DOCSLIB.ORG

Surgical Management of Sphenoid Ridge Meningioma En Plaque (Spheno-Orbital Meningioma) Gasser Hasan Al-Shyal, Mohamed Soliman Mohamed, Mohammad Fathy Eissa

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Surgical Management of Sphenoid Ridge Meningioma En Plaque (Spheno-Orbital Meningioma) Gasser Hasan Al-Shyal, Mohamed Soliman Mohamed, Mohammad Fathy Eissa [Downloaded free from http://www.azmj.eg.net on Monday, December 7, 2020, IP: 41.42.169.215] Original article 295 Surgical management of sphenoid ridge meningioma en plaque (spheno-orbital meningioma) Gasser Hasan Al-Shyal, Mohamed Soliman Mohamed, Mohammad Fathy Eissa Department of Neurosurgery, Faculty of Background and aim Medicine for Girls, Al-Azhar University, Cairo, The aim of the study was to investigate the surgical techniques to remove Egypt meningioma en plaque and to compare our technique and results with other Correspondence to Gasser H. Al-Shyal, MD, authors. PhD, FAANS, Department of Neurosurgery, Al- Patients and methods Azhar University Faculty of Medicine for Girls, Al-zahraa Hospital, Abbassya, Cairo, Egypt. This retrospective series case was done at our University Hospital. Eight patients Tel: +20-1006699718; were managed at Al-Zahraa University Hospital between March 2016 and March e-mail: [email protected] 2018. Preoperative and postoperative clinical and radiological assessments were Received: 14 January 2020 done for each patient. Revised: 11 May 2020 Results Accepted: 2 June 2020 There were eight patients in our study. All patients are women. The age range was Published: 30 October 2020 from 34 to 60 years and the mean was 45.4 years. Proptosis was the main clinical Al-Azhar Assiut Medical Journal 2020, manifestation and it was present in all eight patients. Three (37.5%) patients had 18:295–301 visual impairment while two (25%) of them had headache and retro-orbital pain. We achieved total resection in six (75%) out of our eight patients. All tumors were WHO grade 1 meningiomas. Regarding surgical outcome, proptosis improved in six (75%) of the eight cases. Visual impairment improved in two (66.7%) cases out of three who had visual declination preoperatively. Conclusion Meningioma en plaque can be safely removed without any morbidity or mortality. Proptosis and hyperostosis in the sphenoid bone are highly suggestive and this requires more accurate radiological studies. MRI with contrast is essential for these cases. Extensive bony drilling is required for gross total resection. It also facilitates resection of the soft part of the tumor with its dura. Some cases may need orbital wall reconstruction. Proptosis mostly improves after surgery. Keywords: meningioma, proptosis, pterional approach, skull base, sphenoid wing meningioma, spheno- orbital meningioma Al-Azhar Assiut Med J 18:295–301 © 2020 Al-Azhar Assiut Medical Journal 1687-1693 cavernous sinus, and temporal convexity. Hyperostosis Introduction may result in compression of the optic nerve and or Meningioma accounts for about one-third of the other cranial nerves. Also, it causes proptosis, visual primary brain tumors [1]. The term meningioma en deterioration, and cosmetic deformity [13,14]. plaque (MEP) was first described by Cushing [2], which is flat soft tumor that infiltrates the dura [3]. Proptosis is the most common presentation of MEP. It It invades the bone causing hyperostosis. This occurs is unilateral, nonpulsating, and irreducible. Other mostly along the sphenoid wing [4]. Two synonyms are manifestations include decreased visual acuity, used for the description of these tumors: MEP and headache, and limitation of extraocular muscle spheno-orbital meningiomas [5–8]. movements. Less frequently, swelling in the temporal region, seizure, and facial pain are seen [15]. These tumors are slowly growing, and it has either flat or slightly nodular shape [9]. MEPs are more likely to Differential diagnosis of these lesions is meningeal cause bony hyperostosis than are larger globular tumors sarcoidosis, osteoma, tuberculoma, and fibrous and the amount of hyperostosis is often dysplasia [16,17]. Choosing surgical approach and disproportionate