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Abstract Background Meningiomas are common central nervous system tumors, predominantly intracranial, they rarely develop extracranially. Moreover, benign meningiomas seldom metastasize. Case presentation This article presents a case report of a 55-year-old Chinese male patient with a primary World Health Organization grade 1 meningioma originating from the petrous apex of the temporal bone, accompanied by pulmonary metastasis. Following two incomplete resections of the primary tumor, the patient underwent radiotherapy and has since maintained a stable condition. Conclusion The case report highlights the rare occurrence of pulmonary metastasis in a benign World Health Organization grade 1 meningioma originating from an extracranial site. It also illustrates the important role of radiotherapy in treating patients with meningioma. Additionally, a review of related literature is provided to gain insights for the diagnosis and treatment of the disease.

Background: Meningiomas are common central nervous system tumors, predominantly intracranial, they rarely develop extracranially. Moreover, benign meningiomas seldom metastasize. Case presentation: This article presents a case report of a 55-year-old Chinese male patient with a primary World Health Organization grade 1 meningioma originating from the petrous apex of the temporal bone, accompanied by pulmonary metastasis. Following two incomplete resections of the primary tumor, the patient underwent radiotherapy and has since maintained a stable condition. Conclusion: The case report highlights the rare occurrence of pulmonary metastasis in a benign World Health Organization grade 1 meningioma originating from an extracranial site. It also illustrates the important role of radiotherapy in treating patients with meningioma. Additionally, a review of related literature is provided to gain insights for the diagnosis and treatment of the disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: Meningiomas are one of the most common benign tumors in the intracranial field, and clinical treatment is mainly surgery. However, the postoperative recurrence rate is high, and other treatment modalities do not yet have a definite effect, so the exploration of new targeted drugs is promising for meningioma treatment. At present, the pathogenesis of autophagy in benign meningiomas is not very clear, and a large number of experiments are still needed for in-depth study. OBJECTIVE: To investigate the ultrastructural features and clinical significance of autophagy in benign meningiomas. METHODS: Meningiomas were diagnosed by light microscopy with different subtyping. Diagnosis and typing of meningiomas were aided by transmission electron microscopy, and the ultrastructural morphology and number of autophagosomes in the cytoplasm of meningioma cells of different grades were observed. Western blot assay was used to detect the expression levels of autophagy-related proteins Beclin1 and LC3 in different grades of meningiomas. The altered expression of Vimentin, EMA, PR, S-100 and GFAP in meningiomas was evaluated by immunohistochemical staining. RESULTS AND CONCLUSION: 176 meningiomas were identified, including 98 males and 78 females. (1) Histopathological types CNS WHO grade 1 benign meningiomas comprised a total of 168 cases, including 62 cases of meningocortical type, 36 cases of fibrous type, 58 cases of transitional type, 12 cases of angiomatous type, 4 cases of CNS WHO grade 2 clear cell type, 2 cases of atypical type, and 2 cases of WHO grade 3 anaplastic lesions. (2) Transmission electron microscopy revealed autophagic bodies in 27 cases of WHO grade 1 meningiomas, and no autophagic bodies were detected in WHO grades 2 and 3 meningiomas. (3) LC3 and Beclin1 were highly expressed in WHO grade 1 benign meningiomas by western blot assay and were negatively expressed in WHO grades 2 and 3 meningiomas. (4) The immunohistochemical markers Vimentin, EMA, and PR, were expressed to various degrees, while GFAP and S-100 were negative. (5) A combination of electron microscopy, immunohistochemical staining and western blot assay showed that autophagy only plays an important role in the occurrence and development of WHO grade 1 benign meningiomas. [ABSTRACT FROM AUTHOR]

Objective: Meningiomas can lead to significant morbidity and mortality and have recurrence potential. While previous studies have focused on calculating recurrence risk, the precise location of the recurrence has not been delineated. This study aimed to investigate the spatial clustering pattern of recurrence relative to the original surgical bed for surgically treated Simpson Grade I-III, WHO Grade 1 meningiomas. Methods: Patients diagnosed with grade 1 meningiomas and treated with surgical resection with subsequent recurrence were reviewed. Patient demographics, clinical outcomes, and radiographic characteristics were collected. Radiological images were analyzed to determine the location of recurrence relative to the initial tumor. We characterized recurrence as type A (within the surgical bed), type B (outside of the surgical bed, within 1 cm from the site), and type C (distal ≥ 1 cm of the resection site). Results: Forty-two cases met the inclusion criteria. Twelve patients (29%) were male, and 30 (71%) were female. Median age at first treatment was 47 years, with 5.2 ± 3.4 years until recurrence. Recurrence rate was 54.7% at 5 years and 90.4% at 10 years. Twenty-eight patients (66.7%) had a type A recurrence, 11 (26.1%) had a type B recurrence, and 3 (7.1%) had a type C recurrence. Conclusions: Our series demonstrates that while lesions often recur within the original lesion site, a significant portion recurs beyond the surgical bed. This highlights the substantial possibility of recurrence outside the resection cavity for fully excised benign meningiomas, which may aid in understanding disease progression and in guiding adjuvant therapy. [ABSTRACT FROM AUTHOR]

