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Mohammad NK. Neuroanatomical insights into neuro-ophthalmic presentations of skull base meningiomas: Pathways to precision medicine - A meta-analysis. Surg Neurol Int 2024; 15:224. [PMID: 38974542 PMCID: PMC11225517 DOI: 10.25259/sni_421_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Background Skull base meningiomas are intricately related to neuro-ophthalmic functions and have been related to direct influences on both the afferent and efferent visual pathways due to close contacts with crucial neurovascular structures. The present article reviews the neuro-ophthalmic presentations of these tumors, necessitating the need for precise anatomic information for the delivery of customized diagnostic and therapeutic approaches. Methods A literature review was conducted using PubMed and Scopus, focusing on terms related to skull base meningiomas and their neuro-ophthalmic impacts. The review included recent and seminal articles to assess advances in understanding and managing these tumors from an anatomical perspective. Results The findings underscore the diversity in neuro-ophthalmic manifestations based on the meningioma's location, affecting visual pathways differently. For instance, meningiomas in the optic nerve sheath typically lead to isolated optic neuropathy and are often managed with radiation therapy. In contrast, those extending from the sphenoid wing require more aggressive approaches like open surgery. This review highlights how the tumor's location dictates the choice of treatment, ranging from conservative management to multidisciplinary surgical interventions. Conclusion Proper recognition of the sites of skull base meningiomas results in a treatment tailored to provide therapy aimed explicitly at neuro-ophthalmic outcomes related to the site of the tumors. This approach will not only help to treat effectively but also avoid a wide range of complications and, in turn, increase the effectiveness of the treatment results that a patient will receive. Future studies should aim to refine these anatomical insights toward further advancements in modes of treatment.
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Affiliation(s)
- Najah K. Mohammad
- Department of Surgery, University of Baghdad, College of Medicine, Baghdad, Iraq
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2
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Fouda MA, Kallman S, Boorstin R, Sacks-Zimmerman A, Pannullo SC, Bender HA. The unseen impact - a deep dive into neurocognitive impairment among patients with intracranial meningiomas: a comprehensive systematic review of the literature. Neurosurg Rev 2024; 47:294. [PMID: 38922363 DOI: 10.1007/s10143-024-02530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024]
Abstract
Meningiomas are the most common intracranial tumors, predominantly affecting adults, with a higher incidence in female and elderly populations. Despite their prevalence, research on neurocognitive impairment in meningioma patients remains limited compared to intra-axial tumors such as gliomas. We conducted a comprehensive systematic review of the current literature on neurocognitive outcomes in meningioma patients pre- and post-surgery. Our review revealed significant disparities in reported neurocognitive outcomes, with prospective studies suggesting tumor-related factors as the primary contributors to postoperative deficits, while retrospective studies imply surgical intervention plays a significant role. Regardless of study design or specifics, most studies lack baseline preoperative neurocognitive assessments and standardized protocols for evaluating neurocognitive function. To address these gaps, we advocate for standardized neurocognitive assessment protocols, consensus on neurocognitive domains to be targeted in this population by tailored test batteries, and more prospective studies to elucidate correlations between tumor characteristics, patient attributes, surgical interventions, neurocognitive status, and planning for implementing tailored neurocognitive rehabilitation strategies early in the postoperative course which is crucial for achieving optimal long-term neurocognitive outcomes and enhancing patients' quality of life.
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Affiliation(s)
- Mohammed A Fouda
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA.
| | - Samantha Kallman
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - Rebecca Boorstin
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - Amanda Sacks-Zimmerman
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
| | - H Allison Bender
- Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, 10065, USA
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Carnevale JA, Rosen KU, Chae JK, Pandey A, Bander ED, Godfrey K, Schwartz TH. The Endoscopic Lateral Transorbital Approach for the Removal of Select Sphenoid Wing and Middle Fossa Meningiomas. Surgical Technique and Short-Term Outcomes. Oper Neurosurg (Hagerstown) 2024; 26:165-172. [PMID: 37747338 DOI: 10.1227/ons.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/30/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The endoscopic lateral transorbital approach (eLTOA) is a relatively new approach to the skull base that has only recently been applied in vivo in the management of complex skull base pathology. Most meningiomas removed with this approach have been in the spheno-orbital location. We present a series of select purely sphenoid wing and middle fossa meningiomas removed through eLTOA. The objective here was to describe the selection criteria and results of eLTOA for a subset of sphenoid wing and middle fossa meningiomas. METHODS This is a retrospective study based on a prospectively maintained database of consecutive cases of eLTOA operated on at our institution by the lead author. The cohort's clinical and radiographic characteristics and outcome are presented. RESULTS Five patients underwent eLTOA to remove 3 sphenoid wing and 2 middle fossa meningiomas. The mean tumor volume was 11.9 cm 3 . Gross total resection was achieved in all cases. There were no intraoperative complications. Postoperatively, there was one case of subretinal hemorrhage, which was corrected by open vitrectomy repair, and one case of cerebrospinal fluid leak, which resolved with lumbar drainage. Three patients presented with visual impairment, 1 improved, 1 remained stable, and 1 worsened, but returned to stable after vitrectomy repair. All patients have been free of disease at a median follow-up of 8.9 months. CONCLUSION eLTOA provides a direct minimal access corridor to certain well-selected sphenoid wing and middle fossa meningiomas. eLTOA minimizes brain retraction and provides a high rate of gross total resection. Meningiomas appropriately selected based on size, type, and location of dural attachment, and the eLTOA is a safe, rapid, and highly effective procedure with acceptable morbidity.
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Affiliation(s)
- Joseph A Carnevale
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - Kate U Rosen
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - John K Chae
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - Abhinav Pandey
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - Evan D Bander
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - Kyle Godfrey
- Department of Ophthalmology, Division of Oculoplastic Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
- Department of Otolaryngology and Neuroscience, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
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Stoecklein VM, Wunderlich S, Papazov B, Thon N, Schmutzer M, Schinner R, Zimmermann H, Liebig T, Ricke J, Liu H, Tonn JC, Schichor C, Stoecklein S. Perifocal Edema in Patients with Meningioma is Associated with Impaired Whole-Brain Connectivity as Detected by Resting-State fMRI. AJNR Am J Neuroradiol 2023; 44:814-819. [PMID: 37385680 PMCID: PMC10337612 DOI: 10.3174/ajnr.a7915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/28/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Meningiomas are intracranial tumors that usually carry a benign prognosis. Some meningiomas cause perifocal edema. Resting-state fMRI can be used to assess whole-brain functional connectivity, which can serve as a marker for disease severity. Here, we investigated whether the presence of perifocal edema in preoperative patients with meningiomas leads to impaired functional connectivity and if these changes are associated with cognitive function. MATERIALS AND METHODS Patients with suspected meningiomas were prospectively included, and resting-state fMRI scans were obtained. Impairment of functional connectivity was quantified on a whole-brain level using our recently published resting-state fMRI-based marker, called the dysconnectivity index. Using uni- and multivariate regression models, we investigated the association of the dysconnectivity index with edema and tumor volume as well as cognitive test scores. RESULTS Twenty-nine patients were included. In a multivariate regression analysis, there was a highly significant association of dysconnectivity index values and edema volume in the total sample and in a subsample of 14 patients with edema, when accounting for potential confounders like age and temporal SNR. There was no statistically significant association with tumor volume. Better neurocognitive performance was strongly associated with lower dysconnectivity index values. CONCLUSIONS Resting-state fMRI showed a significant association between impaired functional connectivity and perifocal edema, but not tumor volume, in patients with meningiomas. We demonstrated that better neurocognitive function was associated with less impairment of functional connectivity. This result shows that our resting-state fMRI marker indicates a detrimental influence of peritumoral brain edema on global functional connectivity in patients with meningiomas.