to the relatively small tumor [10–12]. Hyperostosis may extend in the skull base involving the This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 lateral and superior orbital walls of the optic canal and License, which allows others to remix, tweak, and build upon the work the anterior clinoid process. The dural growth is usually non-commercially, as long as appropriate credit is given and the new extensive and may include the basal sphenoid wing, creations are licensed under the identical terms. © 2020 Al-Azhar Assiut Medical Journal | Published by Wolters Kluwer - Medknow DOI: 10.4103/AZMJ.AZMJ_5_20 [Downloaded free from http://www.azmj.eg.net on Monday, December 7, 2020, IP: 41.42.169.215] 296 Al-Azhar Assiut Medical Journal, Vol. 18 No. 3, July-September 2020 strategy for removal of MEP are challenging, because it optic canal was opened to decompress the optic nerve has extensive orbital, bone, and dural involvement in cases with marked hyperostosis in the optic canal. If [18–21]. As a result, MEP has relatively high there was orbital infiltration, tumor in the orbit was recurrence rate than other types of meningioma [22]. followed and removed. We did not remove any tumor However, with the development in microsurgical part infiltrated superior orbital fissure dura to avoid technique and craniofacial approaches it is possible cranial nerve deficits. The blood supply MEP usually to be more radical in the management of these arises from branches of the middle meningeal artery. tumors and many surgeons reported favorable We got good devascularization of the tumor by outcomes [15,23–25]. In our opinion, extensive bony cauterizing these branches after resection of the drilling of the affected bone and good exposure of the sphenoid wing with hyperostotic bone. Soft tumors soft tumor mass is the key to achieving favorable are removed with the dura. The excised dura is replaced surgical outcomes. with the artificial substitute. We removed the affected bone to avoid recurrence and this leads to defects in lateral and/or roof of the orbit. We used a titanium Patients and methods mesh plate to replace drilled bones in the temporal fossa, This retrospective study was conducted at Al-Zahraa but we did not reconstruct the superior wall of the orbit. University Hospital, after approval from the local ethics All cases were examined in the same day after surgery committee and after written informed consent was and were followed up for 1 year. Follow-up imaging obtained from each patient before surgery. Eight (CT bone window and MRI) to access residual and patients were managed at Al-Zahraa University recurrent tumors was done after 6 months and 1 year. Hospital in the interval between March 2016 and March 2018. We reviewed the preoperative clinical Statistical analysis assessment for each patient. We did ophthalmology The study is an observational retrospective case series consultation for each patient to access their visual acuity. study and descriptive statistics was used as follows: We did both MRI and computed tomography (CT) (1) Quantitative data: mean and SD were used to bone window (with 3D reconstruction) for every measure central tendency and dispersion. patient. We reviewed the preoperative images to (2) Qualitative data: the studied variables were access the location of the tumor, the site of analyzed using univariant analysis and presented hyperostosis, and to plan our surgical techniques. as frequencies and percentages (frequency distribution table) for qualitative variables. Axial and coronal CT scan images of the bone window were essential for visualization of hyperostosis. We found that contrast is essential for detecting the Results dural enhancing component of these lesions. In one There were eight patients in our study. All patients are of our cases, the lesion did not appear except in women. The age range was from 34 to 60 with a mean contrasted MRI. Large axial orbital cuts increase the age of 45.4 years (Table 1). sensitivity of picking up small dural enhancement. Clinical manifestations We did pterional craniotomy for all eight cases. Care Proptosis was the main