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Left internal carotid angiograms (lateral view) after initial surgery revealing stasis of the left sylvian vein (arrowheads). A, B: Arterial phase; C, D: venous phase.
Source publication
A 43-year-old female presented with a giant skull base atypical meningioma manifesting as rapid progression of impaired consciousness. The meningioma was located in the ethmoid sinus, sphenoid sinus, nasal cavity, and left middle temporal fossa, and the intracranial portion of the tumor involved the left temporal region with massive surrounding bra...
Context in source publication
Context 1
... week after the initial operation, she underwent an- giography. The tumor was supplied by the bilateral exter- nal carotid arteries. Left internal carotid angiography showed that the left sylvian vein was cut off abruptly, and stasis was present in the late venous phase (Fig. 2). The left cavernous sinus and spheno-parietal sinus were complete- ly occluded. In addition, the ipsilateral vein of Labbe and basal vein of Rosenthal did not appear in the venous phase of left carotid ...
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Citations
... We confirm that WHO grade II and atypical meningiomas more frequently give this type of radiological finding than malignant grades [40], which because of their infiltrative pattern may give symptoms earlier and thus may be diagnosed earlier [41,42]. We confirm that grading (especially atypical forms) [43] influenced by a high proliferation index [12] with high Ki-67 and number of mitoses per field is definitely more suggestive of a high growth rate than the presence of hormone-dependent forms that better explain the higher incidence in the female population and cases of meningiomatosis. ...
Giant intracranial meningiomas (GIMs) are a subgroup of meningiomas with huge dimensions with a maximum diameter of more than 5 cm. The mechanisms by which a meningioma can grow to be defined as a "giant" are unknown, and the biological, radiological profile and the different outcomes are poorly investigated. We performed a multi-centric retrospective study of a series of surgically treated patients suffering from intracranial meningioma. All the patients were assigned on the grounds of the preoperative imaging to giant and medium/large meningioma groups with a cut-off of 5 cm. We investigated whether the presence of large diameter and peritumoral brain edema (PBE) on radiological diagnosis indicates different mortality rates, grading, characteristics, and outcomes in a multi-variate analysis. We found a higher risk of developing complications for GIMs (29.9% versus 14.8%; p < 0.01). The direct proportional relationship between PBE volume and tumor volume was present only in the medium/large group (Pearson correlation with p < 0.01) and not in the GIM group (p = 0.47). In conclusion, GIMs have a higher risk of developing complications in the postoperative phase than medium/large meningioma without higher risk of mortality and recurrence.
... In 1 case of atypical meningioma of the skull base, emergency large decompressive craniectomy was performed due to rapidly progressing impaired consciousness. [12] The patient immediately recovered consciousness and 1 month later underwent radical tumor resection. The relevance of peritumoral edema and prognosis in surgery for intracranial meningioma has been emphasized previously, and decompressive craniectomy is indicated as a successful procedure. ...
Background
Convexity meningiomas are benign brain tumors that are amenable to complete surgical resection and are associated with a low complication rate. The aim of this study was to identify factors that result in acute postoperative neurological worsening after the removal of convexity meningiomas.
Methods
Clinical evaluation and neuroradiological analysis of patients who underwent removal of a supratentorial convexity meningioma were reviewed. Patients were selected when their postoperative course was complicated by acute neurological deterioration requiring decompressive craniectomy.
Results
Six patients (mean age: 43.3 years) underwent surgical removal of a supratentorial convexity meningioma. Brain shift (mean: 9.9 mm) was evident on preoperative imaging due to lesions of varying size and perilesional edema. At various times postoperatively, patient consciousness worsened (up to decerebrate posture) with contralateral paresis and pupillary anisocoria. Computed tomography revealed no postoperative hematoma, however, did indicate increased brain edema and ventricular shift (mean: 12 mm). Emergency decompressive craniectomy and brief ventilator assistance were performed in all patients. Ischemia of the ipsilateral posterior cerebral artery occurred in 3 patients and hydrocephalus occurred in 2 patients. Outcome was good in 2, fair in 2, 1 patient had severe disability, and 1 patient died after 8 months.
Conclusions
Brain shift on preoperative imaging is a substantial risk factor for postoperative neurological worsening in young adult patients after the removal of convexity meningiomas. Emergency decompressive craniectomy must be considered because it is effective in most cases. Other than consciousness impairment, there is no reliable clinical landmark to guide the decision to perform decompressive craniectomy; however, brain ischemia may have already occurred.
