Introduction
Meningiomas are usually slow-growing tumours, constituting about one third of all primary intracranial tumours. They occur more frequently in women. Clinical manifestation of meningiomas ...depends on their location, tumour size and growth rate. In most cases, surgical treatment is the procedure of choice. The success of this treatment is, however, associated with the radicality of the resection. Radiotherapy represents an additional or alternative treatment modality. Gamma knife surgery is another notable treatment method, especially in small and/or slow-growing tumours in eloquent areas or in elderly patients.
Material and methods
Authors describe their experience with the diagnosis, treatment and outcome of the patients with meningioma (
n
= 857). Furthermore, they also assess the postoperative morbidity/mortality and recurrence rate.
Results and conclusions
In view of the benign histology of meningiomas, the success of the treatment largely depends (besides the tumour grading) on the radicality of the resection. The emphasis is also put on appropriate follow-up of the patients. In certain patients, the watch and wait strategy should be also considered as a suitable treatment method.
The positive effects of goal-directed hemodynamic therapy (GDHT) on patient-orientated outcomes have been demonstrated in various clinical scenarios; however, the effects of fluid management in ...neurosurgery remain unclear. Therefore, this study was aimed at assessing the safety and feasibility of GDHT using non-invasive hemodynamic monitoring in elective neurosurgery. The incidence of postoperative complications was compared between GDHT and control groups.
We conducted a single-center randomized pilot study with an enrollment target of 34 adult patients scheduled for elective neurosurgery. We randomly assigned the patients equally into control and GDHT groups. The control group received standard therapy during surgery and postoperatively, whereas the GDHT group received therapy guided by an algorithm based on non-invasive hemodynamic monitoring. In the GDHT group, we aimed to achieve and sustain an optimal cardiac index by using non-invasive hemodynamic monitoring and bolus administration of colloids and vasoactive drugs. The number of patients with adverse events, feasibility criteria, perioperative parameters, and incidence of postoperative complications was compared between groups.
We successfully achieved all feasibility criteria. The GDHT protocol was safe, because no patients in either group had unsatisfactory brain tissue relaxation after surgery or brain edema requiring therapy during surgery or 24 h after surgery. Major complications occurred in two (11.8%) patients in the GDHT group and six (35.3%) patients in the control group (p = 0.105).
Our results suggested that a large randomized trial evaluating the effects of GDHT on the incidence of postoperative complications in elective neurosurgery should be safe and feasible. The rate of postoperative complications was comparable between groups.
Trial registration: ClininalTrials.gov, registration number: NCT04754295, date of registration: February 15, 2021.
Abstract
Meningiomas are the most common primary tumors of the central nervous system (CNS). Atypical meningioma (AM) recurs in 40% of patients despite total resection and radiotherapy (RT). No ...consensus on optimal adjuvant management was found, and it is difficult to identify patients insensitive to RT in real-life clinical practice. A promising group of biomarkers represent microRNAs (miRNAs), short non-coding RNAs that regulate most biological processes, including cell proliferation, differentiation, and apoptosis. The study aims to identify tissue miRNAs capable of predicting patients with AM who could benefit from the indicated adjuvant RT. The study includes 80 patients with AM in the exploratory phase and 400 patients with meningioma in the validation phase. Total RNA enriched with miRNAs was isolated from FFPE tissue using the mirVana miRNA Isolation Kit (TF Scientific). Subsequently, RNA quantity and quality controls were measured using NanoDrop 2000 (TF Scientific) and Qubit 2.0 (TF Scientific) instruments. A global miRNA expression profile was generated using the TaqMan Array Human MicroRNA Cards (TF Scientific), which allow the detection of up to 754 miRNAs simultaneously. Obtained data were processed and integrated through bioinformatics algorithms with clinicopathological data of patients with AM.The study identified significantly dysregulated miRNAs among AM patients with and without recurrence (p < 0.05). Results also suggest dysregulated miRNA expression profile in AM patients with indicated RT who did/did not develop a recurrence (p < 0.05). Lists of individual miRNAs and detailed graphical analyses will be included in the conference presentation.The results will help predict the prognosis of surgically intervened patients more accurately and can help determine which patients will benefit from the adjuvant RT. This research is supported by the AZV grant from the Ministry of Health of the Czech Republic (reg. No. NV19-03-00559) and Conceptual development of research organization (FNBr, 65269705). All rights reserved.