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Affiliation(s)
- V M Stoecklein
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - S Wunderlich
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - B Papazov
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - N Thon
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - M Schmutzer
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
| | - R Schinner
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - H Zimmermann
- Department of Neuroradiology (H.Z., T.L.), Ludwig-Maximilians-University Munich, Munich, Germany
| | - T Liebig
- Department of Neuroradiology (H.Z., T.L.), Ludwig-Maximilians-University Munich, Munich, Germany
| | - J Ricke
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - H Liu
- Department of Radiology (H.L.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Haard Medical School, Boston, Massachusetts
- Department of Neuroscience (H.L.), Medical University of South Carolina, Charleston, South Carolina
| | - J-C Tonn
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - C Schichor
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - S Stoecklein
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
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Locomotion Outcome Improvement in Mice with Glioblastoma Multiforme after Treatment with Anastrozole. Brain Sci 2023; 13:brainsci13030496. [PMID: 36979306 PMCID: PMC10046174 DOI: 10.3390/brainsci13030496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Glioblastoma Multiforme (GBM) is a tumor that infiltrates several brain structures. GBM is associated with abnormal motor activities resulting in impaired mobility, producing a loss of functional motor independence. We used a GBM xenograft implanted in the striatum to analyze the changes in Y (vertical) and X (horizontal) axis displacement of the metatarsus, ankle, and knee. We analyzed the steps dissimilarity factor between control and GBM mice with and without anastrozole. The body weight of the untreated animals decreased compared to treated mice. Anastrozole reduced the malignant cells and decreased GPR30 and ERα receptor expression. In addition, we observed a partial recovery in metatarsus and knee joint displacement (dissimilarity factor). The vertical axis displacement of the GBM+anastrozole group showed a difference in the right metatarsus, right knee, and left ankle compared to the GBM group. In the horizontal axis displacement of the right metatarsus, ankle, and knee, the GBM+anastrozole group exhibited a difference at the last third of the step cycle compared to the GBM group. Thus, anastrozole partially modified joint displacement. The dissimilarity factor and the vertical and horizontal displacements study will be of interest in GBM patients with locomotion alterations. Hindlimb displacement and gait locomotion analysis could be a valuable methodological tool in experimental and clinical studies to help diagnose locomotive deficits related to GBM.
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Sekely A, Tsang DS, Mabbott D, Kongkham P, Zadeh G, Zakzanis KK, Edelstein K. Radiation dose to circumscribed brain regions and neurocognitive function in patients with meningioma. Neurooncol Pract 2022; 9:208-218. [PMID: 35601975 PMCID: PMC9113401 DOI: 10.1093/nop/npac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Although radiation (RT) is standard treatment for many brain tumors, it may contribute to neurocognitive decline. The objective of this study was to investigate associations between RT dose to circumscribed brain regions and specific neurocognitive domains in patients with meningioma. Methods We undertook a retrospective study of 40 patients with meningioma who received RT and underwent an in-depth clinical neurocognitive assessment. Radiation dosimetry characteristics were delineated based on treatment planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Principal components analysis was applied to organize neurocognitive test scores into factors, and multivariate multiple linear regression models were undertaken to examine if RT dose to circumscribed brain regions is associated with specific neurocognitive outcomes. Results Radiation dose to brain regions was associated with neurocognitive functions across a number of domains. High dose to the parietal-occipital region was associated with slower visuomotor processing speed (mean dose, β = -1.100, P = .017; dose to 50% of the region [D50], β = -0.697, P = .049). In contrast, high dose to the dorsal frontal region was associated with faster visuomotor processing speed (mean dose, β = 0.001, P = .036). Conclusions These findings suggest that RT delivered to brain regions (ie, parietal-occipital areas) may contribute to poor neurocognitive outcomes. Given that modern radiotherapy techniques allow for precise targeting of dose delivered to brain regions, prospective trials examining relations between dose and neurocognitive functions are warranted to confirm these preliminary results.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neurosciences, and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kongkham
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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7
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Wolthuis N, Bosma I, Bastiaanse R, Cherian PJ, Smits M, Veenstra W, Wagemakers M, Vincent A, Satoer D. Distinct Slow-Wave Activity Patterns in Resting-State Electroencephalography and Their Relation to Language Functioning in Low-Grade Glioma and Meningioma Patients. Front Hum Neurosci 2022; 16:748128. [PMID: 35399357 PMCID: PMC8986989 DOI: 10.3389/fnhum.2022.748128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/16/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Brain tumours frequently cause language impairments and are also likely to co-occur with localised abnormal slow-wave brain activity. However, it is unclear whether this applies specifically to low-grade brain tumours. We investigate slow-wave activity in resting-state electroencephalography (EEG) in low-grade glioma and meningioma patients, and its relation to pre- and postoperative language functioning. Method Patients with a glioma (N = 15) infiltrating the language-dominant hemisphere and patients with a meningioma (N = 10) with mass effect on this hemisphere underwent extensive language testing before and 1 year after surgery. EEG was registered preoperatively, postoperatively (glioma patients only), and once in healthy individuals. Slow-wave activity in delta- and theta- frequency bands was evaluated visually and quantitatively by spectral power at three levels over the scalp: the whole brain, the affected hemisphere, and the affected region. Results Glioma patients had increased delta activity (affected area) and increased theta activity (all levels) before and after surgery. In these patients, increased preoperative theta activity was related to the presence of language impairment, especially to poor word retrieval and grammatical performance. Preoperative slow-wave activity was also related to postoperative language outcomes. Meningioma patients showed no significant increase in EEG slow-wave activity compared to healthy individuals, but they presented with word retrieval, grammatical, and writing problems preoperatively, as well as with writing impairments postoperatively. Discussion Although the brain-tumour pathology in low-grade gliomas and meningiomas has a different effect on resting-state brain activity, patients with low-grade gliomas and meningiomas both suffer from language impairments. Increased theta activity in glioma patients can be considered as a language-impairment marker, with prognostic value for language outcome after surgery.
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Affiliation(s)
- Nienke Wolthuis
- Center for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, Netherlands
| | - Ingeborg Bosma
- Department of Neurology, University Medical Center Groningen, Groningen, Netherlands
| | - Roelien Bastiaanse
- Center for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, Netherlands
- National Research University Higher School of Economics, Moscow, Russia
| | - Perumpillichira J. Cherian
- Department of Neurology, University Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Neurology, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Wencke Veenstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Michiel Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, Groningen, Netherlands
| | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC – University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Djaina Satoer
- Department of Neurosurgery, Erasmus MC – University Medical Center Rotterdam, Rotterdam, Netherlands
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A systematic review and meta-analysis of the association between cyproterone acetate and intracranial meningiomas. Sci Rep 2022; 12:1942. [PMID: 35121790 PMCID: PMC8816922 DOI: 10.1038/s41598-022-05773-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/17/2022] [Indexed: 12/22/2022] Open
Abstract
The influence of exposure to hormonal treatments, particularly cyproterone acetate (CPA), has been posited to contribute to the growth of meningiomas. Given the widespread use of CPA, this systematic review and meta-analysis attempted to assess real-world evidence of the association between CPA and the occurrence of intracranial meningiomas. Systematic searches of Ovid MEDLINE, Embase and Cochrane Controlled Register of Controlled Trials, were performed from database inception to 18th December 2021. Four retrospective observational studies reporting 8,132,348 patients were included in the meta-analysis. There was a total of 165,988 subjects with usage of CPA. The age of patients at meningioma diagnosis was generally above 45 years in all studies. The dosage of CPA taken by the exposed group (n = 165,988) was specified in three of the four included studies. All studies that analyzed high versus low dose CPA found a significant association between high dose CPA usage and increased risk of meningioma. When high and low dose patients were grouped together, there was no statistically significant increase in risk of meningioma associated with use of CPA (RR = 3.78 [95% CI 0.31–46.39], p = 0.190). Usage of CPA is associated with increased risk of meningioma at high doses but not when low doses are also included. Routine screening and meningioma surveillance by brain MRI offered to patients prescribed with CPA is likely a reasonable clinical consideration if given at high doses for long periods of time. Our findings highlight the need for further research on this topic.