clinical manifestation and it was taken to avoid injury of the frontal branch of the was present in all eight patients. One patient had facial nerve. In some patients, we removed the soft bilateral exophthalmos due to toxic goiter and the tumor that infiltrated the temporalis. After removal of tumor was accidently discovered after doing MRI on the extracranial component of the tumor and the orbits in the Ophthalmology Department. Three separation of temporalis, a high-speed drill was used (37.5%) patients had visual impairment while for removal of hyperostotic bone of the lesser and two (25%) of them had headache and retro-orbital greater sphenoid wings. In two cases, we flattened pain. the marginal tubercle (elevation of the posterior border of the zygomatic process of the frontal bone) Resection, pathological grading, and reconstruction to get good exposure of the lateral wall of the orbit and Gross total resection was done for six (75%) out of the anteroinferior part of the greater sphenoid wing eight patients (Fig. 2). In one of the other two patients, (Fig. 1). Then, the remaining part of the bone is we left the part invading the dura of the superior orbital elevated. We continued drilling of the pathological fissure and the residue did not increase in size within bone of sphenoid wings and roof of the orbit. The the follow-up period. In another one, we left a piece of [Downloaded free from http://www.azmj.eg.net on Monday, December 7, 2020, IP: 41.42.169.215] Surgical management of meningioma en plaque Al-Shyal et al. 297 Figure 1 Increasing exposure with marginal tubercle drilling. Arrow points to the marginal tubercle: (a) before drilling and (b) after drilling. Table 1 Summary of patients with meningioma en plaque Cases Age Sex Preoperative Grade of Tumor Bone Surgical results Complications clinical picture resection grade reconstruction WHO 1 55 F Proptosis, Total 1 Yes Headache and visual Subgaleal CSF collection headache, and impairment improved for 2 months, 3rd nerve visual impairment proptosis is the same palsy 2 45 F Proptosis Total 1 No Proptosis improved No 3 48 F Proptosis Total 1 Yes Proptosis improved No 4 50 F Proptosis, visual Total 1 No Proptosis improved, visual Frontal branch of VII n.
Load more

Recommended publications
  • Outcomes After Surgical Treatment of Meningioma-Associated Proptosis
    CLINICAL ARTICLE J Neurosurg 125:544–550, 2016 Outcomes after surgical treatment of meningioma-associated proptosis Christian A. Bowers, MD,1 Mohammed Sorour, MBBS,1 Bhupendra C. Patel, MD, FRCS, FRCOphth,2 and William T. Couldwell, MD, PhD1 Departments of 1Neurosurgery and 2Ophthalmology, University of Utah, Salt Lake City, Utah OBJECTIVE Meningioma-associated proptosis (MAP) can be cosmetically and functionally debilitating for patients with sphenoorbital and other skull base meningiomas, and there is limited information on the quantitative improvement in proptosis after surgery. Because less extensive removals of tumor involving the orbit fail to reduce proptosis, the senior author has adopted an aggressive surgical approach to the removal of tumor involving the periorbita and orbit. The au- thors of this study retrospectively reviewed outcomes of this surgical approach. METHODS All surgeries for MAP performed by a single surgeon between January 1, 2002, and May 1, 2015, were reviewed. Age, sex, visual symptoms, number and types of surgical treatments, cavernous sinus involvement, complica- tions, duration of follow-up, residual tumor, use of adjuvant radiation therapy, and extent of proptosis resolution as mea- sured by the exophthalmos index (EI) pre- and postoperatively and at the final follow-up were recorded. RESULTS Thirty-three patients (24 female [73%]) with an average age of 51.6 years were treated for MAP. Of the 22 patients with additional visual symptoms (for example, loss of visual acuity, field cut, or diplopia), 15 had improved vision and 7 had stable vision. No patients had worse proptosis after treatment. The average preoperative EI was 1.39, the average immediate postoperative EI was 1.23, and the average final EI at the most recent follow-up was 1.13.