Abstract
Introduction:
Goal-directed hemodynamic therapy aims to reduce the incidence of postoperative complications in patients undergoing surgical procedures. Optimal preload is mandatory to ...achieve adequate cardiac output and oxygen supply to organs and tissues. Neurosurgical patients are at risk of inadequate preload, decreased blood flow and reduced oxygen delivery, all of which can lead to organ dysfunction. Current knowledge regarding the effect of fluid management on patient-orientated outcomes in neurosurgery is limited. Therefore, this study aims to compare the safety and feasibility of goal-directed therapy with standard management in patients undergoing neurosurgical procedures.
Methods and analysis:
Patients undergoing neurosurgical operation will be randomised into two groups. Therapy in the first group of patients will be guided by standard perioperative monitoring. In the second group, perioperative therapy will be guided using non-invasive hemodynamic monitoring in addition to standard monitoring. Administration of fluids and vasoactive drugs will depend on the assessment of stroke volume variation and cardiac index. The safety of goal-directed hemodynamic therapy protocol will be assessed by comparing incidences of adverse events between groups.
Vestibular schwannoma is a posterior cranial fossa tumour, which is usually manifested by unilateral perceptual hearing loss, tinnitus, vertigo, facial tingling, etc. Therapy of vestibular schwannoma ...is chosen according to the size of tumour, its location and growth rate. Therapeutic procedures include microsurgical treatment and/or stereotactic radiosurgery and radiotherapy. Unilateral hearing loss occurs postoperatively, but bulbar syndrome may also develop through perioperative functional impairment of the peripheral nerves near the tumour site. The paper presents the role of a Clinical Speech Therapist in the diagnosis and therapy in a patient after vestibular schwannoma surgery with the development of bulbar symptoms.
Meningeomy grade III patří mezi zřídka se vyskytující neoplazie centrálního nervového systému. Na rozdíl od benigních forem se jedná o onemocnění s agresivním růstem a špatnou prognózou. Resekce, i ...radikální, musí být následována neodkladnou adjuvantní radioterapií, která umožní lepší lokální kontrolu, zejména u parciálně resekovaných tumorů. Navzdory komplexní terapii zůstává tato zřídkavá varianta onemocněním se špatnou prognózou a krátkou délkou přežití. Autoři zpracovávají šestičlennou skupinu pacientů s meningeomem grade III. Skupina je analyzována z hlediska diagnostiky, radikality operace, velikosti rezidua před ozářením, dále z hlediska následné léčby a střední doby přežití. U dvou pacientů byla provedena radikální resekce vč. origa, u zbylých čtyř zůstalo origo neresekováno. Všichni pacienti se následně podrobili radioterapii. V případě výskytu recidivy se postupovalo individuálně, terapie varírovala od reoperace přes ošetření pomocí gamma nože až po paliaci. Střední doba přežití byla 18 ? 7 měsíců. Veškeré terapeutické postupy by měly vést k maximální radikalitě léčby při minimalizaci rizika vzniku neurologického deficitu.
Meningioma grade III is one of rare tumors of the central nervous system. Unlike benign forms, grade III meningiomas are known for rapid aggressive growth and poor prognosis. Compared to benign forms, they tend to grow more intraaxially, infiltrating brain tissue. Resection, even though radical, must be followed by immediate adjuvant radiotherapy that allows better local control, especially in partially resected tumors. The disease continues to have poor prognosis and short survival time irrespective of the comprehensive treatment of this quite infrequent variant of the disease. Adjuvant radiotherapy could be combined with or followed by chemotherapy. Newly available data are to shed new light on this topic. Hormonal therapy and some aspects of molecular biology have been suggested as promising methods to improve patient prognosis. These new methods as well as stereotactic radiosurgery could provide suitable options for the treatment of malignant meningioma recurrence. The authors present case series of six patients with meningioma grade III. The group was analysed in terms of the diagnosis, extent of dissection, size of the residuum before radiation therapy as well as in terms of follow-up and median survival. Two patients underwent radical resection (Simpson 1), while four remaining underwent Simpson 3 resection. Afterwards, all patients underwent radiotherapy. Recurrence was managed individually. Therapy varied from reoperation through gamma knife treatment to palliation. Median survival was 18 ? 7 months. Any therapeutic approach should be as radical as possible while minimizing a risk of neurological deficit. Key words: meningioma WHO grade III – diagnostics – therapy – surveillance The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
J. Musil, A. Mrlian, M. Duba, M. Smrčka
V terapii meningeomů na prvním místě přetrvává chirurgická léčba. Cílem chirurgické léčby je úplné odstranění nádoru, které často znamená úplné vyléčení pacienta. Prognózu pacienta určuje především ...radikalita resekce, dále také anatomické umístění a histologický typ nádoru dle WHO klasifikace. Některé meningeomy, zejm. meningeomy baze lební, které často utiskují nebo obrůstají velké cévy a hlavové nervy, a dále potom meningeomy, které histologicky odpovídají WHO st. III, jsou velmi obtížně léčitelné. Nezanedbatelným faktorem je i celkový stav a interní komorbidity. Autoři uvádějí nejčastější typy obtížně chirurgicky řešitelných meningeomů a popisují zkušenosti svého pracoviště s chirurgickým odstraněním, další léčbou a sledováním pacientů s těmito nádory.
