Search Results (160)

Objective: To evaluate the outcomes of a modified infratemporal fossa approach (ITFA) that preserves the posterior external auditory canal (EAC) in patients with tumors in the infratemporal fossa and skull base, focusing on postoperative hearing and facial nerve function. Methods: This retrospective study included nine patients who underwent ITFA with posterior EAC preservation for tumor removal while minimizing facial nerve rerouting. All surgeries were performed by a single surgeon. Preoperative and postoperative hearing levels, facial nerve function, tumor characteristics, and surgical outcomes were analyzed. Air-bone gaps (ABG) were assessed using pure tone audiometry, and facial nerve function was assessed using the House–Brackmann grading system. Results: The cohort consisted of eight female patients and one male patient, with a mean tumor size of 3.0 cm. Surgical outcomes were promising, with no statistically significant increase in postoperative ABG and well-preserved facial nerve function. Only one patient developed postoperative grade II facial palsy. A residual tumor was identified in one case with extensive meningioma, which has remained stable, and no recurrence or regrowth was noted during the follow-up period (mean: 3.7 years). The modified approach minimized complications related to conductive hearing loss and facial nerve dysfunction. Conclusions: The modified ITFA with posterior EAC preservation provides a promising alternative to conventional ITFA for managing deep-seated tumors. It preserves both hearing and facial nerve function while ensuring adequate tumor resection. Full article

Extracranial metastases from meningiomas are extremely rare, with an incidence of <1%, and their prognosis is poor. Moreover, there is currently no gold standard for their treatment; therefore, the decision-making process is strictly dependent on multidisciplinary discussions. In this report, we describe the case of a 73-year-old patient who was diagnosed with a solitary lung metastasis more than 20 years after the initial treatment for a low-grade meningioma. Molecular characterization of this metastasis was performed using the Oncomine Comprehensive Assay Plus, which identified multiple functional mutations in the beta2-microglobulin (β2M) and ATM genes, both of which may contribute to immune evasion and genomic instability. A short overview of the literature is also reported. To our knowledge, no previous reports exist on single pulmonary metastasis from low-grade meningioma occurring more than 20 years after diagnosis. Full article

Background: The arcuate fasciculus (AF) is a critical white matter (WM) tract that connects key cortical language-processing regions, including the so-called Broca’s and Wernicke’s areas. The aim of the present study was to quantitatively assess its radiological–anatomical–morphometric modifications according to different brain tumor histotypes. Methods: A retrospective multicentric Italian study was conducted. AF reconstructions were calculated for both hemispheres for each patient diagnosed with glioblastoma (GBM), low-grade glioma (LGG), brain metastasis, and meningioma using Elements Fibertracking 2.0 software (Brainlab AG, Munich, Germany). A 3D object of each fascicle was evaluated for its volume, average fractional anisotropy (FA), and length. The cerebral healthy hemisphere was compared to the pathological contralateral in different tumor histotypes. Results: In total, 1294 patients were evaluated. A total of 156 met the inclusion criteria. We found a significant difference between healthy hemisphere and the contralateral for AF mean length and volume (p = 0.01 and p < 0.001, respectively). Considering separately the different tumor histotypes, the GBM subgroup (98, 63%) confirmed the results for mean FA and volume (p-value < 0.001); LGG patients (26, 17%) showed no significant difference between healthy and pathological hemisphere for AF mean length, mean FA, and volume (p-value 0.5, p-value 0.3, p-value <0.1, respectively). In patients affected by brain metastasis (18, 12%), Student’s t-test showed a significant difference for FA (p-value 0.003). No differences were found in patients affected by meningiomas (14, 9%) (14). Conclusions: Thorough knowledge of the microscopic anatomy and function of the arcuate fasciculus, as well as the pattern of growth of the different brain tumor histotypes, along with a careful preoperative neuroradiological assessment are mandatory to plan a tailored surgical strategy and perform a safe and effective surgical technique. The AF could be displaced and infiltrated/destructed by the solid component and peritumoral edema, respectively, of GBM. LGG shows a prevalent infiltrative pattern. Metastases account for AF dislocation due to peritumoral edema. Meningiomas do not affect WM anatomy. Full article

