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Meningiomas are common intracranial neoplasms with benign features, and extracranial metastases are very rare. There have been no previous reports of solitary mediastinal lymph node metastasis from benign meningiomas without pulmonary lesions. Here, we present a case of an 82‐year‐old female who visited our department for mediastinal lymphadenopathy with a history of meningioma treated with total surgical resection six years prior. Endobronchial ultrasound‐guided transbronchial needle aspiration of the left lower paratracheal lymph node revealed a benign meningothelial meningioma. In patients with a history of meningioma, extracranial metastasis should be considered in the differential diagnosis of mediastinal lymphadenopathy., (a) Contrast‐enhanced computed tomography (CT) revealed a bulky lymphadenopathy in the left lower paratracheal area compressing the lower trachea and left main pulmonary artery. (b) On an axial section of the enhanced CT scan, a mediastinal mass compressing the left main bronchus was observed. (c), (d) 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET) showed high uptake of FDG with a maximal standardized uptake value of 9.2 by the tumor.

Background Spontaneous subdural hematoma rarely presents with a hypervascular or malignant tumor but even less frequently in a benign tumor like meningioma. We encountered a patient with acute subdural hematoma associated with benign meningioma. Here, we report this case along with a review of previous reports, especially focusing on their clinical features and possible bleeding mechanisms. Case presentation A 53-year-old Asian woman presented with severe headache and progressive neurologic deterioration due to cerebral edema. The patient was submitted to open surgery for evacuation of the subdural hematoma and concurrent tumor removal on the ipsilateral parietal convexity. A hypervascular, encapsulated mass was identified during surgery and completely removed including the adjacent dura mater (Simpson grade 0). The tumor was histologically confirmed as an angiomatous meningioma (World Health Organization grade I). Her clinical course was uneventful after surgery. Conclusions Although meningiomas are commonly benign according to their histological traits, they can lead to spontaneous bleeding and cause neurologically unstable condition. Therefore, meningiomas need to be considered as a cause of spontaneous subdural hematoma if radiologically suspicious, which should be reflected by proper management for a positive outcome.

Meningioma en plaque (MEP) often needs invasive surgery to resect totally because of its widespread proliferation along the dura mater. We report a minimally invasive surgical technique for non-brain-exposure exoscopic and endoscopic volume reduction in an elderly patient with MEP. An 83-year-old woman presented with gait disturbance and cognitive dysfunction that had progressed over 6 months. Magnetic resonance imaging (MRI) revealed a large MEP on the right frontal lobe with peritumoral edema. On confirming the benign nature of the tumor (WHO grade 1) by biopsy, the main feeders and tumor were transarterially embolized. Volume reduction surgery was performed under the assistance of an exoscope and an endoscope while being careful not to expose and damage the cortex. Her symptoms completely resolved postoperatively. This surgical technique without exposing the brain may be a treatment choice for elderly patients with benign symptomatic convexity MEP.

Meningiomas are the most common non-malignant intracranial tumors and prefer, like most tumors, anaerobic glycolysis for energy production (Warburg effect). This anaerobic glycolysis leads to an increased synthesis of the metabolite methylglyoxal (MGO) or glyoxal (GO), which is known to react with amino groups of proteins. This reaction is called glycation, thereby building advanced glycation end products (AGEs). In this study, we investigated the influence of glycation on sialylation in two meningioma cell lines, representing the WHO grade I (BEN-MEN-1) and the WHO grade III (IOMM-Lee). In the benign meningioma cell line, glycation led to differences in expression of sialyltransferases (ST3GAL1/2/3/5/6, ST6GAL1/2, ST6GALNAC2/6, and ST8SIA1/2), which are known to play a role in tumor progression. We could show that glycation of BEN-MEN-1 cells led to decreased expression of ST3Gal5. This resulted in decreased synthesis of the ganglioside GM3, the product of ST3Gal5. In the malignant meningioma cell line, we observed changes in expression of sialyltransferases (ST3GAL1/2/3, ST6GALNAC5, and ST8SIA1) after glycation, which correlates with less aggressive behavior.

BACKGROUNDMeningiomas are the most common primary extra-axial non-glial intracranial tumors. The severe grade of meningioma, according to WHO, has the highest recurrence rate accompanied by high morbidity and mortality rates. Therefore, it is imperative to perform pre-operative assessments so the clinician can give prompt treatment to gain a better prognosis. It is a novel alternative way of predicting meningioma’s malignancy by calculating the tumor’s apparent diffusion coefficient (ADC) value. The objective of the study was to determine the value of ADC for differentiating benign and malignant meningiomas. METHODSThis cross-sectional study involved 32 subjects with clinically diagnosed or histologically verified meningioma (21 benign and 11 malignant). They underwent a head-magnetic resonance imaging (MRI) examination and biopsy. We calculated the ADC value by creating regions of interest (ROIs) on the solid part of the tumor, guided by contrast and fluid-attenuated inversion recovery (FLAIR) sequence. We analyzed the ADC value with independent t-test and Bland-Altman graphs, calculated the average difference, CI 95%, limit of agreement between observers, and ROC. RESULTSMean ADC of malignant meningiomas (0.877 ± 0.167 x 10-3 mm2/s) was significantly lower than that of benign meningiomas (0.990 ± 0.105 x 10-3 mm2/s) (p