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9
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Fisher FL, Zamanipoor Najafabadi AH, van der Meer PB, Boele FW, Peerdeman SM, Peul WC, Taphoorn MJB, Dirven L, van Furth WR. Long-term health-related quality of life and neurocognitive functioning after treatment in skull base meningioma patients. J Neurosurg 2021; 136:1077-1089. [PMID: 34598137 DOI: 10.3171/2021.4.jns203891] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with skull base meningioma (SBM) often require complex surgery around critical neurovascular structures, placing them at high risk of poor health-related quality of life (HRQOL) and possibly neurocognitive dysfunction. As the survival of meningioma patients is near normal, long-term neurocognitive and HRQOL outcomes are important to evaluate, including evaluation of the impact of specific tumor location and treatment modalities on these outcomes. METHODS In this multicenter cross-sectional study including patients 5 years or more after their last tumor intervention, Short-Form Health Survey (SF-36) and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-BN20 questionnaires were used to assess generic and disease-specific HRQOL. Neurocognitive functioning was assessed with standardized neuropsychological assessment. SBM patient assessments were compared with those of 1) informal caregivers of SBM patients who served as controls and 2) convexity meningioma patients. In addition, the authors compared anterior/middle SBM patients with posterior SBM patients and anterior/middle and posterior SBM patients separately with controls. Multivariable and propensity score regression analyses were performed to correct for possible confounders. RESULTS Patients with SBM (n = 89) with a median follow-up of 9 years after the last intervention did not significantly differ from controls (n = 65) or convexity meningioma patients (n = 84) on generic HRQOL assessment. Statistically significantly but not clinically relevantly better disease-specific HRQOL was found for SBM patients compared with convexity meningioma patients. Anterior/middle SBM patients (n = 62) had significantly and clinically relevantly better HRQOL in SF-36 and EORTC QLQ-BN20 scores than posterior SBM patients (n = 27): physical role functioning (corrected difference 17.1, 95% CI 0.2-34.0), motor dysfunction (-10.1, 95% CI -17.5 to -2.7), communication deficit (-14.2, 95% CI -22.7 to -5.6), and weakness in both legs (-10.1, 95% CI -18.8 to -1.5). SBM patients whose primary treatment was radiotherapy had lower HRQOL scores compared with SBM patients who underwent surgery on two domains: bodily pain (-33.0, 95% CI -55.2 to -10.9) and vitality (-18.9. 95% CI -33.7 to -4.1). Tumor location and treatment modality did not result in significant differences in neurocognitive functioning, although 44% of SBM patients had deficits in at least one domain. CONCLUSIONS In the long term, SBM patients do not experience significantly more sequelae in HRQOL and neurocognitive functioning than do controls or patients with convexity meningioma. Patients with posterior SBM had poorer HRQOL than anterior/middle SBM patients, and primary treatment with radiotherapy was associated with worse HRQOL. Neurocognitive functioning was not affected by tumor location or treatment modality.
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Affiliation(s)
- Fleur L Fisher
- 1Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and Haaglanden Medical Center and Haga Teaching Hospitals, Leiden and The Hague
| | - Amir H Zamanipoor Najafabadi
- 1Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and Haaglanden Medical Center and Haga Teaching Hospitals, Leiden and The Hague.,2Department of Neurology, Leiden University Medical Center, Leiden; The Netherlands
| | - Pim B van der Meer
- 2Department of Neurology, Leiden University Medical Center, Leiden; The Netherlands
| | - Florien W Boele
- 3Leeds Institute of Medical Research at St. James's, St. James's University Hospital, Leeds.,4Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Saskia M Peerdeman
- 5Department of Neurosurgery, Amsterdam University Medical Centers, location VUmc, Amsterdam; and
| | - Wilco C Peul
- 1Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and Haaglanden Medical Center and Haga Teaching Hospitals, Leiden and The Hague
| | - Martin J B Taphoorn
- 2Department of Neurology, Leiden University Medical Center, Leiden; The Netherlands.,6Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Linda Dirven
- 2Department of Neurology, Leiden University Medical Center, Leiden; The Netherlands.,6Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Wouter R van Furth
- 1Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and Haaglanden Medical Center and Haga Teaching Hospitals, Leiden and The Hague
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10
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Magill ST, Nguyen MP, Aghi MK, Theodosopoulos PV, Villanueva-Meyer JE, McDermott MW. Postoperative diffusion-weighted imaging and neurological outcome after convexity meningioma resection. J Neurosurg 2021; 135:1008-1015. [PMID: 33513570 DOI: 10.3171/2020.8.jns193537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Convexity meningiomas are commonly managed with resection. Motor outcomes and predictors of new deficits after surgery are poorly studied. The objective of this study was to determine whether postoperative diffusion-weighted imaging (DWI) was associated with neurological deficits after convexity meningioma resection and to identify the risk factors for postoperative DWI restriction. METHODS A retrospective review of patients who had undergone convexity meningioma resection from 2014 to 2018 was performed. Univariate and multivariate logistic regressions were performed to identify variables associated with postoperative neurological deficits and a DWI signal. The amount of postoperative DWI signal was measured and was correlated with low apparent diffusion coefficient maps to confirm ischemic injury. RESULTS The authors identified 122 patients who had undergone a total of 125 operations for convexity meningiomas. The median age at surgery was 57 years, and 70% of the patients were female. The median follow-up was 26 months. The WHO grade was I in 62% of cases, II in 36%, and III in 2%. The most common preoperative deficits were seizures (24%), extremity weakness/paralysis (16%), cognitive/language/memory impairment (16%), and focal neurological deficit (16%). Following resection, 89% of cases had no residual deficit. Postoperative DWI showed punctate or no diffusion restriction in 78% of cases and restriction > 1 cm in 22% of cases. An immediate postoperative neurological deficit was present in 14 patients (11%), but only 8 patients (7%) had a deficit at 3 months postoperatively. Univariate analysis identified DWI signal > 1 cm (p < 0.0001), tumor diameter (p < 0.0001), preoperative motor deficit (p = 0.0043), older age (p = 0.0113), and preoperative embolization (p = 0.0171) as risk factors for an immediate postoperative deficit, whereas DWI signal > 1 cm (p < 0.0001), tumor size (p < 0.0001), and older age (p = 0.0181) were risk factors for deficits lasting more than 3 months postoperatively. Multivariate analysis revealed a DWI signal > 1 cm to be the only significant risk factor for deficits at 3 months postoperatively (OR 32.42, 95% CI 3.3-320.1, p = 0.0002). Further, estimated blood loss (OR 1.4 per 100 ml increase, 95% CI 1.1-1.7, p < 0.0001), older age (OR 1.1 per year older, 95% CI 1.0-1.1, p = 0.0009), middle third location in the sagittal plane (OR 16.9, 95% CI 1.3-216.9, p = 0.0026), and preoperative peritumoral edema (OR 4.6, 95% CI 1.2-17.7, p = 0.0249) were significantly associated with a postoperative DWI signal > 1 cm. CONCLUSIONS A DWI signal > 1 cm is significantly associated with postoperative neurological deficits, both immediate and long-lasting. Greater estimated blood loss, older age, tumor location over the motor strip, and preoperative peritumoral edema increase the risk of having a postoperative DWI signal > 1 cm, reflective of perilesional ischemia. Most immediate postoperative deficits will improve over time. These data are valuable when preoperatively communicating with patients about the risks of surgery and when postoperatively discussing prognosis after a deficit occurs.
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Borde P, Dutta G, Singh H, Singh D, Jagetia A, Srivastava AK, Bharti R, Prakash A, Kumar A. An analysis of neurocognitive dysfunction in brain tumors. Indian J Psychiatry 2021; 63:377-382. [PMID: 34456351 PMCID: PMC8363892 DOI: 10.4103/psychiatry.indianjpsychiatry_942_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/12/2020] [Accepted: 10/29/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neurocognitive dysfunction is an important issue in patients with frontal lobe lesions. These patients who may be in good neurological status may succumb to neurocognitive dysfunction, affecting their daily living and hampering the quality of life. This study aims to correlate pre- and post-operative neurocognitive dysfunction in patients with frontal lobe lesions. MATERIALS AND METHODS A prospective analysis of 50 patients of newly-diagnosed frontal lobe tumors of any grade deemed suitable for surgical resection was carried out. All patients underwent neurocognitive testing using frontal assessment battery (FAB), mini mental state examination, and verbal learning and memory test pre- and post-operatively. RESULTS In this study, 22 patients had right frontal lobe lesion, whereas in 24 patients, it was located in the left frontal lobe, and 4 patients had bilateral lesions. Only 12 patients were found to be in good FAB score preoperatively, and all of them had symptom duration of less than 3 months. 1-week postsurgery, 26 patients achieved a good score, which increased to 44 at 3rd month. Patients who had psychological dysfunction for more than 3 months had average-to-bad preoperative FAB scores, while at 3rd month postoperatively, only six patients were in average score and none in bad score. CONCLUSION Frontal lobe lesion should be kept in mind in patients with neurocognitive dysfunction. FAB is a simple bedside test that should be included in routine neurological examination in daily neurosurgical practice to assess long-term functional outcome in patients with frontal lobe lesions.