Background: Although meningiomas are typically solitary lesions, occasionally, two or more separate tumors can occur simultaneously or sequentially, in which case the terms “multiple meningiomas” (MM) or “meningiomatosis” are used. Aggressive meningiomatosis is a rare entity that can significantly influence survival rates and quality of life. Methods: The current article aims to report an interesting case of a 54-year-old Caucasian woman with aggressive meningiomatosis and no relevant familial history. The patient had a history of a left convexity frontal meningioma, resected in October 2023 and identified as a meningothelial meningioma, followed by a left convexity frontopolar meningioma, resected in May 2024 and identified as an anaplastic meningioma. Furthermore, while the first lesion rapidly recurred, an important change in the histopathological grade was observed, and a diagnosis of aggressive meningiomatosis was established. Results: The particularity of this case is given not only by the aggressive growth pattern but also by the different histopathological gradings of the meningiomas and the anaplastic transformation of the recurrence. Conclusions: Aggressive meningiomatosis is a challenging medical condition for which rigorous follow-up is mandatory throughout the lifespan. New tumors with different gradings and localizations can arise, and each must be treated as a new entity. The lack of therapeutic protocols in MM makes such case reports valuable, as they highlight the necessity of specific therapeutic recommendations. Full article

Background: Although various theories have been developed to explain ipsilateral hemiparesis, the causes behind this clinical phenomenon are still poorly understood. The main pathophysiological hypotheses include the anatomical variations in decussation of the corticospinal tract, the theory of diaschisis, the Kernohan-Woltman notch phenomenon, and Ectors’ syndrome. The current article aims to report the case of a 43-year-old woman diagnosed with ipsilateral hemiparesis following a right pterional meningioma, later treated by surgery. The different theories behind this paradoxical clinical phenomenon are discussed to elucidate the most likely mechanism behind it. Methods: A 43-year-old right-handed woman with a history of splenomegaly and iron deficiency anemia was admitted to our hospital for refractory headache, right-sided hemiparesis, and generalized tonic-clonic seizures. Clinical examination revealed a right upper motor neuron syndrome, with a grade 4 MRCS muscle strength for the upper and lower limbs. The contrast-enhanced brain MRI revealed an extra-axial right pterional mass lesion with a broad dural base, well-defined margins, and intense post-contrast enhancement, suggestive of meningioma. The patient was surgically treated for the brain lesion. Results: After a Simpson grade I resection with complete removal of the tumor and affected dura, the patient had a favorable local and neurological evolution, and after three weeks, total remission of the symptoms was achieved. Conclusions: To assess the mechanism behind ipsilateral hemiparesis, thorough clinical examination and further research in neuroimaging assessment and functional studies are essential. Full article

The aim of this research was to provide a comparative analysis of the major parameters of the blood lipid spectrum found both in the case of brain tumors and in atherosclerosis, as well as to assess the correlation of these indicators with the proliferative activity index Ki-67 in cells. Blood analyses were conducted on samples from 50 patients with brain tumors and 50 patients with cerebral atherosclerosis. Blood plasma from 50 essentially healthy people was used for controls. Significant differences were found in the parameter values between the atherosclerosis sufferers and the control group only for their ratios of neutral lipids to cholesterol. Of the short-chain fatty acids, butyric acid is of greatest interest due to the significant differences of its levels from the control group in the blood of both patients with meningiomas and of those with gliomas. Statistically significant correlation coefficients between the levels of the Ki-67 cell proliferation marker and, in particular, butyric acid were found when compared with the neutral lipids to cholesterol ratios. These identified parameters of the blood plasma lipid spectrum can be used for preoperative diagnostics of brain tumors. However, these ratios cannot be used as preoperative noninvasive predictors of the level of the Ki-67 mitotic index, as no significant differences corresponding to this were found for low-grade or for high-grade anaplasia of brain tumors. Full article