Surgical treatment is still considered as the method of choice for the treatment of meningiomas. The goal of treatment is to completely surgically remove the tumor; complete excision often results in a permanent cure of the patient. The patient prognosis is mainly determined by the completeness of the resection but anatomical location and histological type of the tumor according to the WHO classification also play an important role. Some meningiomas, especially the skull base meningiomas, often involving large vessels and cranial nerves, as well as WHO grade III meningiomas are very difficult to treat. Patient general health status and internal comorbidities represent another very important factor. The authors describe the most common types of surgically difficult-to-treat meningiomas and describe their experience with surgical removal and additional treatment and surveillance of patients with these tumors. Key words: meningioma – surgery – resection The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
M. Duba, A. Mrlian, E. Neuman, J. Musil, M. Smrčka
Meningeomy jsou zpravidla pomalu rostoucí nádory, které vznikají z arachnoideálních buněk. Tvoří přibližně třetinu všech primárních intrakraniálních nádorů. Vyskytují se častěji u žen. Klinická ...manifestace meningeomů je závislá především na lokalizaci a velikosti tumoru. V terapii se uplatňuje hlavně chirurgická léčba, jejíž úspěšnost je spojena s radikalitou resekce. Další léčebnou modalitou je radiochirurgie, alternativou spíše experimentální zůstává hormonální terapie. Materiál a metodika: Autoři popisují zkušenosti svého pracoviště se záchytem, diagnostikou, terapií a dalším sledováním pacientů s meningeomem (n = 552). Výsledky a závěr: Navzdory převážné histologické benignitě meningeomů, recidivy mohou být poměrně časté a oscilují mezi 10 až 30 %, vždy s ohledem na stupeň radikality operace. Proto je nutná dispenzarizace těchto pacientů a pravidelné kontroly pomocí MR
Meningiomas are usually slow-growing tumors, which arise from arachnoideal cells and represent about one third of all primary intracranial tumors. They occur more frequently in women. Clinical manifestations of meningiomas depend on location and tumor size. In therapy, surgical treatment is mostly applied; the success rate is associated with the amount of the resection. Another treatment modality is radiotherapy, hormonal therapy remains on experimental field. Material a methods: Authors describe their experiences with the diagnosis, the therapy and with the follow up of the patients with meningioma (n = 552). Results and conclusion: Despite of mostly benign histology of meningiomas, their recurrence may be relatively frequent and oscillates between 10 to 30 % often depends of the extension of the operation. Therefore, it is necessary to follow up these patients in compliance with regular monitoring using MR imaging.
Miloš Duba, Andrej Mrlian, Josef Musil, Martin Smrčka, Marek Bradávka
Literatura
Článek přibližuje použitelnost a přínos v praxi využívaných zobrazovacích metod, především funkční magnetické rezonance a difuzní traktografie pro neurochirurgickou operativu intraaxiálních mozkových ...nádorů. Objasňuje také princip nejčastěji používaných elektrofyziologických metod (vyšetření zvratu fáze somatosenzorických evokovaných potenciálů, monitoraci motorických evokovaných potenciálů, kortikální elektrickou stimulaci při operacích s bdělou fází) sloužících k nalezení funkčně významných oblastí mozku a k monitoraci jejich funkčnosti během operace.
The article introduces the applicability and benefit of imaging techniques used in the practice, particularly functional magnetic resonance and diffuse tractography, for neurosurgical treatment of intra-axial brain tumours. It also elucidates the principles of the most commonly employed electrophysiological methods (somatosensory evoked potential phase reversal, motor evoked potential monitoring, electrical cortical stimulation in awake craniotomy) used to detect functionally significant areas of the brain and monitor their functioning during surgery.
Eduard Neuman, Marek Sova, Miloš Duba, Václav Vybíhal, Marián Sadecký, Pavel Fadrus, Martin Smrčka
Literatura
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