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Affiliation(s)
- Pravin Borde
- Department of Neuro-Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Gautam Dutta
- Department of Neuro-Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Hukum Singh
- Department of Neuro-Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Daljit Singh
- Department of Neuro-Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Anita Jagetia
- Department of Neuro-Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Arvind Kumar Srivastava
- Department of Neuro-Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Rohit Bharti
- Department of Neuro-Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Anand Prakash
- Department of Neuro-Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Anil Kumar
- Department of Neuro-Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
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12
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Constanthin PE, Gondar R, Fellrath J, Wyttenbach IM, Tizi K, Weman L, Vayssière P, Schaller K, Meling TR. Neuropsychological Outcomes after Surgery for Olfactory Groove Meningiomas. Cancers (Basel) 2021; 13:2520. [PMID: 34063924 PMCID: PMC8196649 DOI: 10.3390/cancers13112520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In recent years, several studies have reported abnormal pre- and postoperative neuropsychological functioning in patients with meningiomas located in the prefrontal cortex (notably the ventromedial region). In the case of olfactory groove meningiomas, the tumor is in direct contact with the inferior aspect of the prefrontal cortex, a cortical region with crucial roles in decision-making, cognition and memory functions, potentially negatively impacting neuropsychological functions. MATERIALS AND METHODS We retrospectively compared pre- and post-operative neuropsychological testing of 17 patients undergoing surgical removal of olfactory groove meningiomas in our institution between January 2013 and December 2018. Neuropsychological results were obtained from the patients' medical history and normalized as z-scores of their respective cognitive functions. RESULTS Assessment of cognitive follow-up showed an important heterogeneity among patients. Pre-operative cognitive impairment was observed in most patients, particularly in cognitive flexibility (mean z-score: -1.35). Immediate post-operative cognitive status showed an overall impairment in all domains of cognition, significant for the domains of attention (p = 0.0273) and flexibility (p = 0.0234) and almost significant for the domain of language (p = 0.0547). The late follow-up at one year showed a trend towards general improvement, although attention and flexibility remained impaired. DISCUSSION Olfactory groove meningiomas impact pre-frontal cortex cognitive functions, particularly in the domain of cognitive flexibility. After an initial postoperative worsening, patients tended to improve in most aspects after one year, aside from cognitive flexibility and attention.
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Affiliation(s)
- Paul E. Constanthin
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.E.C.); (R.G.); (K.T.); (P.V.); (K.S.)
| | - Renato Gondar
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.E.C.); (R.G.); (K.T.); (P.V.); (K.S.)
| | - Julia Fellrath
- Neuropsychology Unit, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland; (J.F.); (I.M.W.)
| | - Isaline Mottet Wyttenbach
- Neuropsychology Unit, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland; (J.F.); (I.M.W.)
| | - Karima Tizi
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.E.C.); (R.G.); (K.T.); (P.V.); (K.S.)
| | - Leo Weman
- Faculty of Medicine, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Pia Vayssière
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.E.C.); (R.G.); (K.T.); (P.V.); (K.S.)
| | - Karl Schaller
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.E.C.); (R.G.); (K.T.); (P.V.); (K.S.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Torstein R. Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.E.C.); (R.G.); (K.T.); (P.V.); (K.S.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
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Bette S, Ruhland JM, Wiestler B, Barz M, Meyer B, Zimmer C, Ryang YM, Ringel F, Gempt J. Postoperative cognitive functions in patients with benign intracranial lesions. Sci Rep 2021; 11:8757. [PMID: 33888794 PMCID: PMC8062599 DOI: 10.1038/s41598-021-88061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/06/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of this study was to assess pre- and postoperative cognitive functions in patients who underwent surgery for benign intracranial lesions. In total, 58 patients (21 men, 37 women, mean age 51.6 years [range 24–76 years]) with benign intracranial lesions (including benign tumors and vascular lesions) and neuralgia of the trigeminal nerve were included in this prospective study. Extensive cognitive testing was used to categorize attention, memory, and executive functions. Mood and pain were assessed preoperatively (t0, mean 3.7 days before surgery), immediately after surgery/during inpatient stay (t1, mean 7.6 days after surgery), and at first outpatient check-up (t2, mean 99.5 days after surgery). All 58 patients were tested at t0 and t1, but at t2 only 24 patients were available at t2. The data were categorized as improvement/stable condition or deterioration and shown as percentages. The pre- and postoperative values of BDI-II and mood were compared by the Wilcoxon test for paired samples. Binary logistic regression analyses were performed to identify parameters influencing cognition in the subgroup of meningioma patients. Immediately after surgery (t1), the percentage of patients with improvement/stable condition was > 50% in all categories in the majority of subtests (attention: 12/14 subtests, memory: 11/13 subtests, executive functions: 6/9 subtests). Similar results were shown at t2. Mood and pain did not change significantly after surgery. Factors like age, Karnofsky performance status, and tumor volume were not shown as significant influencing factors for cognitive functions in meningioma patients. The results of this study suggest that—in contrast to neuroepithelial tumors—cognitive functions do not deteriorate after surgery of benign intracranial lesions. Further studies are necessary to evaluate the results of this study.
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Affiliation(s)
- Stefanie Bette
- Department of Neuroradiology, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Julia M Ruhland
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Melanie Barz
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.,Department of Neurosurgery, University Medical Centre, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
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Gondar R, Patet G, Schaller K, Meling TR. Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review. Cancers (Basel) 2021; 13:cancers13081846. [PMID: 33924372 PMCID: PMC8070481 DOI: 10.3390/cancers13081846] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Assessment of cognition is crucial in brain tumor care, and clinical outcome along this axis is frequently neglected. As a result, a patient’s quality of life seems more impacted than usually reported in clinical series. With this article, we review the current state of affairs and search for patient- and meningioma-related outcome predictors. We found a great variety in the number and types of neuropsychological tests used and in the dimensions of cognition studied. Furthermore, data mostly originate from a selected part of the globe and therefore may not reflect a global reality. Treatment has an early cognitive impact in the majority of meningioma patients. Further long-term conclusions are precluded by a mean follow-up time shorter than one year. Anticipating cognition outcomes prior to, during, and after treatment of meningiomas remains difficult. Future research should aim for a reliable and worldwide reproducible standard battery of tests. Abstract Clinical outcomes after surgery for intracranial meningiomas might be overvalued as cognitive dimensions and quality of life are probably underreported. This review aims to summarize the current state of cognitive screening and treatment-related outcomes after meningioma surgery. We present a systematic review (Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P) 2015-based) of cognitive outcomes after intracranial meningioma surgery. A total of 1572 patients (range 9–261) with a mean age of 58.4 years (range 23–87), and predominantly female (n = 1084, 68.9%) were identified. Mean follow-up time after treatment was 0.86 ± 0.3 years. Neuropsychological assessment was very heterogeneous, but five dimensions of cognition were described: memory (19/22); attention (18/22); executive functions (17/22); language (11/22); flexibility (11/22 studies). Cognitive abilities were impaired in 18 studies (81.8%), but only 1 showed deterioration in all dimensions simultaneously. Memory was the most affected. with significant post-therapy impairment in 9 studies (40.9%). Postoperatively, only 4 studies (18.2%) showed improvement in at least one dimension. Meningioma patients had significantly lower cognitive scores when compared to healthy subjects. Surgery and radiotherapy for meningiomas were associated with cognitive impairment, probably followed by a partial recovery. Cognition is poorly defined, and the assessment tools employed lack standardization. Cognitive impairment is probably underreported in meningioma patients.
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Affiliation(s)
- Renato Gondar
- Neurosurgical Division, Department of Neurosciences, Geneva University Hospitals, 1206 Geneva, Switzerland; (R.G.); (G.P.); (K.S.)
| | - Gildas Patet
- Neurosurgical Division, Department of Neurosciences, Geneva University Hospitals, 1206 Geneva, Switzerland; (R.G.); (G.P.); (K.S.)
| | - Karl Schaller
- Neurosurgical Division, Department of Neurosciences, Geneva University Hospitals, 1206 Geneva, Switzerland; (R.G.); (G.P.); (K.S.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Torstein R. Meling
- Neurosurgical Division, Department of Neurosciences, Geneva University Hospitals, 1206 Geneva, Switzerland; (R.G.); (G.P.); (K.S.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
- Correspondence: ; Tel.: +41-782-123-925
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15
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Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology. J Neurooncol 2021; 152:195-204. [PMID: 33475932 PMCID: PMC7910228 DOI: 10.1007/s11060-020-03693-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 12/27/2022]
Abstract
Purpose Surgical resection of intracranial meningiomas in patients that are 80 years old and older, i.e. very old patients, is increasingly considered. Meningiomas with a largest diameter of at least 5 cm—‘giant meningiomas’—form a distinct entity, and their surgical resection is considered more difficult and prone to complications. Here, we evaluated functional outcome, morbidity and mortality, and the prognostic value of tumor size in very old patients who underwent resection of giant supratentorial meningiomas. Methods We retrospectively reviewed clinical and radiological data, functional performance (Karnofsky Performance Score), histopathological diagnosis and complications of very old patients who underwent surgery of a supratentorial meningioma at the Helsinki University Hospital between 2010 and 2018. Results We identified 76 very old patients, including 28 with a giant meningioma. Patients with a giant meningioma suffered from major complications more commonly than those with a non-giant meningioma (36% vs. 17%, p = 0.06), particularly from postoperative intracranial hemorrhages (ICH). At the 1-year follow-up, functional performance and mortality rate were comparable between patients with giant meningiomas and those with non-giant meningiomas. An exceptionally high rate of giant meningiomas were diagnosed as atypical meningiomas (WHO II) at an (11 out of 28 cases). Conclusions Giant meningioma surgery entails a high complication rate in frail, very old patients. The prevention of postoperative ICH in this specific patient group is of utmost importance. An atypical histopathology was notably frequent among very old patients with a giant meningioma, which should be taken into account when planning the surgical strategy. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-020-03693-4.