Meningiomas account for approximately 40% of all primary brain tumors, of which 1.5% are classified as grade 3. Whilst meningiomas are discovered on imaging with high-grade meningiomas being associated with certain imaging features, the final diagnosis is based on histopathology in combination with molecular markers. According to the latest World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS), grade 3 should be assigned based on criteria for anaplastic meningiomas, which comprise malignant cytomorphology (anaplasia) that resembles carcinoma, high-grade sarcoma or melanoma; elevated mitotic activity; a TERT promoter mutation and/or a homozygous CDKN2A and/or CDKN2B deletion. Surgery remains the mainstay treatment modality for grade 3 meningiomas, followed by radiotherapy. Limited data are available on the effect of stereotactic radiosurgery and systemic therapy for grade 3 meningiomas; however, studies are underway. Despite optimal treatment, the estimated recurrence rate ranges between 50% and 95% with a 5-year survival rate of 66% and a 10-year estimated survival rate of 14% to 24%. Full article

Accurate detection and diagnosis of brain tumors at early stages is significant for effective treatment. While numerous methods have been developed for tumor detection and classification, several rely on traditional techniques, often resulting in suboptimal performance. In contrast, AI-based deep learning techniques have shown promising results, consistently achieving high accuracy across various tumor types while maintaining model interpretability. Inspired by these advancements, this paper introduces an improved variant of EfficientNet for multi-grade brain tumor detection and classification, addressing the gap between performance and explainability. Our approach extends the capabilities of EfficientNet to classify four tumor types: glioma, meningioma, pituitary tumor, and non-tumor. For enhanced explainability, we incorporate gradient-weighted class activation mapping (Grad-CAM) to improve model interpretability. The input MRI images undergo data augmentation before being passed through the feature extraction phase, where the underlying tumor patterns are learned. Our model achieves an average accuracy of 98.6%, surpassing other state-of-the-art methods on standard datasets while maintaining a substantially reduced parameter count. Furthermore, the explainable AI (XAI) analysis demonstrates the model’s ability to focus on relevant tumor regions, enhancing its interpretability. This accurate and interpretable model for brain tumor classification has the potential to significantly aid clinical decision-making in neuro-oncology. Full article

Introduction: Meningiomas are the most common primary central nervous system tumors, constituting 39.7% of intracranial tumors. Although generally benign, some exhibit aggressive behavior and risk of recurrence, necessitating adjuvant therapy and repeat surgical interventions. Molecular studies have identified tumor-driving mutations, leading to targeted therapies and clinical trials. However, translating preclinical findings into clinical success is often hindered by limitations in current meningioma tumor models. This study aims to develop and validate a standardized protocol for establishing patient-derived meningioma organoids (MEN-Os) that faithfully replicate human disease. Methods: MEN-Os were successfully established from 15 meningioma samples (11 grade 1, 4 grade 2) from neurosurgical resections using an optimized culture protocol. Histological and immunohistochemical analyses were used to assess the resemblance of MEN-Os to original tumor tissues. RNA sequencing compared transcriptional signatures between MEN-Os and corresponding patient-resected tissues. Results: MEN-Os were successfully established from patient-resected samples and maintained in culture for up to four weeks, showing stable growth and structural integrity. Histopathological analysis revealed that MEN-Os preserved key architectural features, including cellular organization, nuclear morphology, and proliferation rates. Immunohistochemical staining for meningioma-specific markers, such as the progesterone receptor, confirmed similar expression patterns to parental tumors. Transcriptomic profiling demonstrated that MEN-Os retained the transcriptional signatures of original tissues, including genes associated with meningioma pathology (NF2, CDKN2A, TP53). Differential expression and deconvolution analyses showed that MEN-Os contained diverse cell populations, including tumor and stromal cells, while preserving the immune microenvironment, as validated by histopathological and transcriptomic profiling. Conclusion: We established a robust, reproducible protocol for generating MEN-Os, which faithfully replicates the histopathological, molecular, and cellular characteristics of original tumors. MEN-Os provide a valuable model for studying meningioma biology and evaluating therapeutic strategies. Full article

