivariate analysis. The cumulative incidence of recurrence was 3% for Ki-67 0% to 4% vs 19% for Ki-67 &gt; 4% meningiomas after 1 yr, but 24% vs 35%, respectively, after 10 yr. There was no significant difference in mean Ki-67 PI between nonrecurrent and recurrent meningioma in a 2-sample t-test (P = .08). The strongest relationship was detected between Ki-67 PI and time to recurrence: Ki-67 &lt; 4% meningiomas recurred after median 4.8 yr, compared to 0.60 to 0.75 yr for patients with higher Ki-67 PI. CONCLUSION Ki-67 PI was a marker for time to recurrence rather than a predictor of recurrence. Ki-67 PI may be utilized for patient tailored follow-up.

scholarly journals Cranial Meningiomas Requiring Cranioplasty

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv14-iv15
Author(s):  
Max Norrington ◽  
Christopher Millward ◽  
John Doherty ◽  
Mohammad Mustafa ◽  
Thomas Humphries ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Intracranial Meningioma ◽  
Who Grade ◽  
Patient Demographics ◽  
Included Patient ◽  
Grade Ii ◽  
Bone Infiltration ◽  
Materials Used ◽  
Intraosseous Meningioma ◽  
Tumour Characteristics

Abstract Aims Bone infiltration in association with intracranial meningioma (4.5% of cases) and primary intraosseous meningioma (2%) are rare. Management can be challenging, as cranial vault reconstruction may be required. This study aimed to examine the surgical techniques used and outcomes in this patient population. Method A single-centre, retrospective cohort study was conducted between January 2010 and September 2020. All adult patients who required cranial reconstruction due to bone involvement of their meningioma were included. Patient demographics, tumour characteristics, operative details, complications, and outcomes were examined. Statistical analyses were performed using SPSS v24.0. Results There were 30 patients (17 female; 56.7%), median age 54 yrs (range 28-86 yrs), of whom 25 (83.3%) had bone infiltration, and 5 (16.7%) had primary intraosseous meningioma. Only 10 patients had a Simpson I or II resection. Twenty-eight had 'on-table' primary cranioplasties. Materials used were titanium (n=13; 43.3%), acrylic (n=10; 33.3%), PMMA (n=5; 16.7%), and hydroxyapatite (n=2; 6.7%). There were 9 (mostly minor) surgical complications and only one wound infection. Twelve patients had WHO grade II tumours, and 14 required radiotherapy. Ten patients (33.3%) had re-operation for recurrent tumour, with a median time to progression of 41 months. At 6 months, 24 patients had a performance score less than 2. Conclusion On-table cranioplasty provides a lower risk surgical option for patients with high risk meningiomas.

Surgical Management of Patients With 22q11.2 Deletion Syndrome

2019 ◽  
Vol 4 (5) ◽  
pp. 857-869
Author(s):  
Oksana A. Jackson ◽  
Alison E. Kaye
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Surgical Decision ◽  
Obstructive Sleep ◽  
Spine Abnormalities ◽  
Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

Abstract #1100: Tumor Induced Osteomalacia: Clinical; Biochemical and Radiological Features from a Single Tertiary Care Centre with Emphasis on Functional Imaging.

2017 ◽  
Vol 23 ◽  
pp. 289
Author(s):  
Vineet Surana ◽  
Rajesh Khadgawat ◽  
Nikhil Tandon ◽  
Chandrashekhar Bal ◽  
Kandasamy Devasenathipathy
Keyword(s):  
Functional Imaging ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Radiological Features

Minimally Invasive Repair of Pectus Excavatum (MIRPE) - The Basel Experience

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 289-295 ◽  
Author(s):  
Haecker ◽  
Bielek ◽  
von Schweinitz
Keyword(s):  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Pulmonary Function Tests ◽  
Preoperative Evaluation ◽  
Skin Incision ◽  
Original Method ◽  
Restrictive Lung Disease ◽  
Cardiac Compression ◽  
Cardiac Evaluation ◽  
Indications For Operation

Purpose: Minimally invasive repair of pectus excavatum (MIRPE) was first reported in 1998 by D. Nuss. This technique has gained wide acceptance during the last 4-5 years. In the meantime, some modifications of the technique have been introduced by different authors. Our retrospective study reports our own experience over the last 36 months and modifications introduced due to a number of complications. Methods: From 3/2000 to 3/2003, 22 patients underwent MIRPE. Patients median age was 15.5 years (10.7 to 20.3 years). Standardised preoperative evaluation included 3D computerised tomography (CT) scan, pulmonary function tests, cardiac evaluation with electrocardiogram and echocardiography, and photo documentation. Indications for operation included at least two of the following: Haller CT index > 3.2, restrictive lung disease, cardiac compression, progression of the deformity and severe psychological alterations. Results: In 22 patients (2 girls, 20 boys) undergoing MIRPE procedure, a single bar was used in 21 patients and two bars in one boy. Lateral stabilisers were fixed with non resorbable sutures on both sides. Overall, postoperative complications occurred in six patients (27.3%). In two patients (9.1%) a redo-procedure was necessary due to bar displacement. An additional median skin incision was performed in two patients to elevate the sternum. Pneumothorax or hematothorax in two patients resulted in routine use of a chest tube on both sides. Long-term favourable results were noted in all patients. Conclusions: The MIRPE procedure is an effective method with elegant cosmetic results. Modifications of the original method help to decrease the complication rate and to accelerate acquirement of expertise.

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