Introduction: Predictors of survival and progression of disease in atypical meningiomas are less well documented in the literature compared to benign meningiomas. Higher grade meningiomas tend to recur often and one of the most critical aspects is how to best deal with relapses. Methods: A total of 77 consecutive patients who underwent craniotomy for atypical meningioma between 1990–2010 at Oslo University Hospital (OUH) were reviewed. Results: Median age at surgery was 62.21 [interquartile range (IQR): 22.87] years. Fifty-one patients (66.2%) had neurological deficits at presentation. Fifty-four patients (70.1%) underwent gross total resection (GTR). Thirty-nine patients (50.7%) had improved/stable neurological outcomes at 6–12 months. Twenty-two patients (28.6%) underwent retreatment, of whom 20 (26.0%) were subjected to resection followed by adjuvant radiotherapy. Overall survival (OS) was significantly longer in patients &lt, 65 years (p &lt, 0.001), with preoperative Karnofsky performance scale (KPS) score of ≥ 70 (p = 0.006), and who required no retreatment (p = 0.033). GTR significantly prolonged the retreatment-free survival rate (p &lt, 0.001). STR carried almost a six-fold greater risk of neurological outcome deterioration (p = 0.044). Conclusions: GTR significantly prolonged retreatment-free survival but had no significant impact on OS. STR was a significant risk factor for deteriorated neurological outcome. Age, preoperative KPS, and retreatment were all strong predictors of OS. Median time-to-retreatment (TTR) did not shorten significantly throughout repeated surgeries.

OBJECT Meningiomas are generally slow-growing, benign tumors, most of which are classified as WHO Grade I. Rarely, benign meningiomas may recur after surgery with transformation into WHO Grade II atypical meningiomas. As atypical meningiomas are different from benign meningiomas in terms of clinical course, and prognosis, predicting the transformation is important for patient management. The purpose of the study was to investigate the radiological and pathological factors that predict the risk of tumor progression from benign to atypical meningioma. METHOD All patients treated with recurrent meningiomas in whom the tumor showed histopathologically confirmed high grade transformation between 2001 and 2017 were included. To evaluate the predictors for transformation, patients’ medical records for previous benign meningioma before transformation were collected. Each patient was matched with 4 age and sex-matched controls treated with benign meningioma, and were analyzed. RESULTS Fourteen patients with high grade transformation were included. The median time interval of transformation was 63 months (range of 19 – 132). Multivariate analysis indicated that increased mitotic index (OR, 10.409, 95% CI, 1.297–83.549, p=0.027) was significant predictive factor of transformation. And prominent peritumoral edema (OR, 33.822, 95% CI, 0.935–223.688, p=0.054) showed relative risk for transformation. CONCLUSION Increased mitotic index and prominent peritumoral edema may be predictors for high grade transformation of benign meningiomas. Although these tumors do not meet the criteria for atypical meningioma, they may be required more attentive observation and management than other benign meningiomas.

Background:The incidence and clinical features of the malignant transformation of benign meningiomas are poorly understood. This study examined the risk of the malignant transformation of benign meningiomas after surgery or stereotactic radiosurgery., Methods:We systematically reviewed studies published between 1979 and 2019 using PubMed, Scopus, and other sources. We analyzed pooled data according to the PRISMA guideline to clarify the incidence rate of malignant transformation (IMT) and factors affecting malignant transformation in surgically or radiosurgically treated benign meningiomas., Results:IMT was 2.98/1000 patient-years (95% confidence interval [CI] = 1.9-4.3) in 13 studies in a single-arm meta-analysis. Although the evidence level of the included studies was low, the heterogeneity of the incidence was mostly explained by the tumor location. In meta-regression analysis, skull base tumors had a significantly lower IMT than non-skull base tumors, but no gender association was observed. IMT after radiosurgery in 9 studies was 0.50/1000 person-years (95% CI = 0.02-1.38). However, a higher proportion of skull base tumors, lower proportion of males, and lower salvage surgery rate were observed in the radiosurgery group than in the surgery group. The median time to malignant change was 5 years (interquartile range = 2.5-8.2), and the median survival after malignant transformation was 4.7 years (95% CI = 3.7-8) in individual case data., Conclusion:IMT of benign meningioma was significantly affected by the tumor location. Radiosurgery did not appear to increase IMT, but exact comparisons were difficult because of differences in study populations.