Objective To investigate the culture of benign meningioma and leptomeningeal primary cells and the effects of lipopolysaccharide（ LPS） on their proliferation. Method Primary benign meningioma and leptomeningeal cells were cultured by chemical digestion. Immunofluorescence was used to identify the meningioma cells. Cell proliferation was tested by CCK-8. The mRNA expression of inflammatory factors such as IL-1β,IL-6,TNF-α and NF-κB was tested by real-time PCR. Results The primary cells of benign meningioma and leptomeningeal cells were successfully cultured.Immunofluorescence identification showed that the cells expressed epithelioma antigen（ EMA） and vimentin（ VIM）. After treatment with LPS,the cell proliferation was up-regulated with time and concentration,and the expression of inflammatory factors,such as IL-1β,TNF-α,IL-6 and NF-κB were increased. Conclusions The success of primary benign meningioma and leptomeningeal cell culture would lay the foundation for further basic research of benign meningioma. After LPS treatment,cell proliferation increases significantly,inflammatory factors and NF-κB expression is up-regulated. And the growth of benign meningiomas has a close relationship with inflammation. [ABSTRACT FROM AUTHOR]

Purpose: Patients with a benign meningioma often have a long survival following the treatment of their meningioma. Since radiotherapy is frequently part of the treatment, long-term side effects are of considerable concern. A controversial long-term side effect of radiotherapy is stroke. Due to its severity, it is important to know the frequency of this side effect. The aim of this study was to assess the stroke incidence and risk factors among patients receiving radiotherapy for their benign meningioma. Methods: We performed a retrospective database study of patients who underwent primary or adjuvant radiotherapy for their benign meningioma at University Hospitals Leuven from January 2003 to December 2017. Results: We included 169 patients with a median age of 51 years (range 22–84). Every patient received fractionated radiotherapy using photons with a median dose of 56 Gy (range 54–56) in fractions of 2 Gy (range 1.8–2). The median follow-up was 5.3 years (range 0.1–14). The cumulative stroke incidence function showed an incidence of 11.6% after 9 years of follow-up, translating to a stroke incidence per year of 1.29%. We found two significant risk factors for stroke: medically treated arterial hypertension (p = 0.005) and history of previous stroke or transient ischemic attack (p < 0.001). 5-year local control and overall survival rates were respectively 97.4% and 91.2%. Other late grade III/IV toxicities occurred in 16.0% (27/169) of patients. Conclusion: Our study shows a higher incidence of stroke in patients who received radiotherapy for their benign meningioma compared to the general population. [ABSTRACT FROM AUTHOR]

Older patients have inferior outcomes for meningioma and experience more post-operative complications. The purpose of this study was to identify national treatment patterns and outcomes based on age for benign meningiomas using the National Cancer Database (NCDB). The NCDB was queried for patients with biopsy-proven World Health Organization Grade (WHO) grade I meningioma diagnosed between 2004 and 2015. Patients were stratified based on age: 18–50, 51–60, 61–70, 71–80, and > 80 years of age. Clinicodemographic details were compared via the Chi Square test. Multivariable logistic regression was used to determine factors associated with receipt of treatment and post-operative complications. Multivariable Cox regression and the Kaplan-Meier method were used to examine survival. 56,960 patients met inclusion criteria with a median follow-up of 48 months. Ages 61–70 (OR 0.73, 95% CI 0.62–0.85, p <.001), ages 71–80 (OR 0.51, 95% CI 0.43–0.60, p <.001), and age > 80 (0.16, 95% CI 0.14–0.19, p <.001) were less likely to receive treatment. Older age groups were associated with increased risk of post-operative complications and post-operative complications predicted for decreased survival. Treatment with surgery (HR 0.57, 95% CI 0.52–0.62, p <.001) and surgery and radiation (HR 0.59, 95% CI 0.50–0.70, p <.001) provided a survival benefit. Older age was associated with a survival decrement. Older patients are less likely to undergo treatment for benign meningioma and are more likely to have post-operative complications. Survival decreased with increasing age. Treatment improved survival among all patients. Risk-benefit ratio of treatment should be carefully considered when treating older patients with benign meningioma. [ABSTRACT FROM AUTHOR]

