Browsing by Subject "Meningioma"

Now showing 1 - 5 of 5
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    Long-term stroke risk in meningioma patients treated with conventionally fractionated photon-based radiation therapy
    (Old City Publishing Group, 2019) McClelland, Shearwood, III; Mitin, Timur; Kubicky, Charlotte D.; Jaboin, Jerry J.; Radiation Oncology, School of Medicine
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    Molecular classification to refine surgical and radiotherapeutic decision-making in meningioma
    (Springer Nature, 2024) Wang, Justin Z.; Patil, Vikas; Landry, Alexander P.; Gui, Chloe; Ajisebutu, Andrew; Liu, Jeff; Saarela, Olli; Pugh, Stephanie L.; Won, Minhee; Patel, Zeel; Yakubov, Rebeca; Kaloti, Ramneet; Wilson, Christopher; Cohen-Gadol, Aaron; Zaazoue, Mohamed A.; Tabatabai, Ghazaleh; Tatagiba, Marcos; Behling, Felix; Almiron Bonnin, Damian A.; Holland, Eric C.; Kruser, Tim J.; Barnholtz-Sloan, Jill S.; Sloan, Andrew E.; Horbinski, Craig; Chotai, Silky; Chambless, Lola B.; Gao, Andrew; Rebchuk, Alexander D.; Makarenko, Serge; Yip, Stephen; Sahm, Felix; Maas, Sybren L. N.; Tsang, Derek S.; International Consortium on Meningiomas (ICOM); Rogers, C. Leland; Aldape, Kenneth; Nassiri, Farshad; Zadeh, Gelareh; Neurological Surgery, School of Medicine
    Treatment of the tumor and dural margin with surgery and sometimes radiation are cornerstones of therapy for meningioma. Molecular classifications have provided insights into the biology of disease; however, response to treatment remains heterogeneous. In this study, we used retrospective data on 2,824 meningiomas, including molecular data on 1,686 tumors and 100 prospective meningiomas, from the RTOG-0539 phase 2 trial to define molecular biomarkers of treatment response. Using propensity score matching, we found that gross tumor resection was associated with longer progression-free survival (PFS) across all molecular groups and longer overall survival in proliferative meningiomas. Dural margin treatment (Simpson grade 1/2) prolonged PFS compared to no treatment (Simpson grade 3). Molecular group classification predicted response to radiotherapy, including in the RTOG-0539 cohort. We subsequently developed a molecular model to predict response to radiotherapy that discriminates outcome better than standard-of-care classification. This study highlights the potential for molecular profiling to refine surgical and radiotherapy decision-making.
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    Supraorbital transciliary keyhole approach for removal of tuberculum sellae meningioma: 3D surgical video
    (Scientific Scholar, 2021-01-05) Cuellar-Hernandez, J. Javier; Olivas-Campos, J. Ramon; Tabera-Tarello, Paulo M.; Anokwute, Miracle; Valadez-Rodriguez, Alan; Neurological Surgery, School of Medicine
    Background: Tuberculum sellae meningiomas have an incidence from 5 to 10% of all intracranial meningiomas[2] and tend to be surgically difficult and challenging tumors given their proximity to important structures such as the internal carotid artery (ICA), anterior cerebral artery (ACA), and optic nerves.[3] Typically, their growth is posteriorly and superiorly oriented, thereby displacing the optic nerves and causing visual dysfunction, which is the primary indication for surgical treatment.[1] The main goals of the treatment are the preservation or restoration of visual abilities and a complete tumor resection.[1] Conventionally, surgical approaches to tuberculum meningiomas involve largely invasive extended bifrontal, interhemispheric, orbitozygomatic, pterional, and subfrontal eyebrow approaches. The supraorbital craniotomy, however, is a minimally invasive transcranial approach that offers a similar surgical corridor to conventional transcranial approaches, using a limited craniotomy and minimal brain retraction that can be used for tumoral and vascular pathologies,[4,5] offering added cosmetic outcomes.[1] We present the case of a patient undergoing a supraorbital transciliary craniotomy with a tuberculum sellae meningioma causing bitemporal hemianopsia. Case description: A 70-year-old female with chronic headaches and progressive vision loss and visual field deficit for about 1 year. On ophthalmological evaluation, she was able to fixate and follow objects with each eye, light perception was only present in the right eye, and the vision in the left eye was 0.2 decimal units. Her visual fields demonstrated severe campimetric deficits. Her extraocular movements were intact and bilateral pupils were equal, round, and reactive to light. MRI of the brain demonstrated tuberculum sellae meningioma with bilateral optic canal invasion, displacing the chiasm, and extending ≥180° around the medial ICA wall and anterior ACA wall. The patient underwent supraorbital transciliary keyhole approach for total resection of the tumor. Postoperatively, visual acuity and visual field were significantly improved. Conclusion: Performing a supraorbital transciliary keyhole craniotomy for tuberculum sellae meningiomas requires an adequate and meticulous preoperative planning to determine the optimal surgical corridor to the lesion. The use of supraorbital craniotomy is safe with good cosmetic results and potentially lower morbidity allowing for adequate exposure, resection, and release of neurovascular structures.