Meningiomas are the most the common primary brain tumors in adults, representing approximately a third of all intracranial neoplasms. They classically are found to be more common in females, with the exception of higher grades that have a predilection for males, and patients of older age. Meningiomas can also be seen as a spectrum of inherited syndromes such as neurofibromatosis 2 as well as ionizing radiation. In general, the 5-year survival for a WHO grade I meningioma exceeds 80%; however, survival is greatly reduced in anaplastic meningiomas. The standard of care for meningiomas in a surgically-accessible location is gross total resection. Radiation therapy is generally saved for atypical, anaplastic, recurrent, and surgically inaccessible benign meningiomas with a total dose of ~60 Gy. However, the method of radiation, regimen and timing is still evolving and is an area of active research with ongoing clinical trials. While there are currently no good adjuvant chemotherapeutic agents available, recent advances in the genomic and epigenomic landscape of meningiomas are being explored for potential targeted therapy.

Rationale: Bevacizumab has shown good efficacy in radiation necrosis (RN) following gamma knife radiosurgery (GKRS) and associated peritumoral edema. However, few studies have reported bevacizumab failure. Moreover, the pathologic transformation of benign meningioma following GKRS has never been reported. Patients concerns: A 41-year-old man was admitted with focal seizure on the right arm. Diagnoses: Magnetic resonance imaging (MRI) demonstrated a 4.7 cm-sized convexity meningioma involving left motor cortex. Interventions: Subtotally resected tumor was confirmed as a meningothelial meningioma and subsequently treated by GKRS. During 4-year follow-up after GKRS, seizure and hemiparesis had persisted with progressively worsened peritumoral edema regardless of steroid and bevacizumab treatment. Radical debulking of tumor was achieved and immunohistopathological examination revealed angiomatous meningioma with necrotic core presenting scanty VEGF expression. Outcomes: A follow-up MRI at 4 months after debulking surgery showed a marked reduction of peritumoral edema with improvement of symptoms. Lessons: This is the first report of pathologically confirmed angiomatous transformation following GKRS. Although the pathogenesis is not fully understood, this rare pathologic transformation may be closely related to RN. Also, if bevacizumab is resistant, debulking surgery for reducing tumor burden could be an effective treatment option to control the RN.

Neurofibromatosis type 2 (NF2) is an autosomal dominant Mendelian tumor predisposition disorder caused by germline pathogenic variants in the tumor suppressor NF2. Meningiomas are the second most common neoplasm in NF2, often occurring in multiple intracranial and spinal locations within the same patient. In this prospective longitudinal study, we assessed volumes and growth rates of ten spinal and ten cranial benign meningiomas in seven NF2 patients that concluded with surgical resection and performed whole-exome sequencing and copy-number variant (CNV) analysis of the tumors. Our comparison of the volume and the growth rate of NF2-associated spinal and cranial meningiomas point to the differences in timing of tumor initiation and/or to the differences in tumor progression (e.g., non-linear, saltatory growth) at these two anatomical locations. Genomic investigation of these tumors revealed that somatic inactivation of NF2 is the principal and perhaps the only driver of tumor initiation; and that tumor progression likely occurs via accumulation of CNVs, rather than point mutations. Results of this study contribute to a better understanding of NF2-associated meningiomas clinical behavior and their genetic underpinnings.

Highlights • Amplitude of intraoperative VEPs is used to monitor the function of optic radiation during neurosurgery. • We present a case where significant unilateral latency shift of the P100 component was observed. • VEP latency shifts may predict visual outcome during surgery for tumors close to the optic radiation., Objectives Intraoperative visual evoked potentials (VEPs) are used to monitor the function of optic radiation during neurosurgery with the P100 amplitude decrement as a predictor of post-operative visual deficit. However, there is currently no evidence of early VEP changes indicating reversible visual field affection. Methods In this case report, we used VEPs during surgery for a benign meningioma located in the atrium of the right lateral ventricle. The tumor was accessed through a transcortical approach via a two-centimeter corticotomy in the lateral aspect of the superior parietal lobule. We performed flash VEPs and simultaneous recordings of electroretinography alongside with multimodal intraoperative monitoring. Results We observed a significant and sustained unilateral latency shift of the P100 component of VEPs, while amplitudes temporarily dropped to 80% of baseline but recovered entirely at the end of surgery. After the operation, the patient had a left-sided lower-quadrant anopia, which recovered completely during the following three months. Diagnostic VEP with pattern reversal monocular full field stimulation at one month postoperatively showed normal latencies bilaterally. Conclusion Our case indicates that the VEP (P100) latency may be a new and valuable indicator (in addition to VEP amplitude) of the visual pathways. Significance Monitoring VEPs may be useful to detect an imminent injury and a potentially reversible functional deficit.

