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Nair PM, Palanisamy A, Ramalakshmi R, Devibala M, Saranya M, Sivaranjini S, Thangavelu R, Mahalingam M. Oncothermia and Integrative Medicine-A Novel Paradigm for Infratentorial Meningioma Management: A Case Report With One-Year Follow-Up. Cureus 2025; 17:e77005. [PMID: 39912042 PMCID: PMC11797076 DOI: 10.7759/cureus.77005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2025] [Indexed: 02/07/2025] Open
Abstract
Infratentorial meningiomas (IM) pose unique challenges in treatment due to their location and proximity to critical neurovascular structures such as cranial nerves, arteries, veins, etc. This case report presents the efficacy of an integrative medicine approach in managing IM, highlighting the multidisciplinary collaboration of modern medicine, yoga, naturopathy, and homeopathy. A 60-year-old male with IM, deemed unsuitable for surgery, underwent a tailored integrative medicine protocol involving oncothermia, ozone therapy, high-dose vitamin C, hydrogen inhalation, time-restricted feeding, hydrotherapy, biologicals, acupuncture, and yoga. Follow-up assessments revealed significant symptom reduction, stable biochemical markers, and tumor size reduction observed in MRI scans. While individual modalities have demonstrated benefits in cancer care, this case underscores the potential of integrating diverse therapies to address the multifaceted challenges of IM. The findings offer valuable insights into the evolving landscape of integrative medicine in brain tumor management, suggesting promise for improved patient outcomes and enhanced quality of life. Further research and clinical trials are warranted to comprehensively evaluate the safety and efficacy of integrative approaches in IM treatment.
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Affiliation(s)
- Pradeep Mk Nair
- Department of Integrative Oncology, Mirakle Integrated Health Centre, Pollachi, IND
| | - Ayyappan Palanisamy
- Department of Medical Oncology, Mirakle Integrated Health Centre, Pollachi, IND
| | | | - Muniappan Devibala
- Department of Integrative Oncology, Mirakle Integrated Health Centre, Pollachi, IND
| | | | - Sekar Sivaranjini
- Department of Integrative Oncology, Mirakle Integrated Health Centre, Pollachi, IND
| | - R Thangavelu
- Department of General Medicine, Mirakle Integrated Health Centre, Pollachi, IND
| | - Manickam Mahalingam
- Department of Integrative Oncology, Mirakle Integrated Health Centre, Pollachi, IND
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Albakr A, Baghdadi A, Karmur BS, Lama S, Sutherland GR. Meningioma recurrence: Time for an online prediction tool? Surg Neurol Int 2024; 15:155. [PMID: 38840600 PMCID: PMC11152515 DOI: 10.25259/sni_43_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: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 06/07/2024] Open
Abstract
Background Meningioma, the most common brain tumor, traditionally considered benign, has a relatively high risk of recurrence over a patient's lifespan. In addition, with the emergence of several clinical, radiological, and molecular variables, it is becoming evident that existing grading criteria, including Simpson's and World Health Organization classification, may not be sufficient or accurate. As web-based tools for widespread accessibility and usage become commonplace, such as those for gene identification or other cancers, it is timely for meningioma care to take advantage of evolving new markers to help advance patient care. Methods A scoping review of the meningioma literature was undertaken using the MEDLINE and Embase databases. We reviewed original studies and review articles from September 2022 to December 2023 that provided the most updated information on the demographic, clinical, radiographic, histopathological, molecular genetics, and management of meningiomas in the adult population. Results Our scoping review reveals a large body of meningioma literature that has evaluated the determinants for recurrence and aggressive tumor biology, including older age, female sex, genetic abnormalities such as telomerase reverse transcriptase promoter mutation, CDKN2A deletion, subtotal resection, and higher grade. Despite a large body of evidence on meningiomas, however, we noted a lack of tools to aid the clinician in decision-making. We identified the need for an online, self-updating, and machine-learning-based dynamic model that can incorporate demographic, clinical, radiographic, histopathological, and genetic variables to predict the recurrence risk of meningiomas. Conclusion Although a challenging endeavor, a recurrence prediction tool for meningioma would provide critical information for the meningioma patient and the clinician making decisions on long-term surveillance and management of meningiomas.
