The extended, transnasal, transsphenoidal approach for anterior skull base meningioma: considerations in patient selection

Hypopituitarism in non-neuroendocrine pituitary tumors: a systematic review

The existing evidence on pituitary function impairment in non-neuroendocrine pituitary tumors (non-PitNETs) is limited and scattered. We performed a systematic review using PubMed, Embase, Scopus, and Cochrane of all reported studies that evaluated pituitary function in craniopharyngiomas, meningiomas, germinomas, pituitary lymphomas, pituicytomas, granular cell tumors, spindle cell oncocytomas, and pituitary metastases over the past 35 years. A total of 5,614 patients from 114 studies were analyzed. The weighted mean age was 35.01 ± 2.7 years (95% CI: 34.9-35.1) and 47.5 ± 14.1% (95% CI: 47.1-47.8) were women. The overall weighted proportion of hypopituitarism was 49.1 ± 24.2% (95% CI: 48.4-49.7) and arginine vasopressin deficiency (AVD) was 18.43 ± 16.6% (95% CI: 17.9-18.9). According to tumor type, prevalence of hypopituitarism was 67.3 ± 8.1% (95% CI: 66.5-68.9) for germinomas, 61.4 ± 20.8% (95% CI: 58.8-64.1) for metastases, 58.7 ± 22.2% (95% CI: 46.2-71.3) for lymphomas, 54.4 ± 30.8% (95% CI: 45.6-63.3) for pituicytomas, 53.8 ± 12.3% (95% CI: 47.5-59.8) for oncocytomas, 49.1 ± 17.2% (95% CI: 48.6-49.6) for craniopharyngiomas, 29.7 ± 16.6% (95% CI: 22.4-36.9) for granular cell tumors, and 11.5 ± 9.1% (95% CI: 10.8-12.3) for meningiomas. When comparing the most prevalent non-PitNETs, the weighted prevalence of hypopituitarism was higher in metastases compared to craniopharyngiomas (χ2 = 696.8, df = 1), p < 0.0001. Similarly, the weighted prevalence of hypopituitarism in craniopharyngiomas was higher compared to meningiomas (χ2 = 16,278.13, df = 1), p < 0.0001. In conclusion, non-PitNETs result in hypopituitarism in approximately half of the cases and AVD in nearly one-fifth. Pituitary metastases and craniopharyngiomas demonstrate greater local aggressiveness and a higher likelihood of disrupting hypothalamic-pituitary function compared to meningiomas.

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

OBJECTIVEThe authors retrospectively analyzed the follow-up data in 130 patients with intracranial benign meningiomas after Gamma Knife radiosurgery (GKRS), evaluated the tumor progression-free survival (PFS) rate and neurological function preservation rate, and determined the predictors by univariate and multivariate survival analysis.METHODSThis cohort of 130 patients with intracranial benign meningiomas underwent GKRS between May 2012 and May 2015 at the Second Hospital of Tianjin Medical University. The median age was 54.5 years (range 25-81 years), and women outnumbered men at a ratio of 4.65:1. All clinical and radiological data were obtained for analysis. No patient had undergone prior traditional radiotherapy or chemotherapy. The median tumor volume was 3.68 cm3 (range 0.23-45.78 cm3). A median margin dose of 12.0 Gy (range 10.0-16.0 Gy) was delivered to the tumor with a median isodose line of 50% (range 50%-60%).RESULTSDuring a median follow-up of 36.5 months (range 12-80 months), tumor volume regressed in 37 patients (28.5%), was unchanged in 86 patients (66.2%), and increased in 7 patients (5.4%). The actuarial tumor progression-free survival (PFS) rate was 98%, 94%, and 87% at 1, 3, and 5 years, respectively, after GKRS. Tumor recurred in 7 patients at a median follow-up of 32 months (range 12-56 months). Tumor volume ≥ 10 cm3 (p = 0.012, hazard ratio [HR] 8.25, 95% CI 1.60-42.65) and pre-GKRS Karnofsky Performance Scale score < 90 (p = 0.006, HR 9.31, 95% CI 1.88-46.22) were independent unfavorable predictors of PFS rate after GKRS. Of the 130 patients, 101 (77.7%) presented with one or more neurological symptoms or signs before GKRS. Neurological symptoms or signs improved in 40 (30.8%) patients, remained stable in 83 (63.8%), and deteriorated in 7 (5.4%) after GKRS. Two (1.5%) patients developed new cranial nerve (CN) deficit. Tumor volume ≥ 10 cm3 (p = 0.042, HR = 4.73, 95% CI 1.06-21.17) and pre-GKRS CN deficit (p = 0.045, HR = 4.35, 95% CI 0.84-22.48) were independent unfavorable predictors for improvement in neurological symptoms or signs. Six (4.6%) patients developed new or worsening peritumoral edema with a median follow-up of 4.5 months (range 2-7 months).CONCLUSIONSGKRS provided good local tumor control and high neurological function preservation in patients with intracranial benign meningiomas. Patients with tumor volume < 10 cm3, pre-GKRS Karnofsky Performance Scale score ≥ 90, and no pre-GKRS CN deficit (I-VIII) can benefit from stereotactic radiosurgery. It can be considered as the primary or adjuvant management of intracranial benign meningiomas.

Differentiation of suprasellar meningiomas from non-functioning pituitary macroadenomas by 18F-FDG and 13N-Ammonia PET/CT

Background

Differentiation of suprasellar meningiomas (SSMs) from non-functioning pituitary macroadenomas (NFPMAs) is useful for clinical management. We investigated the utility of ¹³N-ammonia combined with ¹⁸F-FDG positron emission tomography (PET)/computed tomography (CT) in distinguishing SSMs from NFPMAs retrospectively.

Methods

Fourteen NFPMA patients and eleven SSM patients with histopathologic diagnosis were included in this study. Every patient underwent both ¹⁸F-FDG and ¹³N-ammonia PET/CT scans. The tumor to gray matter (T/G) ratios were calculated for the evaluation of tumor uptake.

Results

The uptake of ¹⁸F-FDG was higher in NFPMAs than SSMs, whereas the uptake of ¹³N-ammonia was obviously lower in NFPMAs than SSMs. The differences of ¹⁸F-FDG and ¹³N-ammonia uptake between the two groups were significant respectively (0.92[0.46] vs 0.59[0.29], P < 0.05, ¹⁸F-FDG; 1.58 ± 0.56 vs 2.80 ± 1.45, P < 0.05, ¹³N-ammonia). Tumor classification demonstrated a high overall accuracy of 96.0% for differential diagnosis. When the two traces were combined, only 1 SSM was misclassified into the NFPMA group.

Conclusion

SSMs and NFPMAs have different metabolic characteristics on ¹⁸F-FDG and ¹³N-ammonia PET images. The combination of these two tracers can effectively distinguish SSMs from NFPMAs.