... A search of PubMed Õ (using the key words ''meningioma'' and ''sphenoid sinus'') revealed four reports of meningioma involving the sphenoid sinus (Table 1). 4,8,10,11 An additional report of 30 extracranial sinonasal tract meningiomas included only two cases originating purely from the sphenoid sinus. 3 Meningioma typically appears as an isodense or hyperdense mass on computed tomography (CT) images. ...
Meningiomas are slow-growing benign lesions that constitute ∼ 25% of primary intracranial tumours. Extracranial meningioma of the sphenoid sinus is extremely rare and may arise from ectopic arachnoid nests left behind during embryonic development. We present the case of a 61-year-old woman with left oculomotor nerve paralysis. Magnetic resonance imaging (MRI) revealed a 43 × 31 × 33 mm mass in the sphenoid sinus invading anteriorly into the posterior ethmoid sinus and superiorly into the base of the anterior cranial fossa. Microscopic transnasal transsphenoidal surgery was performed with multilayer reconstruction to the cranial base. Postoperative MRI confirmed total resection and recovery was uneventful. The pathological diagnosis was grade I meningothelial meningioma. Meningioma should be included in the differential diagnosis of sphenoid sinus mass. Surgery is the first-choice treatment and a transnasal transphenoidal approach is recommended. Cranial base reconstruction is important to avoid postoperative cerebrospinal fluid leakage.
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Purpose
There is a need to better understanding the prognostic factors that influence high-value care outcomes following meningioma surgery. The goal of this study was to develop predictive models to determine patients at risk for experiencing an extended hospital length of stay (LOS), non-routine discharge disposition, or a 90-day hospital readmission after non-skull base meningioma resection.
Methods
This study utilized data from 396 patients who received surgical resection of non-skull base meningiomas at a single institution between January 1st, 2005 and December 31st, 2020. The Mann-Whitney U test was used for bivariate analysis of continuous variables and Fisher’s exact test was used for bivariate analysis of categorical variables. Multivariate analysis was conducted using logistic regression models.
Results
Most patients had falcine or parasagittal meningiomas (66.2%), with the remainder having convexity (31.8%) or intraventricular tumors (2.0%). Non-elective surgery (p<0.0001) and increased tumor volume (p=0.0022) were significantly associated with LOS >4 days in multivariate analysis. Independent predictors of non-routine discharge disposition included male sex (p=0.0090), non-married status (p=0.024), non-elective surgery (p=0.0067), tumor location within the parasagittal or intraventricular regions (p=0.0084), and increased modified frailty index (mFI-5) score (p=0.039). Hospital readmission within 90 days was independently associated with having non-private insurance (p=0.010) and non-married status (p=0.0081). Three models predicting prolonged LOS, non-routine discharge disposition and 90-day readmission were implemented in the form of an open-access, online calculator, available at https://neurooncsurgery3.shinyapps.io/non_skull_base_meningiomas/.
Conclusion
Following external validation, our open-access, online calculator may be useful for assessing likelihood of adverse postoperative outcomes in non-skull base meningioma patients.
Background: Giant intracranial meningiomas (GIMs) are extremely rare and are usually considered arduous to resect totally with poorer prognosis. The real mechanisms by which a meningioma can grow to be defined as "giant" are unknown, as well as the real biological , radiological profile and the different outcomes.
Methods: We performed a retrospective review of a consecutive series of surgically-treated patients suffering from intracranial Meningioma. All the patients were assigned on the ground of the preoperative imaging to the Giant and Medium/Large Meningiomas. We investigated whether the presence large diameter on radiological diagnosis is indicative for different mortality rate, grading, characteristic and clinical/neurological outcome.
Results: The study shows that surgically treated giant meningiomas have a higher risk of developing complications in the postoperative phase (Chi square= 11.121, dF=1, p=0.001). The direct proportional relationship between peritumoral brain edema (PBE) volume and tumor volume was present only in the medium/large group and was not present in the giant meningioma group. When comparing the degree of performance there is a statistically significant difference between localization and KPS immediately postoperatively (p=0.04) particularly for sphenopetroclival meningiomas (p=0.071), and partially with GIM of the olfactory groove with arterial encasement. The most frequently encountered complications include the occurrence of ischemia (p=0.049), infection (p=0.03), and the occurrence of postoperative seizures.
Conclusions: We identified that the major surgical risk factor for GIMs is location, where the petro-clival region and, to a lesser extent the anterior basicranium offer a greater risk of neurovascular involvement and arterial encasement. On other hand, the risk correlated with PBE is poorer in GIM although there is a well-noted correlation between the Edema volume and outcome in meningiomas.