Background/Objectives: NF2-related schwannomatosis (NF2) is a tumor predisposition syndrome that typically presents with bilateral vestibular schwannomas, together with other intracranial and spinal schwannomas, meningiomas, and/or ependymomas. Bevacizumab, a VEGF inhibitor, has the potential to decrease schwannoma volume and improve hearing in adults, but the literature on the effects in children is sparse. This narrative review aims to evaluate the use of bevacizumab in pediatric NF2 patients, focusing on hearing, tumor progression, and toxicity. Methods: A literature review was conducted following PRISMA guidelines. Articles were searched in PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier on 18 July 2024. Inclusion criteria were patients ≤ 18 years, diagnosed with NF2 and treated with bevacizumab. Two authors independently assessed the quality of the evidence and extracted relevant data from the included articles. Results: Seventeen articles including 62 pediatric NF2 patients met the inclusion criteria. Studies varied widely in treatment regimens and outcome parameters. Tumor regression was reported in 6/56 patients (11%) and 38/56 (68%) remained stable. Hearing improved in 15/45 patients (33%) and did not further deteriorate in 27/45 (60%). An improvement in other symptoms was seen in 6/29 patients (28%). Toxicity was reported in five studies, documenting 13 adverse events in 28 patients ranging from grade 1 to grade 3. Treatment was discontinued in both patients who experienced grade 3 toxicity. Conclusions: Bevacizumab seems to be a viable treatment option for pediatric NF2 patients. Tumor regression or stabilization is achieved in the majority of patients (77%). Moreover, a considerable number of pediatric patients experience hearing stabilization or improvement (93%). Bevacizumab appears to be relatively well tolerated, offering a non-invasive therapeutic option for children with NF2 suffering from progressive vestibular schwannomas and hearing loss. Full article

Background/Objectives: Tumor interactions with their surrounding environment, particularly in the case of peritumoral edema, play a significant role in tumor behavior and progression. While most studies focus on the radiomic features of the tumor core, this work investigates whether peritumoral edema exhibits distinct radiomic fingerprints specific to glioma (GLI), meningioma (MEN), and metastasis (MET). By analyzing these patterns, we aim to deepen our understanding of the tumor microenvironment’s role in tumor development and progression. Methods: Radiomic features were extracted from peritumoral edema regions in T1-weighted (T1), post-gadolinium T1-weighted (T1-c), T2-weighted (T2), and T2 Fluid-Attenuated Inversion Recovery (T2-FLAIR) sequences. Three classification tasks using those features were then conducted: differentiating between Low-Grade Glioma (LGG) and High-Grade Glioma (HGG), distinguishing GLI from MET and MEN, and examining all four tumor types, i.e., LGG, HGG, MET, and MEN, to observe how tumor-specific signatures manifest in peritumoral edema. Model performance was assessed using balanced accuracy derived from 10-fold cross-validation. Results: The radiomic fingerprints specific to tumor types were more distinct in the peritumoral regions of T1-c images compared to other modalities. The best models, utilizing all features extracted from the peritumoral regions of T1-c images, achieved balanced accuracies of 0.86, 0.81, and 0.76 for the LGG-HGG, GLI-MET-MEN, and LGG-HGG-MET-MEN tasks, respectively. Conclusions: This study demonstrates that peritumoral edema, as characterized by radiomic features extracted from MRIs, contains fingerprints specific to tumor type, providing a non-invasive approach to understanding tumor-brain interactions. The results of this study hold the potential for predicting recurrence, distinguishing progression from pseudo-progression, and assessing treatment-induced changes, particularly in gliomas. Full article

BACKGROUND: Maximal safe resection is the objective of most neuro-oncological operations. Intraoperative magnetic resonance imaging (iMRI) may guide the surgeon to improve the extent of safe resection. There is limited evidence comparing the impact of iMRI on the rates of further resection between tumour types. AIM: To investigate the impact of iMRI on the rate of further resection following visualisation of residual tumour. METHODS: A retrospective cohort study identified all intracranial tumour operations performed in the 1.5 T iMRI machine of a single centre (2007–2023). Patients were identified using SurgiNet and were grouped according to their histopathological diagnosis in accordance with the WHO 2021 classification. The primary outcome was the rate of reoperation due to iMRI visualisation of residual tumours. RESULTS: A total of 574 cases were identified, including 152 low-grade gliomas (LGG), 108 high-grade gliomas (HGG), 194 pituitary neuroendocrine tumours (PitNETs), 15 metastases, and 6 meningiomas. Further resection following iMRI visualisation occurred in 45% of LGG cases, 47% of HGG cases, 29% of PitNET cases, and no meningioma or metastasis cases. Chi-square analysis showed that the rate of further resection after iMRI use across 2018–2023 was significantly higher than that across 2007–2012 (46% versus 33%, p = 0.036). CONCLUSION: Intraoperative MRI for guiding further resection was most useful in cases of LGG and HGG, possibly reflecting the difficulty of differentiating these tumour types from normal brain tissue. In addition, there was increased reliance on iMRI over time, which may represent our surgeons becoming accustomed to its use. Full article