    [Show full text]
  • Venous Drainage Pattern Analysis of Medial Sphenoid Wing Meningiomas Related to Surgical Planning
    ORIGINAL ARTICLE Indonesian Journal of Neurosurgery (IJN) 2020, Volume 3, Number 2: 63-67 P-ISSN.2089-1180, E-ISSN.2302-2914 Venous drainage pattern analysis of medial sphenoid wing meningiomas related to surgical planning Muhammad Adam Pribadi1, Muhammad Wildan Hakim2, Nur Setiawan Suroto2*, Rahadian Indarto Susilo2, Irwan Barlian Immadoel Haq2 ABSTRACT Background: Medial sphenoid wing meningiomas involved to the postoperative complication were retrospectively reviewed using anterior clinoid process (APC) and located medial on the lesser and the patient’s medical and surgical records. greater wing of the sphenoid. Surgical planning of medial sphenoid Results: Based on the 7 surgical cases, 5 cases found as cortical wing meningiomas must be carefully considered, which in skull type, sphenobasal type was found in 2 cases and did not find base surgery has emphasized the essential of venous preserving the cavernous type. The average tumor volume of cortical and and the morbidity when accidentally sacrificed. sphenobasal type was 47,7 cm3, 36 cm3 respectively. In this study, Objective: This study aimed to understand the characteristic one surgical complication was identified, frontal intracerebral venous drainage pattern of medial sphenoid wing meningiomas hemorrhage (ICH) from postoperative computed tomography (CT) and correlate with surgical planning scan evaluation in patients who diagnosed with sphenobasal type. Methods: A retrospective analysis evaluation was performed on Conclusion: Complication because venous damage in cases of 7 patients with medial sphenoid wing meningiomas using digital Medial sphenoid wing meningiomas was rare. However, surgical subtraction angiography (DSA) to determine the venous drainage strategies that aimed to avoid venous complications influenced system characteristics before surgery.
    [Show full text]
  • Lateral and Middle Sphenoid Wing Meningioma
    The Neurosurgical Atlas by Aaron Cohen-Gadol, M.D. Lateral and Middle Sphenoid Wing Meningioma Approximately 15 to 20% of all meningiomas arise from the sphenoid wing, with half of them emanating from the lateral and middle portion of this bone. Lateral sphenoid wing meningiomas arise from the pterion and typically grow along the Sylvian fissure. There are no pathologic or genetic features specific to lateral and middle sphenoid wing meningiomas, although World Health Organization (WHO) class II and III meningiomas are less common in this region of the brain than over the convexities. Classification Sphenoid wing meningiomas can be divided into three main groups: 1) meningiomas arising from the anterior clinoid and medial third of the sphenoid wing, 2) meningiomas arising from the middle and lateral sphenoid wing, and 3) en plaque meningiomas of the sphenoid wing or spheno-orbital meningiomas. In my opinion, surgical classification should simplify stratification of surgical objectives. I therefore divide lateral and middle sphenoid wing meningiomas into two main categories: 1) globular or traditional tumors, and 2) hyperostotic en plaque or spheno-orbital tumors. Globular tumors are relatively straightforward and can be transformed into convexity tumors after resection of the lateral sphenoid wing. However, spheno-orbital tumors are more technically challenging because expansile osteotomy is necessary to remove a reasonable portion of the tumor-infiltrated bone and correct the proptosis. Intraorbital extension of these tumors is not uncommon. In this chapter, I discuss meningiomas of the middle and lateral portions of the sphenoid wing. Large tumors of the middle portion of the sphenoid wing involving the optic apparatus, superior orbital fissure, or cavernous sinus are discussed in the Medial Sphenoid Wing Meningioma Chapter.