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Affiliation(s)
| | | | - Brij S. Karmur
- Department of Clinical Neurosciences, Project neuroArm, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Elkady A, Soliman MAR, Ali AM. Clinical Outcomes of Infratentorial Meningioma Surgery in a Developing Country. World Neurosurg 2020; 137:e373-e382. [PMID: 32032796 DOI: 10.1016/j.wneu.2020.01.202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND No data are available on incidence, surgical approaches, complications, and survival for patients with infratentorial meningiomas in developing countries. Predictors for surgical resection, recurrence, and complications were analyzed based on the surgical outcomes of patients with infratentorial meningiomas. METHODS A total of 101 consecutive cases of infratentorial meningiomas operated on between April 2012 and April 2017 at our institute were reviewed retrospectively. The patients had a mean age of 55.1 ± 5 years, a female predominance of 62.3%, and the mean duration of follow-up duration was 44.2 ± 15.5 months. RESULTS The most common surgical approach was retrosigmoid (n = 51) followed by suboccipital (n = 36), subtemporal (n = 8), and far lateral (n = 6). The preoperative presentation showed that affected cranial nerve was the most common presenting symptom (47.5%) followed by weakness (24.8%) and affected vision (16.8%) followed by headache (8.9%) and gait disturbance (6.9%). The extent of resection was grade I (n = 63), grade II (n = 15)and grade III (n = 23) according to the Simpson grading. The complication rate was 56 cases (55.4%); the most common complication was cranial nerve palsy (42.6%), followed by weakness (31.7%), hydrocephalus (16.8%), chest infection (8.9%), ataxia (4%), deep venous thrombosis (4%), cerebrospinal fluid leak (3%) and meningitis and pulmonary embolism (both 1%). CONCLUSIONS The location, surgical approach, preoperative Karnofsky Performance Status, and peritumor edema were significantly associated with complications. Compared with developed countries, we had a higher complication rate (P < 0.001), lower recurrence rate (P = 0.15), and slightly lower total resection rate (P = 0.29). These findings might be attributed to the patient's late presentation to the tertiary center and poor technical resources.
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Affiliation(s)
- Ali Elkady
- Department of Neurosurgery, University of Cairo, Cairo, Egypt
| | | | - Ahmed M Ali
- Department of Neurosurgery, University of Cairo, Cairo, Egypt
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Wang C, Kaprealian TB, Suh JH, Kubicky CD, Ciporen JN, Chen Y, Jaboin JJ. Overall survival benefit associated with adjuvant radiotherapy in WHO grade II meningioma. Neuro Oncol 2018; 19:1263-1270. [PMID: 28371851 DOI: 10.1093/neuonc/nox007] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Adjuvant radiotherapy (RT) after surgical resection of World Health Organization (WHO) grade II meningioma, also known as atypical meningioma (AM), is a topic of controversy. The purpose of this study is to compare overall survival (OS) with or without adjuvant RT after subtotal resection (STR) or gross total resection (GTR) in AM patients diagnosed according to the 2007 WHO classification. Methods The National Cancer Database was used to identify 2515 patients who were diagnosed with AM between 2009 and 2012 and underwent STR or GTR with or without adjuvant RT. Propensity score matching was first applied to balance covariates including age, year of diagnosis, sex, race, histology, and tumor size in STR or GTR cohorts stratified by adjuvant RT status. Multivariate regression according to the Cox proportional hazards model and Kaplan-Meier survival plots with log-rank test were then used to evaluate OS difference associated with adjuvant RT. Results GTR is associated with improved OS compared with STR. In the subgroup analysis, adjuvant RT in patients who underwent STR demonstrated significant association with improved OS compared with no adjuvant RT (adjusted hazard ratio [AHR] 0.590, P = .045); however, adjuvant RT is not associated with improved OS in patients who underwent GTR (AHR 1.093, P = .737). Conclusions Despite the lack of consensus on whether adjuvant RT reduces recurrence after surgical resection of AM, our study observed significantly improved OS with adjuvant RT compared with no adjuvant RT after STR.