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16
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Corniola MV, Bouthour W, Vargas MI, Meling TR. Visual field restoration after Simpson grade I resection of symptomatic occipital lobe meningioma: illustrative case and review of the literature. Acta Neurochir (Wien) 2021; 163:67-71. [PMID: 32901397 DOI: 10.1007/s00701-020-04569-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Abstract
Intracranial meningiomas mostly affect patients in their fifth decade and beyond, raising pertinent questions regarding the risk of surgery, particularly in the elderly. Here, we describe the case of a septuagenarian patient with occipital meningioma causing severe visual field cuts that experienced full recovery of the visual function after a Simpson I resection of the lesion. This case illustrates the potential of recovery of the brain, even in the case of severely impaired function in elderly patients. To complete the picture, we review the literature on occipital meningiomas, advocating for systematic reports and increase data collection on post-operative neurological recovery in the elderly.
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Affiliation(s)
- Marco V Corniola
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Walid Bouthour
- Department of Clinical Neurosciences, Division of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Maria-Isabel Vargas
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Zamanipoor Najafabadi AH, van der Meer PB, Boele FW, Taphoorn MJB, Klein M, Peerdeman SM, van Furth WR, Dirven L. Determinants and predictors for the long-term disease burden of intracranial meningioma patients. J Neurooncol 2020; 151:201-210. [PMID: 33073326 PMCID: PMC7875939 DOI: 10.1007/s11060-020-03650-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/12/2020] [Indexed: 01/04/2023]
Abstract
Introduction Meningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae. To help identify patients at risk for these late effects, we first assessed variables associated with impaired long-term health-related quality of life (HRQoL) and impaired neurocognitive function on group level (i.e. determinants). Next, prediction models were developed to predict the risk for long-term neurocognitive or HRQoL impairment on individual patient-level. Methods Secondary data analysis of a cross-sectional multicenter study with intracranial WHO grade I/II meningioma patients, in which HRQoL (Short-Form 36) and neurocognitive functioning (standardized test battery) were assessed. Multivariable regression models were used to assess determinants for these outcomes corrected for confounders, and to build prediction models, evaluated with C-statistics. Results Data from 190 patients were analyzed (median 9 years after intervention). Main determinants for poor HRQoL or impaired neurocognitive function were patients’ sociodemographic characteristics, surgical complications, reoperation, radiotherapy, presence of edema, and a larger tumor diameter on last MRI. Prediction models with a moderate/good ability to discriminate between individual patients with and without impaired HRQoL (C-statistic 0.73, 95% CI 0.65 to 0.81) and neurocognitive function (C-statistic 0.78, 95%CI 0.70 to 0.85) were built. Not all predictors (e.g. tumor location) within these models were also determinants. Conclusions The identified determinants help clinicians to better understand long-term meningioma disease burden. Prediction models can help early identification of individual patients at risk for long-term neurocognitive or HRQoL impairment, facilitating tailored provision of information and allocation of scarce supportive care services to those most likely to benefit. Electronic supplementary material The online version of this article (10.1007/s11060-020-03650-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amir H Zamanipoor Najafabadi
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands. .,Haaglanden Medical Center & Haga Teaching Hospitals, The Hague, The Netherlands. .,Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands.
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands
| | - Florien W Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, LS9 7TF, UK.,Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin Klein
- Department of Medical Psychology, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia M Peerdeman
- Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands.,Haaglanden Medical Center & Haga Teaching Hospitals, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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Zhang P, Li Y, Zhang J, Zhang H, Wang X, Dong L, Yan Z, She L, Wang X, Wei M, Tang C. Risk factors analysis and a nomogram model establishment for late postoperative seizures in patients with meningioma. J Clin Neurosci 2020; 80:310-317. [DOI: 10.1016/j.jocn.2020.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/02/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023]
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Sun C, Dou Z, Wu J, Jiang B, Iranmanesh Y, Yu X, Li J, Zhou H, Zhong C, Peng Y, Zhuang J, Yu Q, Wu X, Yan F, Xie Q, Chen G. The Preferred Locations of Meningioma According to Different Biological Characteristics Based on Voxel-Wise Analysis. Front Oncol 2020; 10:1412. [PMID: 32974148 PMCID: PMC7472960 DOI: 10.3389/fonc.2020.01412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Meningiomas presented preferred intracranial distribution, which may reflect potential biological natures. This study aimed to analyze the preferred locations of meningioma according to different biological characteristics. Method: A total of 1,107 patients pathologically diagnosed with meningiomas between January 2012 and December 2016 were retrospectively analyzed. Preoperative MRI were normalized, and lesions were semiautomatically segmented. The stereospecific frequency and p value heatmaps were constructed to compare two biological phenotypes using two-tailed Fisher's exact test. Age, sex, WHO grades, extent of resection (EOR), recurrence, and immunohistochemical markers including p53, Ki67, epithelial membrane antigen (EMA), progesterone receptor (PR), and CD34 were statistically analyzed. Recurrence-free survival (RFS) were analyzed by Kaplan-Meier method. Result: Of 1,107 cases, convexity (20.8%), parasagittal (16.1%), and falx (11.4%) were the most predominant loci of meningiomas. The p-value heatmap suggested lesion predominance in the left frontal and occipital convexity among older patients while in the left sphenoid wing, and right falx, parasellar/cavernous sinus, and middle fossa among younger patients. Lesions located at anterior fossa and frontal structures were more frequently seen in the male while left parietal falx and tentorial regions, and right cerebellopontine angle in the female. Grades II and III lesions presented predominance in the frontal structures compared with grade I ones. Meningiomas at the left parasagittal sinus and falx, tentorium, intraventricular regions, and skull-base structures were significantly to receive subtotal resection. Lesions with p53 positivity were statistically located at the left frontal regions and parasellar/cavernous sinus, higher Ki67 index at the left frontal and bilateral parietal convexity and right parasellar/cavernous sinus, EMA negativity at the right olfactory groove and left middle fossa, and CD34 positivity at the sellar regions and right sphenoid wing. Tumor recurrence rates for grades I, II, and III were 2.8, 7.9, and 53.8%, respectively. Inferior RFS, higher Ki67 index, grades II and III, and a larger preoperative volume were observed in older patients. Recurrent meningiomas were more frequently found at the occipital convexity, tentorium, sellar regions, parasagittal sinus, and left sphenoid wing. Conclusion: The preferred locations of meningioma could be observed according to different biological characteristics, which might be helpful for clinical decisions.
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Affiliation(s)
- Chongran Sun
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhangqi Dou
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiawei Wu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Biao Jiang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yasaman Iranmanesh
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaobo Yu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianru Li
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hang Zhou
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chen Zhong
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yucong Peng
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianfeng Zhuang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qian Yu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyan Wu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Yan
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi Xie
- School of Life Science, Westlake University, Hangzhou, China
| | - Gao Chen
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Rijnen SJM, Meskal I, Bakker M, De Baene W, Rutten GJM, Gehring K, Sitskoorn MM. Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive functioning. Neuro Oncol 2020; 21:911-922. [PMID: 30753679 DOI: 10.1093/neuonc/noz039] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Meningioma patients are known to face cognitive deficits before and after surgery. We examined individual changes in cognitive performance over time and identified preoperative predictors of cognitive functioning 12 months after surgery in a large sample of meningioma patients. METHODS Patients underwent neuropsychological assessment (NPA) using CNS Vital Signs 1 day before (T0) and 3 (T3) and 12 (T12) months after surgery. Patients' sociodemographically corrected scores on 7 cognitive domains were compared with performance of a normative sample using one-sample z tests and chi-square tests of independence. Reliable change indices with correction for practice effects were calculated for individual patients. Linear mixed effects models were used to identify preoperative predictors of performance at T12. RESULTS At T0, 261 patients were assessed, and 229 and 82 patients were retested at T3 and T12, respectively. Patients showed impaired cognitive performance before and after surgery, and although performance improved on the group level, cognitive scores remained significantly lower than in the normative sample up to T12. On the individual level, performance remained stable in the majority of patients. Better preoperative performance, younger age, male sex, and higher educational level predicted better late cognitive performance. CONCLUSIONS Meningioma patients face serious and persistent pre- and postsurgical cognitive deficits. A preoperative NPA together with sociodemographic characteristics may provide valuable information on the late cognitive outcome of individual meningioma patients. These results can help to inform patients and clinicians on late cognitive outcomes at an early stage, and emphasizes the importance of presurgical NPA and timely cognitive rehabilitation.