• Progression of postoperative benign meningiomas after gamma knife radiosurgery was classified into 3 categories. • Progression outside the high-dose field and progression of World Health Organization (WHO) grade were focused on. • Remote progression occurred earlier than progression of WHO grade in some patients. • A longer pre-operative maximum diameter was associated with progression out of the margin dose and progression of WHO grade. The use of gamma knife radiosurgery (GKS) for meningiomas after cranial surgery has been extensively evaluated; however, studies on tumor progression, including recurrence out of the margin dose line, are scarce. Hence, we aimed to evaluate the meningioma recurrence after GKS within and out of the margin dose. We included 37 consecutive patients with World Health Organization (WHO) grade 1 meningiomas who were treated with GKS following cranial surgery. Radiologically indicated recurrences were classified into three patterns by their relationship to the margin dose and tumor. The median follow-up was 58.9 months; 2 (5.4%) patients died. Only 2 (5.4%) patients did not keep active daily lives because of tumor progression. Cumulative local control at 5 years was 85.2%. Local recurrence and recurrence out of the margin dose occurred in 5 (13.5%) and 13 (35.1%) patients, respectively. A larger preoperative maximum diameter was a risk factor for local recurrence (hazard ratio [HR]: 2.118; P = 0.033), adjacent progression (HR: 1.633; P = 0.015), and remote progression (HR: 2.016; P = 0.003). Symptomatic adverse radiation effects occurred in 1 patient. Salvage GKS and cranial surgery were performed in 9 (24.3%) and 8 (21.6%) patients, respectively. Progression to WHO grade 2–3 occurred in 5 (13.5%) patients. A larger preoperative maximum diameter was a risk factor for progression of WHO grade (HR: 2.016, P = 0.033). Progression out of the margin dose was associated with a larger preoperative tumor size. [ABSTRACT FROM AUTHOR]

• Compared to VMAT and IMRT, IMPT significantly reduces the hippocampi doses. • Large dose reductions are also observed for normal brain and other organs at risk. • The results support consideration of IMPT for skull-base meningiomas >3 cm. Radiotherapy of skull-base meningiomas is challenging due to the close proximity of multiple sensitive organs at risk (OARs). This study systematically compared intensity modulated proton therapy (IMPT), non-coplanar volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) based on automated treatment planning. Differences in OARs sparing, with specific focus on the hippocampi, and low-dose delivery were quantified. Twenty patients, target diameter >3 cm, were included. Automated plan generation was used to calculate a VMAT plan with three non-coplanar arcs, an IMRT plan with nine non-coplanar beams with optimized gantry and couch angles, and an IMPT plan with three patient-specific selected non-coplanar beams. A prescription dose of 50.4 GyRBE in 28 fractions was used. The same set of constraints and prioritized objectives was used. All plans were rescaled to the same target coverage. Repeated measures ANOVA was used to assess the statistical significance of differences in OAR dose parameters between planning techniques. Compared to VMAT and IMRT, IMPT significantly improved dose conformity to the target volume. Consequently, large dose reductions in OARs were observed. With respect to VMAT, the mean dose and D 40% in the bilateral hippocampus were on average reduced by 48% and 74%, respectively (p ≤ 0.005). With IMPT, the mean dose in the normal brain and volumes receiving 20–30 Gy were up to 47% lower (p ≤ 0.01). When comparing IMPT and IMRT, even larger dose differences in those OARs were observed. For skull-base meningiomas IMPT allows for a considerable dose reduction in the hippocampi, normal brain and other OARs compared to both non-coplanar VMAT and IMRT, which may lead to a clinically relevant reduction of late neurocognitive side effects. [ABSTRACT FROM AUTHOR]

Highlights • Proton therapy is an efficient alternative to photonic radiotherapy for the treatment of intra cranial or cervical benign tumors. • For these tumors, proton therapy could reduce neurocognitive impairment and risk of radio-induced secondary cancers. • Proton therapy achieves excellent local control with low toxicity rates. • Large randomized trials are still needed to assess proton therapy clinical advantages in comparison with radiosurgery or intensity modulated radiotherapy. Abstract 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. [ABSTRACT FROM AUTHOR]