BACKGROUND: Pediatric cranial radiotherapy (CrRT) markedly increases risk of meningiomas. We studied meningioma risk factors with emphasis on independent and joint effects of CrRT dose, exposed cranial volume, exposure age, and chemotherapy. METHODS: The Dutch Cancer Oncology Group-Long-Term Effects after Childhood Cancer (DCOG-LATER) cohort includes 5-year childhood cancer survivors (CCSs) whose cancers were diagnosed in 1963-2001. Histologically confirmed benign meningiomas were identified from the population-based Dutch Pathology Registry (PALGA; 1990-2015). We calculated cumulative meningioma incidence and used multivariable Cox regression and linear excess relative risk (ERR) modeling. RESULTS: Among 5843 CCSs (median follow-up: 23.3 y, range: 5.0-52.2 y), 97 developed a benign meningioma, including 80 after full- and 14 after partial-volume CrRT. Compared with CrRT doses of 1-19 Gy, no CrRT was associated with a low meningioma risk (hazard ratio [HR] = 0.04, 95% CI: 0.01-0.15), while increased risks were observed for CrRT doses of 20-39 Gy (HR = 1.66, 95% CI: 0.83-3.33) and 40+ Gy (HR = 2.81, 95% CI: 1.30-6.08). CCSs whose cancers were diagnosed before age 5 versus 10-17 years showed significantly increased risks (HR = 2.38, 95% CI: 1.39-4.07). In this dose-adjusted model, volume was not significantly associated with increased risk (HR full vs partial = 1.66, 95% CI: 0.86-3.22). Overall, the ERR/Gy was 0.30 (95% CI: 0.03-unknown). Dose effects did not vary significantly according to exposure age or CrRT volume. Cumulative incidence after any CrRT was 12.4% (95% CI: 9.8%-15.2%) 40 years after primary cancer diagnosis. Among chemotherapy agents (including methotrexate and cisplatin), only carboplatin (HR = 3.55, 95% CI: 1.62-7.78) appeared associated with meningioma risk. However, we saw no carboplatin dose-response and all 9 exposed cases had high-dose CrRT. CONCLUSION: After CrRT 1 in 8 survivors developed late meningioma by age 40 years, associated with radiation dose and exposure age, relevant for future treatment protocols and awareness among survivors and physicians.

Aim: This study aimed to investigate the relationship between clinicopathological characteristics of atypical meningiomas (AM) and its post-operative recurrence. Materials and Methods: The clinicopathological characteristics and findings from follow up were retrospectively reviewed and compared between AM and benign meningioma (BM) patients. Univariate and multivariate analyses were employed to identify the factors related to the post-operative recurrence of AM. Results: More BM patients were females and received complete resection; the recurrence rate was significantly lower in BM patients as compared to AM patients. The progesterone receptor (PR), E-cadherin protein (E-Ca) and β-catenin positive rates and Ki67 labeling index were significantly different between two groups. Univariate analysis showed the age, tumor size, tumor invasiveness, E-Ca expression, and extent of resection were related to the post-operative recurrence of AM. However, multivariate analysis showed only the extent of resection and tumor invasiveness were the independent factors associated with the post-operative recurrence of AM. Conclusions: The extent of resection and tumor invasiveness are related to the post-operative recurrence of AM. To improve the surgical procedures to maximize the tumor resection is important to improve the prognosis of AM patients.

Purpose: Prospective evaluation of the efficacy of perfusion-CT (PCT) in differentiating Meningioma (low-grade and high-grade), Schwannoma and Macroadenoma. Material and methods: PCT was performed in 48 patients [16 low-grade-meningiomas, 9 high-grade-meningiomas, 11 Schwannomas, and 12 Macroadenomas]. Perfusion parameters included cerebral-blood-volume [CBV], cerebral-blood-flow [CBF], mean-transit-time [MTT] and time-to-peak [TTP]. These were derived both from the lesion and normal parenchyma and were normalised [n] by obtaining the ratio. Lesions were statistically compared using student t-test and ROC analysis. Results: The mean nCBV and nCBF of low and high-grade meningiomas showed statistical difference (P 12.43, nCBF > 6.43 yielded good sensitivity and specificity.The mean nCBV, nCBF and nMTT of macroadenomas and benign meningiomas showed statistical difference (P 2.81 yielded good sensitivity and specificity.The mean nCBV, nCBF, nMTT and nTTP of schwannomas and benign meningiomas showed statistical difference (P 3.34, nTTP