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Affiliation(s)
- Sophie J M Rijnen
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Ikram Meskal
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Wouter De Baene
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Karin Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Margriet M Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
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21
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Kang MJ, Pyun JM, Baek MJ, Hwang K, Han JH, Park YH, Kim CY, Kim S. Predictors of pre-operative cognitive impairment in meningioma patients over 60 years old. BMC Neurol 2020; 20:225. [PMID: 32493294 PMCID: PMC7268376 DOI: 10.1186/s12883-020-01806-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the cognitive function of patients over 60 years old with meningioma using a domain-specific neuropsychological test and to investigate the relevant factors affecting pre-operative cognitive decline in different subdomains. METHODS We retrospectively investigated 46 intracranial meningioma patients between the ages of 60 and 85 years. All patients underwent brain MRI and neuropsychological test. Tumor size, location, peritumoral edema, and medial temporal atrophy (MTA) were examined to determine the association with cognitive impairment. We performed a logistic regression analysis to examine the odds ratios (ORs) for cognitive decline of four subdomains: verbal memory, language, visuospatial, and executive functions. RESULTS Tumor size and age were associated with executive dysfunction (OR 1.083, 95% confidence interval (CI) 1.006-1.166, and OR 1.209, 95% CI 1.018-1.436, respectively). There was no statistically significant association in other cognitive domains (language, verbal memory, and visuospatial function) with variables in regression analysis. CONCLUSIONS We conclude that tumor size and age are positively related with executive function in pre-operative meningioma patients over 60 years old.
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Affiliation(s)
- Min Ju Kang
- Department of Neurology, Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jung-Min Pyun
- Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Jae Baek
- Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - SangYun Kim
- Department of Neurology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Clinical and Biological Correlates of Preoperative Cognitive Functioning of Glioma and Meningioma Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2054859. [PMID: 32461966 PMCID: PMC7232682 DOI: 10.1155/2020/2054859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 03/31/2020] [Accepted: 04/17/2020] [Indexed: 01/13/2023]
Abstract
Objectives This study aimed to investigate the association of high-sensitivity C-reactive protein (hsCRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) serum concentrations with cognitive functions of glioma and meningioma patients. Methods 177 brain tumor patients awaiting for brain tumor surgery participated in the study. Patients were assessed preoperatively, using neuropsychological tests for verbal memory, psychomotor speed, mental flexibility, and verbal fluency. The functional status of patients was evaluated using the Karnofsky Performance Index. Blood samples were drawn for evaluation of serum hsCRP and NT-proBNP concentrations upon hospital admission. Results The highest NT-proBNP concentration was observed in meningioma patients. Glioma and meningioma patients did not differ in hsCRB concentration. Patients in the highest hsCRP tertile were older and more frequently reported cardiovascular comorbidity. Patients in the highest NT-proBNP tertile were older, more frequently with cardiovascular comorbidity, females, and diagnosed with a meningioma. hsCRP was significantly related to slower psychomotor speed in high-grade glioma patients (rho = 0.30, p < 0.05). In meningioma sample, NT-proBNP correlated with decreased psychomotor speed (rho = 0.38, p < 0.01), mental flexibility (rho = 0.33, p < 0.01), worse cumulative learning (rho = −0.27, p < 0.05), and delayed recall (rho = 0.30, p < 0.01). However, the relationship between the NT-proBNP and cognitive functions became nonsignificant when demographic and clinical covariates were included into analysis. Higher hsCRP concentration remained significantly related to slower psychomotor speed (p = 0.02) and worse mental flexibility (p = 0.05) in glioma patients, independently from demographic and clinical covariates. Preoperative cognitive functioning was also predicted by older age, gender, side and location of the tumor, and tumor malignancy, and general functional status of a patient. Conclusions NT-proBNP was not associated with memory, language, and attention/executive cognitive domains of glioma and meningioma patients. Increased hsCRP was related to slower psychomotor speed and worse mental flexibility in glioma patients, indicating that inflammation processes are important for cognitive functioning in glial tumors.
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Risk factors for neurocognitive impairment in patients with benign intracranial lesions. Sci Rep 2019; 9:8400. [PMID: 31182758 PMCID: PMC6557851 DOI: 10.1038/s41598-019-44466-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 05/15/2019] [Indexed: 11/27/2022] Open
Abstract
This study was designed to assess risk factors for neurocognitive impairment in patients with benign intracranial lesions including tumors and vascular lesions. 74 patients (29 m, 51 f, mean age 54.4 years) with surgery for benign intracranial lesions were included in this prospective single-center study. Extensive neuropsychological testing was performed preoperatively, including tests for attention, memory and executive functions. Furthermore, headache and depression were assessed using the german version of the HDI (IBK) and the BDI-II. Multiple linear regression analyses of the percentile ranks (adjusted for age, sex and education) including the parameters age, Karnofsky Performance Status Scale (KPS), mood, pain and lesion size were performed to identify risk factors for cognitive impairment. Using the Mann-Whitney U test, the influence of hemisphere and type of lesion (tumor/vascular) was assessed. Posthoc Bonferroni correction was performed. Poorer neurocognitive functions were observed only in the category attention in patients with higher age (divided attention, WMS) and reduced KPS (WMS). Lesion volume, mood, pain, hemisphere or the type of the lesion (tumor, vascular) were not identified as risk factors for poorer neurocognitive functions in patients with benign intracranial lesions. Age and KPS are the main risk factors for poorer neurocognitive functions in the category attention in patients with benign intracranial lesions. Knowledge of these risk factors might be important to find appropriate therapy regimes to improve cognitive functions and quality of life.
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Ekpene U, Ametefe M, Akoto H, Bankah P, Totimeh T, Wepeba G, Dakurah T. Pattern of intracranial tumours in a tertiary hospital in Ghana. Ghana Med J 2019; 52:79-83. [PMID: 30662079 DOI: 10.4314/gmj.v52i2.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study seeks to describe the pattern of intracranial tumours in Korle Bu Teaching Hospital (KBTH) based on patient demographics, clinical presentation, spatial distribution of tumour and histological findings. Method The study design is retrospective and descriptive. Data was obtained from the clinical records of patients with intracranial tumours treated in our neurosurgery unit between January 2010 to December 2015, and histology reports obtained from the histopathology unit. Patients with intracranial tumours without definitive histological diagnosis were excluded. Results Of the 102 histologically diagnosed brain tumours, out of 335 brain tumour cases seen in the period under review, 58 (56.9%) were females and 44 (43.1%) were males (p = 0.031). Gliomas were the commonest intracranial tumours - 39(38.2%) followed by Meningiomas 37(36.2%) and Pituitary Adenoma - 9(8.8%). Astrocytoma was the commonest type of Glioma comprising 30(77%) of the 39 cases. Meningotheliomatous meningioma was the commonest type of meningioma with 11 (29.7%) of 37 cases. Of the 39 Gliomas 17(43.6%) were males and 22(56.4%) were females, while for the Meningioma 17(46%) were males and 20(54%) were females. The commonest symptom was headache (64%) and the commonest tumour location was supratentorial (77.5%). The crude incidence rate of intracranial tumours in this study was 1.34 per 100,000 populations per year. Conclusion Gliomas are the commonest intracranial tumours seen in our series. Overall, females were more commonly affected than males in most brain tumours in this series, including both gliomas and meningiomas. Funding Not declared.