Radiation has been used to treat meningiomas since the mid-1970s. Traditionally, radiation was reserved for patients unfit for major surgery or those with surgically inaccessible tumors. With an increased quantity and quality of imaging, and an aging population, there has been a rise in incidentally diagnosed meningiomas with smaller tumors at diagnosis time. Deciding if, how, and when to intervene must be determined on a case-by-case basis. Anatomical location and adjacent vital structures are crucial for decision-making. Prior review articles have detailed outcomes of radiosurgery in broad anatomical regions such as the skull base, but a recent deluge of research on increasingly specific anatomical subregions deserves attention. This narrative review synthesizes information regarding specific anatomical subregions, including anatomical challenges, radiosurgical outcomes, and unique considerations. Via MEDLINE and ascendancy search, we utilized evidence available for each anatomical region and herein discuss details of published research and explore future directions. Meningioma management remains individualized based on patient comorbidities, tumor location/characteristics, symptomatic burden, and patient age. In addition to stereotactic radiosurgery’s established role for surgically inaccessible, recurrent, and high-grade meningiomas, its use as upfront management for small asymptomatic meningiomas is increasingly investigated. For all subregions reported, radiosurgical intervention resulted in high tumor control rates and acceptably low adverse radiation events. Full article

Background: Although its validity has recently been questioned since its introduction, the Simpson grade has remained one of the most relevant factors in estimating the recurrence risk of intracranial meningiomas. This study aims to assess its role in spinal meningiomas through a retrospective analysis of a mono-institutional surgical series and literature meta-analysis. Methods: We conducted a systematic review and meta-analysis of the literature from 1980 to 2023, complemented by a mono-institutional series of 74 patients treated at “Santa Maria delle Grazie” hospital. Demographic, clinical, neuroradiological, pathological, surgical, and outcome data of case series were analyzed. For the meta-analysis, studies were selected based on predefined inclusion criteria, and a fixed-effects model was used to synthesize data due to assumed homogeneity among included studies. Statistical analyses included odds ratios (OR) for recurrence risk and assessment of publication bias using Peter’s test. Results: Mono-institutional sample included 74 patients, most of whom were women (85%) with a median age of 61.9 years. The thoracic spine was the most common tumor location (81%). Recurrences occurred in patients with Simpson grade II and III resections. The meta-analysis involved 2142 patients from 25 studies and revealed a significantly higher recurrence rate for Simpson grades III–V compared to grades I–II (OR 0.10; CI95 0.06–0.16). Additionally, Simpson grade II had a higher recurrence risk than grade I (OR 0.42; CI95 0.20–0.90). Conclusions: The Simpson grading remains a valid predictor of recurrence also for spinal meningiomas. Our findings revealed a significant increase in recurrence rate with higher Simpson grades. These results support the need to strive for Simpson grade I resection when feasible. Full article

The high recurrence rate of feline meningioma despite the generally benign histomorphology warrants additional markers of clinical aggressiveness. The Ki-67 index is commonly used as prognostic marker for meningioma recurrence in people. Osteopontin (OPN) is a protein involved in tumor progression and may be a potential malignancy marker. To date, osteopontin expression has not been investigated in feline meningioma. The aim of this study was to evaluate the extent of Ki-67 and osteopontin immunostaining of feline meningioma and to find possible associations with WHO (World Health Organization) grades and subtypes. Fifty-three feline meningioma samples were graded according to the human WHO classification and underwent immunohistochemical examination for Ki-67 and OPN. Fifty samples were classified as WHO grade I and three as WHO grade II. The mean Ki-67 ratio was 9.19 ± 9.47. Osteopontin expression was correspondingly high with a mean OPN IHC score of 150.17 (0–242.8), and a median Allred score of 7 (0–8). There was no significant correlation with Ki-67 index, osteopontin expression, WHO grades, or subtypes. The overall high expressions of osteopontin and Ki-67 may help explain the tendency for recurrence of feline meningioma. The human WHO grading system may not be sufficient to accurately estimate the clinical behavior of meningioma in this species. Full article