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Affiliation(s)
- Chenyang Wang
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Tania B Kaprealian
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - John H Suh
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Charlotte D Kubicky
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Jeremy N Ciporen
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Yiyi Chen
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Jerry J Jaboin
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
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Gonzalez-Quarante LH, Ruiz-Juretschke F, Iza-Vallejo B, Scola-Pliego E, Poletti D, Sola Vendrell E. Expanded Endoscopic Transclival Approach for Resection of a Chordoid Meningioma without Dural Attachment (MWODA) Located in the Prepontine Cistern. World Neurosurg 2016; 91:675.e5-675.e10. [DOI: 10.1016/j.wneu.2016.04.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/17/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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Nanda A, Bir SC, Maiti TK, Konar SK, Missios S, Guthikonda B. Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma. J Neurosurg 2016; 126:201-211. [PMID: 27058201 DOI: 10.3171/2016.1.jns151842] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The clinical significance of the Simpson system for grading the extent of meningioma resection and its role as a predictor of the recurrence of World Health Organization (WHO) Grade I meningiomas have been questioned in the past, echoing changes in meningioma surgery over the years. The authors reviewed their experience in resecting WHO Grade I meningiomas and assessed the association between extent of resection, as evaluated using the Simpson classification, and recurrence-free survival (RFS) of patients after meningioma surgery. METHODS Clinical and radiological information for patients with WHO Grade I meningiomas who had undergone resective surgery over the past 20 years was retrospectively reviewed. Simpson and Shinshu grading scales were used to evaluate the extent of resection. Statistical analysis was conducted using Kaplan-Meier curves and Cox proportional-hazards regression. RESULTS Four hundred fifty-eight patients were eligible for analysis. Overall tumor recurrence rates for Simpson resection Grades I, II, III, and IV were 5%, 22%, 31%, and 35%, respectively. After Cox regression analysis, Simpson Grade I (extensive resection) was revealed as a significant predictor of RFS (p = 0.003). Patients undergoing Simpson Grade I and II resections showed significant improvement in RFS compared with patients undergoing Grade III and IV resections (p = 0.005). Extent of resection had a significant effect on recurrence rates for both skull base (p = 0.047) and convexity (p = 0.012) meningiomas. Female sex and a Karnofsky Performance Scale score > 70 were also identified as independent predictors of RFS after resection of WHO Grade I meningioma. CONCLUSIONS In this patient cohort, a significant association was noted between extent of resection and rates of tumor recurrence. In the authors' experience the Simpson grading system maintains its relevance and prognostic value and can serve an important role for patient education. Even though complete tumor resection is the goal, surgery should be tailored to each patient according to the risks and surgical morbidity.
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Affiliation(s)
- Anil Nanda
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Shyamal C Bir
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Tanmoy K Maiti
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Subhas K Konar
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Symeon Missios
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
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Cohen-Inbar O, Lee CC, Schlesinger D, Xu Z, Sheehan JP. Long-Term Results of Stereotactic Radiosurgery for Skull Base Meningiomas. Neurosurgery 2015; 79:58-68. [DOI: 10.1227/neu.0000000000001045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
BACKGROUND:
Gamma knife radiosurgery (GKRS) is well established in the management of inaccessible, recurrent, or residual benign skull base meningiomas. Most series report clinical outcome parameters and complications in the short intermediate period after radiosurgery. Reports of long-term tumor control and neurological status are still lacking.
OBJECTIVE:
To report the presentation, treatment, and long-term outcome of skull base meningiomas after GKRS.
METHODS:
From a prospectively collected institutional review board-approved database, we selected patients with a World Health Organization grade I skull base meningioma treated with a single-session GKRS and a minimum of 60 months follow-up. One hundred thirty-five patients, 54.1% males (n = 73), form the cohort. Median age was 54 years (19–80). Median tumor volume was 4.7 cm3 (0.5–23). Median margin dose was 15 Gy (7.5–36). Median follow-up was 102.5 months (60.1–235.4). Patient and tumor characteristics were assessed to determine the predictors of neurological function and tumor progression.
RESULTS:
At last follow-up, tumor volume control was achieved in 88.1% (n = 119). Post-GKRS clinical improvement or stability was reported in 61.5%. The 5-, 10-, and 15-year actuarial progression-free survival rates were 100%, 95.4%, and 68.8%, respectively. Favorable outcome (both tumor control and clinical preservation/improvement) was attained in 60.8% (n = 79). Pre-GKRS performance status (Karnofsky Performance Scale) was shown to influence tumor progression (P = .001) and post-GKRS clinical improvement/preservation (P = .003).
CONCLUSION:
GKRS offers a highly durable rate of tumor control for World Health Organization grade I skull base meningiomas, with an acceptably low incidence of neurological deficits. The Karnofsky Performance Scale at the time of radiosurgery serves as a reliable long-term predictor of overall outcome.
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Affiliation(s)
- Or Cohen-Inbar
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Cheng-chia Lee
- Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - David Schlesinger
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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