Background : Surgical access to the spinal cord at the level of C2 vertebra presents technical limitations, due to anatomical particularities in this region. The ventral slot technique does not allow space for the removal of dorsolateral masses. The axis hemilaminectomy technique provides limited access to the dorsal aspect of spinal cord and there is a risk of damaging the vertebral arteries. The axis dorsal laminotomy technique allows good access to spinal cord and preserves the atlantoaxial and nuchal ligaments, however few papers describe this technique. The objective of this paper is to report the axis dorsal laminotomy performed in a dog with a meningioma at this level. Case : An 11-year-old male, Maltese dog, was presented with a 15-day history of progressive weakness, intense cervical pain and difficulty in locomotion of the four limbs. He was being treated with painkillers without improvement. On clinical examination, the physiological parameters were normal. Neurological examination showed tetraparesis with the syndrome localized in the cranial cervical region. The main differential diagnoses were intervertebral disc disease, neoplasia, inflammatory or infectious disease. Computed tomography was performed and the evaluation of images allowed the visualization of an intradural-extramedullary neoplastic process, promoting important spinal compression, with approximate dimensions of the lesion 0.70 cm high x 0.67 cm wide x 0.78 cm long, with apparent involvement of the meninges, with a more lateralized location on the left, with meningioma being the main differential diagnosis. Thus, exploratory surgery, through the technique of dorsal laminotomy of the axis was performed. After the removal of the mass, the spinous process was repositioned in its anatomical location and fixed with 0.6 mm steel cerclage wire that was passed through the holes made in the dorsal lamina of the axis. After the surgery a neck brace was kept for 45 days. According to the histological changes observed, the neoplasm was classified as grade one meningothelial meningioma. The patient showed gradual improvement and started walking again 4 days after the surgery, staying well and without pain for 5 months, when there was a recurrence of the neoplasia. Discussion : Surgical access to the cervical region in question is limited due to the presence of complex ligamentous structures, vascular network and the anatomical features of the first and second cervical vertebrae. Thus, the dorsal axis laminotomy technique was used. The approach allowed good visualization of the spinal canal as well as the preservation of the atlantoaxial ligament, maintaining atlantoaxial stability. Through histopathological analysis, the neoplasm was classified as grade I meningothelial, which is considered a benign meningioma, but its behavior is considered malignant due to the compression of the spinal cord and the impossibility of removal with surgical margins, as recommended for oncological surgeries. The patient's survival after surgical treatment is in accordance with that described by other authors which varies from 2.2 to 47 months. Radiotherapy seems to improve the prognosis, but this therapeutic modality is not easily available in the country. There is also insufficient information on the use of chemotherapy for this type of neoplasia, or on the relationship between tumor graduation and survival. The surgery was proposed in order to confirm the suspicion, decompress the spinal cord and collect material for biopsy; the technique performed is feasible and no intraoperative complications have occurred.

Tumor-infiltrating lymphocytes (TIL) are an important component of the microenvironment in brain tumors and particularly in meningiomas. It is considered that immune cell infiltrates in meningiomas of the brain are composed of different populations of immune cells that perform a wide range of functions. Objective: To investigate the quantitative composition and distribution of CD4, CD8, CD20 tumor-infiltrating lymphocytes (TIL) in the tumor microenvironment of the brain meningiomas. Material and methods. Using immunohistochemistry 60 cases of meningiomas were analyzed. Results. The lowest quantity of CD4+ and CD8+ TIL was established in angiomatous subtypes and the median amount of CD4+ and CD8+ TIL in meningothelial subtypes was the highest, it was equal to 9 (1; 26) and 16 (8; 47) cells respectively. It was found that the number of CD4+ TIL was significantly higher in meningothelial variants than the number of CD4+ TIL in angiomatous (p = 0,035) and fibroblastic cases (p = 0,040). The number of CD8+ TIL in meningothelial subtypes was statistically significantly higher than in angiomatous (p = 0,010) and transitional (p = 0,003). We revealed that in grade I meningiomas number of CD8+ TIL significantly exceeded the number of CD4+ TIL (p = 0,003). The CD8+/CD4+ TIL ratio was 1,66. The median number of CD4+ TIL in anaplastic meningiomas was 9 (3; 20) cells, and CD8+ TIL – 14 (9; 80) cells. Although the number of CD8+ TIL exceeded the number of CD4+ TIL, but the results were not statistically significant (p = 0,164). The CD8+/CD4+ TIL ratio was 2,99. Median quantity of CD20+ TIL was increased in the following row: fibroblastic – 1 (0; 6) cells, transitional – 5,5 (0; 10) cells, meningothelial – 14,5 (0; 39) cells and anaplastic meningiomas – 24 (2,5; 46) cells. Conclusions. In benign meningiomas quantity of CD8+ TIL significantly exceeded the number of CD4+ TIL, that can play an important role in limiting the rate of growth of these tumors. There was no statistically significant difference in the number of CD4+, CD8+ and CD20+ TIL between grade I and grade III meningiomas. Interaction of immune cells in the tumor microenvironment is complex and largely depends on the phenotype of TIL, its establishment will be able to uncover the mechanisms of progression in anaplastic meningiomas.