    [Show full text]
  • Tumors of the Meninges and Related Tissues: Meningiomas and Sarcomas
    CHAPTER 30 Tumors of the Meninges and Related Tissues: Meningiomas and Sarcomas Kimberly P. Cockerham, John S. Kennerdell, Joseph C. Maroon, and Ghassan K. Bejjani ANATOMY OFTHE MENINGES Associations Dura Mater Diagnosis Arachnoid Treatment Pia Mater Adjuvant Therapy MENINGIOMAS Clinical Characteristics by Location Histogenesis SARCOMAS OFTHE MENINGES AND BRAIN Incidence Chondrosarcoma Pathology Osteogenic Sarcoma Cytogenetics Primary Sarcoma of the Meninges and Brain Endocrinology Rhabdomyosarcoma ANATOMY OF THE MENINGES The meninges of the brain and spinal cord consist of three into several freely communicating compartments. They in- different layers: the dura mater, arachnoid (tela arach- clude the falx cerebri, the tentorium cerebelli, the falx cere- noidea), and pia mater. Considerable anatomic differences belli, and the diaphragma sellae. exist among these structures, and these differences influence The falx cerebri, so named because of its sickle-like form, the nature, location, and spread of tumors that arise from is a fixed, arched process that descends vertically in the them. longitudinal fissure between the cerebral hemispheres (Fig. 30.2). The tentorium cerebelli is an arched lamina that is DURA MATER elevated in its midportion and inclines downward toward its peripheral attachments on both sides. It covers the superior The dura mater, typically referred to as the dura, is a thick surface of the cerebellum and supports the occipital lobes membrane that is adjacent to the inner table of the skull and (Fig. 30.2). The falx cerebelli is a small triangular process acts both as the functional periosteum of the skull and the of dura mater that lies beneath the tentorium cerebelli in outermost membrane of the brain (Fig.
    [Show full text]
  • Meningiomas Involving the Optic Canal: Pattern of Involvement and Implications for Surgical Technique
    Neurosurg Focus 30 (5):E12, 2011 Meningiomas involving the optic canal: pattern of involvement and implications for surgical technique AHMED NAGEEB M. TAHA, M.D.,1 KADIR ERKMEN, M.D.,3 Ian F. DUnn, M.D.,2 SVETLana PRAVDEnkOVA, M.D., PH.D.,4 anD OssaMA AL-MEftY, M.D.2 1Mansoura University Hospital, Mansoura-Dakhlia, Egypt; 2Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts; 3Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; and 4Arkansas Neuroscience Institute, St. Vincent Infirmary Medical Center, Little Rock, Arkansas Object. Juxtasellar meningiomas frequently extend into the optic canal. Removing these meningiomas from the optic canal is crucial for favorable visual outcome. Methods. The authors performed a retrospective analysis of 45 patients with anterior and middle fossa menin- giomas with involvement of the optic pathway in whom surgery was performed by the senior author (O.A.M.) during the period from 1993 to 2007. Extent of resection and recurrence rates were determined by pre- and postoperative MR imaging studies. Visual outcomes were evaluated with full ophthalmological examinations performed before and after surgery. Results. Forty-five patients (31 women and 14 men) were involved in this study; their mean age was 51.6 years. Patients were followed for a mean of 29.8 months (range 6–108 months). No surgery-related death occurred. The average tumor size was 3.1 cm. Total resection of the tumor (Simpson Grade I) was achieved in 32 patients (71.1%). Gross-total resection (Simpson Grades II and III) was achieved in 13 patients (28.9%). Only 1 patient harboring a left cavernous sinus meningioma had tumor recurrence and underwent repeat resection.
    [Show full text]
  • Left Frontotemporal Craniotomy for Sphenoid Wing Meningioma
    Mfgu!gspoupufnqpsbm!! dsbojpupnz!! gps!tqifopje!xjoh! nfojohjpnb!! Mike Steffy n this case study, the author will present information on meningiomas and an overview of a craniotomy with specific details from a left fron- !J totemporal craniotomy performed on a patient diagnosed with a sphenoid wing meningioma. TYPES OF INTRACRANIAL TUMORS Depending on their point of origin, intracranial tumors are classified typically as either primary or secondary. Primary intracranial tumors originate within the brain, the menin- ges or the pituitary gland, and occur in approximately 35,000 people per year in the United States.6 Primary tumors are classified further into: N Intra-axial tumors, which originate inside the brain parenchyma and include astrocytomas, oligodendrogliomas, ependymomas, medulloblastomas, hemangioblastomas, primary central nervous system lymphomas, germ cell tumors and pineal region tumors; and N Extra-axial tumors, which originate outside the parenchyma and include meningiomas, schwannomas and pituitary adenomas. NOVEMBER 2007 The Surgical Technologist 497 ©iStockphoto.com/Dean Hoch ©iStockphoto.com/Dean 287 NOVEMBER 2007 1 CE CREDIT Secondary intracranial tumors are metastatic Meningiomas occur most often in adults and lesions of tumors that originate outside the brain. primarily in middle-aged women. In some patients, An estimated 150,000 to 250,000 patients present the tumors may be associated with a condition with this type of tumor annually in the US.6 such as meningiomatosis or neurofibromatosis, or a history of radiation therapy in childhood. MENINGIOMAS Surgery is often the indicated treatment, since Meningiomas represent about 20% of all prima- gross total resection of the tumor may cure the ry intracranial tumors, making them the second patient.