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    The extended supracerebellar transtentorial approach for resection of medial tentorial meningiomas
    (Scientific Scholar, 2014-03-15) Ansari, Shaheryar F.; Young, Ronald L.; Bohnstedt, Bradley N.; Cohen‑Gadol, Aaron A.; Neurological Surgery, School of Medicine
    Background: The supracerebellar transtentorial (SCTT) approach has been established as a safe corridor to access the posteriomedial basal temporal region. Previous reports have demonstrated the efficacy of this route in the resection of intrinsic tumors and small arteriovenous malformations. Only one report in the English literature has described its use to resect a medial tentorial meningioma. Methods: The authors discuss the relevant surgical anatomy of this approach and its advantages compared with more traditional routes, and illustrate its application to remove medial tentorial meningiomas through two operative cases with accompanying videos. Results: In illustrative case one, the patient recovered from surgery with no deficits. All his preoperative symptoms had resolved at 3-month follow-up. At the 4-year follow-up, MRI did not demonstrate any growth of the residual tumor. In case two, gross total resection was achieved and the patient did not suffer any postoperative language or visual deficit. At 2-year follow-up, no tumor recurrence was present. Conclusion: The SCTT approach has a potential to safely access extra-axial lesions located around the medial tentorial incisura. As demonstrated in these two cases, the approach merits consideration in patients with tentorial meningiomas as an alternative to more widely utilized skull base approaches and subtemporal routes.
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    Trends in the Management Paradigms of Intracranial Meningioma
    (Thieme, 2021) Aljuboori, Zaid; Alhourani, Ahmad; Woo, Shiao; Hattab, Eyas; Yusuf, Mehran; Nelson, Megan; Andaluz, Norberto; Ding, Dale; Savage, Jesse; Williams, Brian; Neurological Surgery, School of Medicine
    Objective: Intracranial meningiomas are the most common primary brain tumor. Treatment paradigms have evolved over time. There are limited number of population-based studies that examine this modern evolution. Here, we describe the trends of management of intracranial meningiomas using a national database. Methods: The data were obtained from the National Cancer Database for the years 2004 to 2015, the collected variables included: patients' age, gender, insurance type, income, comorbidity score, the tumor size and grade, and treatment modality (observation, surgery, radiotherapy, or combination therapy). We performed statistical analyses to detect association between unique variables and outcomes. In addition, we performed mortality analyses for various treatment modalities. Results: A total of 199,096 patients with a diagnosis of intracranial meningioma were included, the majority of patients were white females, mean age of 61 years, and half of the tumors were ≤ 3 cm. Observation was the most commonly used management modality followed by surgical resection, radiotherapy, and combination therapy. For the entire time period, there was an increased use of observation as a primary management method. Predictors of mortality included increased age, larger tumor size, higher tumor grade, treatment at a community hospital, and higher comorbidity scores. Conclusion: Population-based studies of intracranial meningiomas are uncommon; our study is one of the few reports that examine the changes in the modern management paradigms of meningioma in the United States over time. Additionally, we shed light on the factors that affected survival of patients with this condition.