An 80-year-old male with a previous history of thymoma and kidney cancer underwent a 18F fluorodeoxyglucose (FDG) positron emission tomography (PET)/contrast-enhanced computed tomography (CT) scan: two pulmonary nodules were discovered, both characterized by an increased glucose uptake. Of them, only one showed mild contrast enhancement. Both nodules were surgically resected: the first nodule was a benign meningioma and the second one was a malignant meningioma. This case study shows that malignancy of meningioma in the lung is not correlated with 18F FDG uptake and the contrast enhancement, thus suggesting that PET/CT may represent a suboptimal imaging modality for the evaluation of these lesions.

Introduction The depth-dose distribution of a proton beam, materialized by the Bragg peak makes it an attractive radiation modality as it reduces exposure of healthy tissues to radiations, compared with photon therapy Prominent indications, based on a long-standing experience are: intraocular melanomas, low-grade skull-base and spinal canal malignancies. However, many others potential indications are under investigations such as the benign morbid conditions that are compatible with an extended life-expectancy: low grade meningiomas, paragangliomas, pituitary adenomas, neurinomas craniopharyngioma or recurrent pleomorphic adenomas. Materials Given the radiation-induced risk of secondary cancer and the potential neurocognitive and functional alteration with photonic radiotherapy, we systematically analyzed the existing clinical literature about the use of proton therapy as an irradiation modality for cervical or intracranial benign tumors. The aim of this review was to report clinical outcomes of adult patients with benign intracranial or cervical tumors treated with proton therapy and to discuss about potential advantages of proton therapy over intensity modulated radiotherapy or radiosurgery. Results Twenty-four studies were included. There was no randomized studies. Most studies dealt with low grade meningiomas (n = 9). Studies concerning neurinoma (n = 4), pituitary adenoma (n = 5), paraganglioma (n = 5), or craniopharyngioma (n = 1) were fewer. Whatever the indication, long term local control was systematically higher than 90% and equivalent to series with conventional radiotherapy. Conclusion Proton-therapy for treatment of adult benign intracranial and cervical tumors is safe. Randomized or prospective cohorts with long term cognitive evaluations are needed to assess the real place of proton-therapy in the treatment of adults benign head and neck tumors.

BACKGROUND: Despite the good prognosis of benign meningioma, little is known about eventual impairment of patients’ psychological quality of life (pQoL), social and neuropsychological functioning after surgery. These patients might even fail to re-integrate into their private and work environment. Participating in a rehabilitation program (rehab) might be of advantage, but the impact is still undetermined. The BReMen trial (Belastung und Rehabilitation bei Meningeompatienten) aims to approach these topics. MATERIAL AND METHODS: In a prospective 2-year-follow up trial 80 patients with newly diagnosed meningioma WHO°I are planned to be included. Test time points included pre- (T1), post-surgery (T2), 3, 6, 12 and 24 months post-surgery (T3-T6). Patients` characteristics included: age, gender, educational training, localization/size of meningioma, Barthel-, distress- and work-ability-index, time to return to work.Test batteries focused on pQoL and affect: Short Form-36 Health questionnaire (SF-36), EORTC Quality of Life Questionnaire - Score 30, EORTC Quality of Life Questionnaire for brain tumor patients, PHQ-9 depression score, GAD 7 general anxiety score. Cognitive functioning was meassured by Regensburger Wortflüssigkeitstest, Verbaler Lern- und Merkfähigkeitstest (VLMT), Trail Making Test A and B, Farb-Wort-Test, Aufmerksamkeits-Belastungstest (d2-R) and Wechsler-Memory-Scale-Revised. RESULTS: This interim analysis focused on SF-36 scores, PHQ-9 and distress levels, VLMT and d2-R. So far, 50 patients were recruited, 18 patients dropped out, 32 patients reached T5. 16 of them chose to participate in rehab after surgery, 17 patients refused. Both groups presented an increasing memory function till T5 independently of rehab.Patients with a lower pQoL preferred to enter rehab, improving their SF-36 scores afterwards but again declined at T5. Similarly, patients with a higher depression score also favored rehab with a positive long term effect, thereby declining their distress levels. Additionally, patients showed a higher attention at T5 (d2-R) after rehab compared to T1, while patients without rehab declined. CONCLUSION: The decline of patients’ depression levels and improved attention might reflect the benefit of rehab. However, the re-decline of their pQoL following rehab one year after resection could be a hint for an advantage of long-term neuropsychological support in addition to short term rehab. Hopefully, these questions will be answered with the final analysis of this trial.