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Affiliation(s)
- Ubong Ekpene
- Neurosurgery Unit, Department of Surgery, Korle Bu Teaching Hospital, P.M.B KB77, Accra. Ghana
| | - Mawuli Ametefe
- Neurosurgery Unit, Department of Surgery, Korle Bu Teaching Hospital, P.M.B KB77, Accra. Ghana
| | - Henry Akoto
- Neurosurgery Unit, Department of Surgery, Korle Bu Teaching Hospital, P.M.B KB77, Accra. Ghana
| | - Patrick Bankah
- Neurosurgery Unit, Department of Surgery, Korle Bu Teaching Hospital, P.M.B KB77, Accra. Ghana
| | - Teddy Totimeh
- Neurosurgery Unit, Department of Surgery, Korle Bu Teaching Hospital, P.M.B KB77, Accra. Ghana
| | - George Wepeba
- Neurosurgery Unit, Department of Surgery, Korle Bu Teaching Hospital, P.M.B KB77, Accra. Ghana
| | - Thomas Dakurah
- Neurosurgery Unit, Department of Surgery, Korle Bu Teaching Hospital, P.M.B KB77, Accra. Ghana
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Ghanimi Zamli AK, Chew-Ean T, Wan Hitam WH. Bilateral Inferior Altitudinal Visual Field Defect in Recurrent Intracranial Meningioma: A Case Report. Cureus 2019; 11:e4436. [PMID: 31245223 PMCID: PMC6559694 DOI: 10.7759/cureus.4436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Altitudinal visual field defect is a rare presentation of retrochiasmal lesion especially when bilateral visual fields were affected. In fact, bilateral inferior altitudinal visual field defect (BIAVFD) usually occurred in patients who survived a gunshot injury to the occipital lobe or as a direct trauma to the brain. We report a rare case of BIAVFD secondary to occipital meningioma. A high index of suspicion enables timely investigation and diagnosis when dealing with atypical presentation of intracranial meningioma.
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Affiliation(s)
| | - Tan Chew-Ean
- Ophthalmology, Universiti Sains Malaysia, Kota Bharu, MYS
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26
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Ottenhausen M, Rumalla K, Younus I, Minkowitz S, Tsiouris AJ, Schwartz TH. Predictors of postoperative motor function in rolandic meningiomas. J Neurosurg 2019; 130:1283-1288. [PMID: 29799346 DOI: 10.3171/2017.12.jns172423] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Resection of supratentorial meningiomas is generally considered a low-risk procedure, but tumors involving the rolandic cortex present a unique challenge. The rate of motor function deterioration associated with resecting such tumors is not well described in the literature. Thus, the authors sought to report the rates and predictors of postoperative motor deficit following the resection of rolandic meningiomas to assist with patient counseling and surgical decision-making. METHODS An institution's pathology database was screened for meningiomas removed between 2000 and 2017, and patients with neuroradiological evidence of rolandic involvement were identified. Parameters screened as potential predictors included patient age, sex, preoperative motor severity, tumor location, tumor origin (falx vs convexity), histological grade, FLAIR signal (T2-weighted MRI), venous involvement (T1-weighted MRI with contrast), intratumoral hemorrhage, embolization, and degree of resection (Simpson grade). Variables of interest included preoperative weakness and postoperative motor decline (novel or worsened permanent deficit). The SPSS univariate and bivariate analysis functions were used, and statistical significance was determined with alpha < 0.05. RESULTS In 89 patients who had undergone resection of convexity (80.9%) or parasagittal (19.1%) rolandic meningiomas, a postoperative motor decline occurred in 24.7%. Of 53 patients (59.6%) with preoperative motor deficits, 60.3% improved, 13.2% were unchanged, and 26.4% worsened following surgery. Among the 36 patients without preoperative deficits, 22.2% developed new weakness. Predictors of preoperative motor deficit included tumor size (41.6 vs 33.2 cm3, p = 0.040) and presence of FLAIR signal (69.8% vs 50.0%, p = 0.046). Predictors of postoperative motor decline were preoperative motor deficit (47.2% vs 22.2%, p = 0.017), minor (compared with severe) preoperative weakness (25.6% vs 21.4%, p < 0.001), and preoperative embolization (54.5% vs 20.5%, p = 0.014). Factors that trended toward significance included parafalcine tumor origin (41.2% vs 20.8% convexity, p = 0.08), significant venous involvement (44.4% vs 23.5% none, p = 0.09), and Simpson grade II+ (34.2% vs 17.6% grade I, p = 0.07). CONCLUSIONS Resection of rolandic area meningiomas carries a high rate of postoperative morbidity and deserves special preoperative planning. Large tumor size, peritumoral edema, preoperative embolization, parafalcine origin, and venous involvement may further increase the risk. Alternative surgical strategies, such as aggressive internal debulking, may prevent motor decline in a subset of high-risk patients.
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Affiliation(s)
| | | | | | | | | | - Theodore H Schwartz
- Departments of1Neurological Surgery
- 2Otolaryngology, and
- 3Neuroscience, Weill Cornell Medical College, New York, New York
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The association between preoperative edema and postoperative cognitive functioning and health-related quality of life in WHO grade I meningioma patients. Acta Neurochir (Wien) 2019; 161:579-588. [PMID: 30756243 PMCID: PMC6407739 DOI: 10.1007/s00701-019-03819-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/23/2019] [Indexed: 10/28/2022]
Abstract
BACKGROUND Studies on the associations between preoperative cerebral edema, cognitive functioning, and health-related quality of life (HRQOL) in WHO grade I meningioma patients are virtually lacking. We studied the association between preoperative cerebral edema on postoperative cognitive functioning and HRQOL 6 months postoperatively in WHO grade I meningioma patients. METHODS Twenty-one consecutive WHO grade I meningioma patients, who underwent surgery, were matched individually for age, gender, and educational level to healthy controls. Tumor and edema volume were assessed on preoperative T1- and T2-weighted MRI images, respectively. At least 5 months postoperatively, functional status, cognitive functioning, and HRQOL, using a cognitive test battery and the Short-Form Health Survey (SF-36), were determined. The correlation between preoperative tumor and cerebral edema volume with postoperative cognitive functioning and HRQOL was investigated using Kendall's tau coefficients. RESULTS Compared to healthy controls, patients had lower verbal memory capacity (p = .012), whereas HRQOL was similar to matched healthy controls. In all cognitive domains, postoperative functioning was much lower in patients with preoperative cerebral edema than in those without. There were significant correlations between preoperative cerebral edema and tumor volume and postoperative cognitive functioning. Preoperative cerebral edema and/or tumor volume were not associated with HRQOL. CONCLUSIONS Our results suggest that WHO grade I meningioma patients with larger volumes of preoperative cerebral edema are more at risk of experiencing limitations in longer-term cognitive functioning than patients with no or less edema preoperatively. This is an important knowledge for neurologists and neurosurgeons treating patients with a meningioma. More studies regarding the effect of peritumoral edema on cognitive functioning in meningioma patients are necessary.
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Ehresman JS, Garzon-Muvdi T, Rogers D, Lim M, Gallia GL, Weingart J, Brem H, Bettegowda C, Chaichana KL. Risk of Developing Postoperative Deficits Based on Tumor Location after Surgical Resection of an Intracranial Meningioma. J Neurol Surg B Skull Base 2018; 80:59-66. [PMID: 30733902 DOI: 10.1055/s-0038-1667066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/06/2018] [Indexed: 02/01/2023] Open
Abstract
Object Meningiomas occur in various intracranial locations. Each location is associated with a unique set of surgical nuances and risk profiles. The incidence and risk factors that predispose patients to certain deficits based on tumor locations are unclear. This study aimed to determine which preoperative factors increase the risk of patients having new deficits after surgery based on tumor location for patients undergoing intracranial meningioma surgery. Methods Adult patients who underwent primary, nonbiopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate logistic regression analyses were used to identify associations with postoperative deficits based on tumor location. Results Postoperatively, from the 761 included patients, there were 39 motor deficits (5.1%), 23 vision deficits (3.0%), 19 language deficits (2.5%), 27 seizures (3.5%), and 26 cognitive deficits (3.4%). The factors independently associated with any postoperative deficits were preoperative radiation (hazard ratio [HR] [95% confidence interval, CI] 3.000 [1.346-6.338], p = 0.008), cerebellopontine angle tumors (HR [95% CI] 2.126 [1.094-3.947], p = 0.03), Simpson grade 4 resections (HR [95% CI] 2.000 [1.271-3.127], p = 0.003), preoperative motor deficits (HR [95% CI] 1.738 [1.005-2.923], p = 0.048), preoperative cognitive deficits (HR [95% CI] 2.033 [1.144-3.504], p = 0.02), and perioperative pulmonary embolisms (HR [95% CI] 11.741 [2.803-59.314], p = 0.0009). Conclusion Consideration of the factors associated with postoperative deficits in this study may help guide treatment strategies for patients with meningiomas.