    [Show full text]
  • A New Scoring System for Predicting Extent of Resection in Medial
    Wang et al. Chinese Neurosurgical Journal (2020) 6:35 https://doi.org/10.1186/s41016-020-00214-0 中华医学会神经外科学分会 CHINESE MEDICAL ASSOCIATION CHINESE NEUROSURGICAL SOCIETY RESEARCH Open Access A new scoring system for predicting extent of resection in medial sphenoid wing meningiomas based on three-dimensional multimodality fusion imaging Zilan Wang1†, Xiaolong Liang2†, Yanbo Yang1, Bixi Gao1, Ling Wang3, Wanchun You1, Zhouqing Chen1* and Zhong Wang1* Abstract Background: Three-dimensional (3D) fusion imaging has been proved to be a promising neurosurgical tool for presurgical evaluation of tumor removal. We aim to develop a scoring system based on this new tool to predict the resection grade of medial sphenoid wing meningiomas (mSWM) intuitively. Methods: We included 46 patients treated for mSWM from 2014 to 2019 to evaluate their tumors’ location, volume, cavernous sinus involvement, vascular encasement, and bone invasion by 3D multimodality fusion imaging. A scoring system based on the significant parameters detected by statistical analysis was created and evaluated. Results: The tumor volumes ranged from 0.8 cm3 to 171.9 cm3. A total of 39 (84.8%) patients had arterial involvement. Cavernous sinus (CS) involvement was observed in 23 patients (50.0%) and bone invasion was noted in 10 patients (21.7%). Simpson I resection was achieved in 10 patients (21.7%) and Simpson II resection was achieved in 17 patients (37.0%). Fifteen patients (32.6%) underwent Simpson III resection and 4 patients (8.7%) underwent Simpson IV resections. A scoring system was created. The score ranged from 1 to 10 and the mean score of our patients was 5.3 ± 2.8.
    [Show full text]
  • Reconstruction After Resection of Sphenoid Wing Meningiomas
    ORIGINAL ARTICLE Reconstruction After Resection of Sphenoid Wing Meningiomas Deirdre Leake, MD; Chad Gunnlaugsson, MD; Janet Urban, MD; Lawrence Marentette, MD Objective: To review our experience of reconstructing Results: A total of 24 resections were performed on 22 the lateral and superior orbital walls after resection of sphe- patients. The average follow-up was 14.6 months. All pa- noid wing meningiomas. We will review the presenta- tients had meningiomas with similar preoperative pre- tion and complications, examine the aesthetic results post- sentations, and for 21 of the 22 patients aesthetic recon- operatively, and compare preoperative and postoperative struction resulted in the near symmetry of the 2 sides. computed tomographic scans. To our knowledge, a com- All patients are currently alive, those who underwent com- parative analysis of preoperative defect and postopera- plete resection are without recurrence, and 15 (68.2%) tive reconstruction has not been performed. did not incur complications. One patient experienced a worsening of temporal wasting following radiation Methods: We conducted a retrospective analysis, with therapy. a minimum of 5 months and a maximum of 9 years of follow-up in an academic multidisciplinary skull base cen- Conclusion: Reconstruction of the defect with split cal- ter. Twenty-two patients were treated for sphenoid wing varial bone and free abdominal fat grafts affords the pa- meningiomas by resection and reconstruction with split calvarial bone graft and, for more than half of the pa- tient excellent aesthetic results as well as good symme- tients, also with free abdominal fat graft. The main out- try, as demonstrated by a postoperative computed come measures were aesthetic evaluation of patients and tomographic scan.