Introduction: Meningiomas are the most common benign Central nervous system neoplasms with higher prevalence in women. Clinical and epidemiological data reveal that meningiomas are hormone sensitive tumours and they have been found to express hormonal receptors. Though majority of meningiomas are benign, they lead to significant morbidity and mortality. Aim: This study deals with the immunohistochemical expression of Progesterone Receptor (PR) in meningiomas in correlation with various clinicopathological parameters and behaviour of the tumour. Materials and Methods: This was a retrospective and prospective study carried out at neuropathology department in a tertiary care hospital during a consecutive period of three years from 2013 to 2016. The antibodies to PR were used for 60 randomly selected cases of meningioma operated during a consecutive period of three years. The PR expression in relation to age and sex of patient, site and various histopathological grades of the tumour and their rates of recurrence were studied. Statistical analysis was carried out using SPSS software version 17. Various tests used in the study were the chi-square test for discrete variables and the t-test for continuous variables. Results: Immunohistochemical analysis revealed PR expression in 66.7% of cases. In comparison with grade I meningiomas the PR expression in high grade (grade II and III) meningiomas were found to be from weak to absent. This shows a positive association between low rates of expression of PR and increased tumour aggressiveness. Conclusion: It is concluded that expression of PR by the tumour in correlation with other histopathological features especially histological grade of the tumour has been considered as a useful prognostic tool in assessing the behaviour of meningiomas.

Primary extradural meningioma is about 1-2% of all meningiomas. Primary intraosseous meningioma is a rare form of intra-bone tumors that account for approximately 67% of extradural meningiomas. We report a primary intraosseous meningioma of a 69-year-old man who had headaches and a mass on right parietal scalp for the past few months. Remarkably, the brain tissue within the osteolytic cavity of the skull was normal in computed tomography and magnetic resonance images. Resection, duraplasty, and cranioplasty were performed. The patient's symptoms disappeared after surgery, and the histological diagnosis was an osseous meningothelial meningioma (World Health Organization grade I).

Менингиомы головного мозга – вторая по частоте диагностирования опухоль центральной нервной системы у взрослых, составляя до 30% всех первичных новообразований. С целью определения наличия и оценки уровня экспрессии цитокератина в доброкачественных и злокачественных менингиомах головного мозга в образцах ткани менингиом, удаленных во время нейрохирургических операций у 30 больных, проведено иммуногистохимическое исследование с использованием моноклональных антител Mo a-Hu Cytokeratine (PanCK), Clone AE1/AE3 («DAKO», Дания). Установлено, что анапластические менингиомы экспрессировали цитокератин в 80% случаев. Среди доброкачественных менингиом положительная экспрессия обнаружена в 40% фибробластических вариантов. Это свидетельствует, что цитокератины необходимо включить в панель иммуногистохимических маркеров, используемых при дифференциальной диагностике различных вариантов менингиом., Meningiomas of the brain are the second most common tumor of the CNS in adults, accounting about 30% of all primary tumors.Aim. In order to determine the presence and to assess the expression level of cytokeratin (CK) in benign and malignant brain meningiomas tissue samples were obtained during neurosurgical operations from 30 patients.Methods and results. Tissue samples were studied immunohistochemically by using monoclonal antibodies Mo a-Hu Cytokeratine (PanCK), Clone AE1/AE3 («DAKO», Denmark). It was established that anaplastic meningiomas expressed CK in 80% of cases. Among benign meningiomas positive expression was found in 40% of fibroblastic subtypes., Менінгіоми головного мозку – друга за частотою діагностування пухлина центральної нервової системи, що становить до 30% усіх первинних новоутворень. З метою визначення наявності та оцінювання рівня експресії цитокератину в доброякісних і злоякісних менінгіомах головного мозку у зразках тканини менінгіом, котрі видалені під час нейрохірургічних операцій у 30 хворих, здійснили імуногістохімічне дослідження з використанням моноклональних антитіл Mo a-Hu Cytokeratine (PanCK), Clone AE1/AE3 («DAKO», Данія). Встановили, що анапластичні менінгіоми експресували цитокератин у 80% випадків. Серед доброякісних менінгіом позитивну експресію виявили в 40% фібробластичних варіантів. Це свідчить, що цитокератини треба включити в панель імуногістохімічних маркерів, які використовують під час диференційної діагностики різних варіантів менінгіом.

Meningiomas are the second most common primary tumors affecting the central nervous system. Surgical treatment can be curative in case of complete resection. 5-aminolevulinic acid (5-ALA) has been established as an intraoperative tool in malignant glioma surgery. A number of studies have tried to outline the merits of 5-ALA for the resection of intracranial meningiomas. In the present paper, we review the existing literature about the application of 5-ALA as an intraoperative tool for the resection of intracranial meningiomas. PubMed was used as the database for search tasks. We included articles published in English without limitations regarding publication date. Tumor fluorescence can occur in benign meningiomas (WHO grade I) as well as in WHO grade II and WHO grade III meningiomas. Most of the reviewed studies report fluorescence of the main tumor mass with high sensitivity and specificity. However, different parts of the same tumor can present with a different fluorescent pattern (heterogenic fluorescence). Quantitative probe fluorescence can be superior, especially in meningiomas with difficult anatomical accessibility. However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder. The use of 5-ALA as a tool to guide resection of intracranial meningiomas remains experimental, especially in cases with tumor recurrence. The principle of intraoperative fluorescence as a real-time method to achieve complete resection is appealing, but the usefulness of 5-ALA is questionable. 5-ALA in intracranial meningioma surgery should only be used in a protocolled prospective and long-term study.