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Affiliation(s)
- Jeff S Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Davis Rogers
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Kaisorn L Chaichana
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, United States
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Pranckevičienė A, Jurkuvėnas V, Deltuva VP, Tamašauskas A, Bunevičius A. Preoperative verbal memory problems and their clinical prognostic value in meningioma patients: A prospective study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:503-512. [PMID: 29617166 DOI: 10.1080/23279095.2018.1450750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study aimed to evaluate clinical utility of The Hopkins Verbal Learning Test-Revised (HVLT-R) for assessment of preoperative memory function in meningioma patients and to investigate prognostic value of memory assessment in predicting outcomes after meningioma excision surgery. A total of 93 meningioma patients were assessed 2-3 days preoperatively using HVLT-R, and EORTC QLQ-30 and QLQ-BN20. Functional outcome at discharge was evaluated using The Glasgow Outcome Scale. A sample of 95 healthy controls was matched to patients according to age, gender, and education. Meningioma patients demonstrated impaired working memory, delayed recall and recognition, flatter learning slope, and less effective acquisition. Location of meningioma was not related to any of the studied memory scores. Patients with left sided meningiomas more often produced false positive recognitions and demonstrated worse delayed recall when compared to patients with right sided, but not bilateral meningiomas. Verbal memory impairment was not associated with perceived health status. Functional outcome at discharge was predicted by tumor side, global health status score, and HVLT-R Cumulative learning score. Cumulative verbal learning impairment was associated with greater risk for poor functional outcome, indicating that cognitive impairment has added prognostic value beyond established prognostic indicators of meningioma patients.
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Affiliation(s)
- Aistė Pranckevičienė
- Neuroscience Institute, Lithuanian University of Health Sciences , Kaunas , Lithuania
| | | | | | - Arimantas Tamašauskas
- Neuroscience Institute, Lithuanian University of Health Sciences , Kaunas , Lithuania
| | - Adomas Bunevičius
- Neuroscience Institute, Lithuanian University of Health Sciences , Kaunas , Lithuania
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Zamanipoor Najafabadi AH, Peeters MCM, Lobatto DJ, Broekman MLD, Smith TR, Biermasz NR, Peerdeman SM, Peul WC, Taphoorn MJB, van Furth WR, Dirven L. Health-related quality of life of cranial WHO grade I meningioma patients: are current questionnaires relevant? Acta Neurochir (Wien) 2017; 159:2149-2159. [PMID: 28952044 PMCID: PMC5636848 DOI: 10.1007/s00701-017-3332-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/11/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The clinical relevance of Health-Related Quality of Life (HRQoL) in meningioma patients has been increasingly acknowledged in recent years. Various questionnaires have been used. However, almost none of these questionnaires has been particularly developed for and/or validated in this patient group. Therefore, the aim of this study was to assess the relevance and comprehensiveness of existing HRQoL questionnaires used in meningioma research and to assess the agreement between patients and health care professionals (HCPs) on the most relevant and important HRQoL issues. METHODS A systematic literature search, following the PRISMA statement, was conducted to identify all HRQoL questionnaires used in meningioma research. Semi-structured interviews were organized with patients and HCPs to (1) assess the relevance of all issues covered by the questionnaires (score 0-3: not relevant-highly relevant), (2) assess the ten most important issues, and (3) identify new relevant HRQoL issues. RESULTS Fourteen different questionnaires were found in the literature, comprising 140 unique issues. Interviews were conducted with 20 patients (median age 57, 71% female) and 10 HCPs (4 neurosurgeons, 2 neurologists, 2 radiotherapists, 1 rehabilitation specialist, 1 neuropsychologist; median experience 13 years). Meningioma patients rated 17-80% of the issues in each of the questionnaires as relevant, HCPs 90-100%. Patients and HCPs agreed on the relevance of only 49 issues (35%, Cohen's kappa: 0.027). Both patients and HCPs considered lack of energy the most important issue. Patients and HCPs suggested five additional relevant issues not covered by current HRQoL questionnaires. CONCLUSIONS Existing HRQoL questionnaires currently used in meningioma patients do not fully cover all relevant issues to these patients. Agreement between patients and HCPs on the relevance of issues was poor. Both findings support the need to develop and validate a meningioma-specific HRQoL questionnaire.
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Affiliation(s)
- Amir H Zamanipoor Najafabadi
- Department of Neurosurgery, Leiden University Medical Center, Postal Zone J11-R, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
| | - Marthe C M Peeters
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel J Lobatto
- Department of Neurosurgery, Leiden University Medical Center, Postal Zone J11-R, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Marieke L D Broekman
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Timothy R Smith
- Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nienke R Biermasz
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia M Peerdeman
- Department of Neurosurgery, VU Medical Center, Amsterdam, The Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Postal Zone J11-R, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Postal Zone J11-R, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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Chen LJ, Wang YJ, Tseng GF. Cortical compression rapidly trimmed transcallosal projections and altered axonal anterograde transport machinery. Neuroscience 2017; 362:79-94. [PMID: 28827177 DOI: 10.1016/j.neuroscience.2017.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/26/2022]
Abstract
Trauma and tumor compressing the brain distort underlying cortical neurons. Compressed cortical neurons remodel their dendrites instantly. The effects on axons however remain unclear. Using a rat epidural bead implantation model, we studied the effects of unilateral somatosensory cortical compression on its transcallosal projection and the reversibility of the changes following decompression. Compression reduced the density, branching profuseness and boutons of the projection axons in the contralateral homotopic cortex 1week and 1month post-compression. Projection fiber density was higher 1-month than 1-week post-compression, suggesting adaptive temporal changes. Compression reduced contralateral cortical synaptophysin, vesicular glutamate transporter 1 (VGLUT1) and postsynaptic density protein-95 (PSD95) expressions in a week and the first two marker proteins further by 1month. βIII-tubulin and kinesin light chain (KLC) expressions in the corpus callosum (CC) where transcallosal axons traveled were also decreased. Kinesin heavy chain (KHC) level in CC was temporarily increased 1week after compression. Decompression increased transcallosal axon density and branching profuseness to higher than sham while bouton density returned to sham levels. This was accompanied by restoration of synaptophysin, VGLUT1 and PSD95 expressions in the contralateral cortex of the 1-week, but not the 1-month, compression rats. Decompression restored βIII-tubulin, but not KLC and KHC expressions in CC. However, KLC and KHC expressions in the cell bodies of the layer II/III pyramidal neurons partially recovered. Our results show cerebral compression compromised cortical axonal outputs and reduced transcallosal projection. Some of these changes did not recover in long-term decompression.
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Affiliation(s)
- Li-Jin Chen
- Department of Anatomy, College of Medicine, Tzu-Chi University, Hualien, Taiwan.
| | - Yueh-Jan Wang
- Department of Anatomy, College of Medicine, Tzu-Chi University, Hualien, Taiwan.
| | - Guo-Fang Tseng
- Department of Anatomy, College of Medicine, Tzu-Chi University, Hualien, Taiwan.
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Hendrix P, Hans E, Griessenauer CJ, Simgen A, Oertel J, Karbach J. Neurocognitive Function Surrounding the Resection of Frontal WHO Grade I Meningiomas: A Prospective Matched-Control Study. World Neurosurg 2016; 98:203-210. [PMID: 27989970 DOI: 10.1016/j.wneu.2016.10.095] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patients with intracranial meningiomas can experience neurocognitive dysfunctions in specific cognitive domains depending on tumor location and size. The literature regarding cognitive function surrounding the resection of frontal meningiomas is sparse. METHODS We performed a prospective matched-control study to investigate the cognitive performance of frontal meningioma patients undergoing resection. The neurocognitive status 1 week and 2 months after resection was compared with the preoperative status and matched-controls. Matching was performed for age, sex, handedness, education, and profession. An extensive test battery was used to assess perceptual speed, executive function, visual-spatial and verbal working memory, short- and long-term memory, verbal fluency, fluid intelligence, anxiety, and depression. RESULTS Twelve patients with frontal World Health Organization grade I meningioma and 12 matched-controls underwent cognitive testing. Macroscopically, complete removal was achieved in all cases. Comparison of patients and controls revealed significant cognitive impairments in perceptual speed, executive function, short-term memory, and verbal fluency preoperatively and postoperatively. At 2 months' follow-up, perceptual speed and verbal fluency were still significantly impaired, whereas executive function and short-term memory were equal to that in the control group. None of the patients experienced cognitive deterioration after surgical therapy. CONCLUSION Patients with frontal meningiomas display preoperative and postoperative deficits in perceptual speed, executive function, short-term memory, and verbal fluency. The risk for cognitive deterioration owing to surgical resection is low. Within the first two months after surgery, executive function and short-term memory appear to recover.
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Affiliation(s)
- Philipp Hendrix
- Department of Neurosurgery, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg (Saar), Germany.
| | - Elisa Hans
- Department of Neurosurgery, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg (Saar), Germany
| | - Christoph J Griessenauer
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg (Saar), Germany
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg (Saar), Germany
| | - Julia Karbach
- Department of Psychology, Goethe University, Frankfurt, Germany
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