    [Show full text]
  • Neurotransmitter a Publication of Santa Barbara Neuroscience Institute at Cottage Health System
    NeUrotransmitter A PublicAtion of SAntA BarbArA neuroScience inStitute At cottAge HeAltH SyStem summer 2011 Radiosurgery for Sphenoid Wing Meningioma Page 5 Tourette Syndrome and Coexisting Conditions Page 8 2 Neurotransmitter In the Next Issue • University of California, Santa Barbara, and Santa Barbara Cottage Hospital—A Synergistic Translational Research Collaborative • Intraoperative MRI comes to Santa Barbara: Advancing the Care of Cranial-Based Tumor Patients Thomas H. Jones, MD Gary D. Milgram, RN, MBA Executive Medical Editor Executive Editor Table of Contents Philip Delio, MD Charlie Milburn 4 Acute Inpatient Rehabilitation Referral Medical Editor, Neurology Publisher Alois Zauner, MD Candice St. Jacques 5 Radiosurgery for Sphenoid Wing Meningioma Medical Editor, Neurosurgery Managing Editor 6 Headache Management—A Guide for Emergency Sean Snodgress, MD Monika Bliss Morris Department and Primary Care Physicians Medical Editor, Neuroradiology Designer Maria Zate 8 Tourette Syndrome and Coexisting Conditions Advisory Editor 10 Diagnosis and Surgical Management of To be added to the mailing list, please contact Cavernous Malformations Gary Milgram at [email protected]. About Santa Barbara Cottage Hospital and Cottage Health System The not-for-profit Cottage Health System is the parent organization of Santa Barbara Cottage Hospital (and its associated Cottage Children’s Hospital and Cottage Rehabilitation Hospital), Santa Ynez Valley Cottage Hospital and Goleta Valley Cottage Hospital. The Santa Barbara Neuroscience Institute at Cottage Health System is a physician- led initiative established to focus on medical conditions over the full cycle of care. The Institute aims to deliver the highest value to the patient by incorporating 4 8 best practices, applying resources judiciously, and measuring and reporting outcomes relentlessly.
    [Show full text]
  • 1 Proton Therapy for Atypical Meningiomas Mark W. Mcdonald
    Proton therapy for atypical meningiomas of Neuro-Oncology, 123(1), 123–128. http://doi.org/10.1007/s11060-015-1770-9 McDonald, M. W., Plankenhorn, D. A., McMullen, K. P., Henderson, Dropcho, E. J., Shah, V., & Cohen-Gadol, A. (2015). Proton therapy for atypical meningiomas. Journal This is the author's manuscript of article published in final edited form as: Mark W. McDonald, M.D.,1,5 David A. Plankenhorn, B.S., 1 Kevin P. McMullen, M.D., 1,5 Mark A. Henderson M.D., 1 Edward J. Dropcho, M.D., 3 Mitesh V. Shah, M.D., 2, 4 Aaron A. Cohen-Gadol, M.D., M.Sc. 2, 4 1 Department of Radiation Oncology, 2 Department of Neurological Surgery, 3 Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 4 Goodman Campbell Brain and Spine, Indianapolis, IN 5 Indiana University Health Proton Therapy Center, Bloomington, IN Keywords: meningioma; atypical; radiation; proton therapy Corresponding author: Mark W. McDonald, MD Winship Cancer Institute of Emory University Department of Radiation Oncology 1365 Clifton Road NE, Suite A1300 Atlanta, GA 30322 Office: 404.778.3473 Fax: 404.778.4139 [email protected] Dr. McDonald is now affiliated with the department of radiation oncology at Emory University. Dr. Henderson is now affiliated with the department of radiation oncology at Oregon Health and Science University. 1 Abstract We report clinical outcomes of proton therapy in patients with World Health Organization grade 2 (atypical) meningiomas. Between 2005 and 2013, 22 patients with atypical meningiomas were treated to a median dose of 63 Gy (RBE) using proton therapy, as an adjuvant therapy after surgery (n=12) or for recurrence or progression of residual tumor (n=10).