Lipomatous meningiomas are extremely rare subtypes of benign meningiomas and are classified as metaplastic meningioma in the World Health Organization classification. We present a 77-year-old man presented with the history of a gradually intensifying headache for the last 3 months. A right frontoparietal mass was detected on his cranial magnetic resonance imaging. The patient was operated on via a right frontoparietal craniotomy, and histopathological diagnosis was lipomatous meningioma. Distinctive characteristics of lipomatous meningiomas were discussed with special emphasis to importance of immunohistochemical examinations, particularly for its differentiation from the tumors showing similar histology though having more aggressive character.

Benign meningiomas uncommonly lead to significant cerebral edema, with only a few cases previously reported in the medical literature. The present study describes the case of a 49-year-old female who had a meningioma resection. She subsequently developed malignant cerebral edema and had episodes that were initially concerning for seizure activity. However, transient blood flow changes concerning for intracranial pressure (ICP) crises, were demonstrated on electroencephalogram (EEG) as well as noninvasive cerebral blood flow monitoring. The present case highlights the importance of close monitoring in patients with post meningioma resection cerebral edema because of the possibility of ICP crises.

Meningiomas are slow growing neoplasms of the central nervous system (CNS). Most of the tumors are benign and distant metastasis from a benign meningioma is rare. Metastasis to the liver, although rare, usually presents with hypoglycemia or occurs in conjunction with a clinical history of an intracranial meningioma or following the resection of a prior CNS meningioma, thus making clinical diagnosis relatively easy. Here we present an unusual case of metastatic meningioma to the liver in a 54-year-old female who presented with an incidental liver mass by ultrasound. Her clinical history and physical examination were unremarkable. A partial hepatectomy revealed a meningioma on histology. Further investigation by imaging studies showed a frontal parasagittal dural mass which was confirmed to be a World Health Organization (WHO) grade 1 meningioma. To our knowledge, this is the first report of a clinically silent metastatic meningioma to the liver without either a concurrent or a previous history of meningioma. Precise diagnosis of this challenging case requires high clinical suspicion, histopathology, and immunohistochemistry.

It is not known how long it takes from the initial neoplastic transformation of a cell to the detection of a tumor, which would be valuable for understanding tumor growth dynamics. Meningiomas show a broad histological, genetic and clinical spectrum, are usually benign and considered slowly growing. There is an intense debate regarding their age and growth pattern and when meningiomas should be resected. We have assessed the age and growth dynamics of 14 patients with meningiomas (WHO grade I: n = 6 with meningothelial and n = 6 with fibrous subtype, as well as n = 2 atypical WHO grade II meningiomas) by combining retrospective birth-dating of cells by analyzing incorporation of nuclear-bomb-test-derived 14C, analysis of cell proliferation, cell density, MRI imaging and mathematical modeling. We provide an integrated model of the growth dynamics of benign meningiomas. The mean age of WHO grade I meningiomas was 22.1 ± 6.5 years, whereas atypical WHO grade II meningiomas originated 1.5 ± 0.1 years prior to surgery (p, Highlights • The age of meningiomas has been difficult to study and is not understood, however age and growth dynamics may affect clinical decision making regarding surgery • We determined the age and dynamics of meningioma tumor cells using 14C retrospective birth dating strategy together with MR imaging and histological parameters • We demonstrate that the average time between initial tumorous cell transformation and detection with resection is 26.3 years in fibrous and years in 17.8 meningothelial meningiomas Meningiomas are usually benign, slowly growing and frequently occurring brain tumors that are detected incidentally upon imaging or because of causing symptoms. Many tumors remain stable, while others keep growing, why there is a debate whether or not meningiomas need surgical resection upon diagnosis. Specifically, if tumors grow in difficultly accessible brain areas, it would be clinically valuable to predict their age and growth dynamics. The 14C (radiocarbon) retrospective birth dating technique, an approach taking advantage of the above-ground atomic bomb tests during the Cold War, harbors the unique feature of dating the tumor age, thus providing insights into tumor origination and growth. Using this technique we here establish the age of meningiomas and provide an integrated model – using also MRI and histological parameters – to predict future growth of detected meningiomas, which may help in clinical decision making whether to resect the tumor.

Rationale: Meningiomas are mostly regarded as benign tumors histologically,accounting for 13% to 26% of all primary intracranial tumors.It is testified that multiple meningiomas occur in