    [Show full text]
  • Clinicopathological Characteristics of Intracranial Meningiomas
    Original Article Nepal Journal of Neuroscience 2020;17(2):16-25 Clinicopathological characteristics of intracranial meningiomas Rajiv Jha MCh1, Prakash Bista MCh2 1National Neurosurgical Referral Center, NAMS Bir Hospital, Kathmandu, Nepal, 2National Neurosurgical Referral Center, Bir Hospital, Kathmandu, Nepal Date of submission: 26th May 2020 Date of acceptance: 15th July 2020 Date of publication: 12th August 2020 Abstract Background: Meningioma comprises 25-30% of total central nervous system tumors detected. Ninety percent of meningiomas are benign, 6% are atypical, and 2% are malignant. Complete resection is often curative. Objectives: The objective of this study is to give ideas about the descriptive epidemiology, clinical presentation and histopathology of current scenario at National Neurosurgical Referral Center, Nepal. Methods: This is a prospective study from the period of January 2015 to September 2019 in the department of neurosurgery, National Academy of Medical Science, Bir Hospital. Inclusion criteria consists of all the histopathological proven cases of meningioma during the study period. Result: A total of 150 meningioma cases were operated during the study period. The average age of presentation was 42 years. Male to female ratio was 1:2. Most common affected age group was 30-50 years. The most common clinical symptoms for intracranial meningioma were headache followed by vomiting and paresis. Among intracranial meningioma, the most common location was convexity meningioma followed by sphenoid wing meningiomas and parasagittal meningiomas. Most common histopathological variety encountered was transitional meningioma, World health organization grade I. Conclusion: Meningiomas are slow growing, extra-axial tumor, usually benign which are most commonly located along convexities, sphenoid ridge and parasagittal area.
    [Show full text]
  • Meningioma and Psychiatric Symptoms an Individual Patient
    Asian Journal of Psychiatry 42 (2019) 94–103 Contents lists available at ScienceDirect Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp Meningioma and psychiatric symptoms: An individual patient data analysis T ⁎ Shreeya Gyawalia, Pawan Sharmab, , Ananya Mahapatrac a Arogin Health Care and Research Centre, Kathmandu, Nepal b Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal c Department of Psychiatry, Dr Ram Manohar Lohia Hospital PGIMER, New Delhi, India ARTICLE INFO ABSTRACT Keywords: Meningioma is a slow-growing benign tumor arising from meninges and is usually asymptomatic. Though Meningioma neuropsychiatric symptoms are common in patients with brain tumors, they often can be the only manifestation Psychiatry in cases of meningioma. Meningiomas might present with mood symptoms, psychosis, memory disturbances, Psychiatric symptoms personality changes, anxiety, or anorexia nervosa. The diagnosis of meningioma could be delayed where only Psychiatric manifestations psychiatric symptoms are seen. A comprehensive review of the literature and individual patient data analysis was conducted, which included all case reports, and case series on meningioma and psychiatric symptoms till September 2018 with the search terms “meningioma” and “psychiatric symptoms/ depression/ bipolar disorder/ mania/ psychosis/ obsessive-compulsive disorder”. Search engines used included PubMed, MEDLINE, PsycINFO, Cochrane database and Google Scholar. Studies reported varied psychiatric symptoms in cases with meningioma of differing tumor site, size and lateralization. Factors which led to a neuroimaging work-up included the oc- currence of sudden new or atypical psychiatric symptoms, a lack of response to typical line of treatment and the presence of neurological signs or symptoms such as headache, seizures, diplopia, urinary incontinence etc.
    [Show full text]