• 대한두경부종양학회지
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• 제26권2호
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• pp.259-261
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• 2010

The meningiomas are slowly growing tumors arising from meningoepithelial cells and they generally occur in the intracranial space. Tumor extension to the extracranial structures occurred in about 20 percent of intracranial meningiomas. Meningiomas extending to the cervical area are uncommom. Beacuse these patients complain of localized symptoms, sometimes those tumors have been operated as cervical tumors. In this report, we incidentally found a meningioma in the left parapharyngeal space in a 63-year-old female, who was confirmed by histopathologic diagnosis to have meningioma. We report herewith this case with the review of literatures.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.217-223
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• 2007

Objective : The apparent increase in the incidence of the intracranial meningiomas in the elderly is due in part to improved diagnostic tools and improved span of life. The authors carried out a retrospect study to validate the use of the Clinical-Radiological Grading System [CRGS] as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival. Methods : From January 1997 to January 2006, the authors consecutively recruited and surgically treated 20 patients older than 65 years of age with radiologic findings of intracranial meningiomas and a preoperative evaluation based on the CRGS. Results : High CRGS score was associated with a higher probability of good outcome [p=0.004] and a lower probability of postoperative complications [p=0.049]. Among the different subset items of the CRGS score, larger maximum tumor diameters [$D{\geqq}4cm$] and the presence of a severe peritumoral edema were associated with incidence rate of postoperative poor outcome and complications [p<0.05]. Additionally, the critical location of the tumor was also correlated with poor outcome [p<0.05]. Conclusion : A CRGS score higher than 13 is a good prognostic indication of survival. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial meningiomas as surgical candidates.

• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.58-60
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• 2014

Spinal meningiomas typically adhere to the dura matter. Non-dural based spinal meningiomas are rare and most are clear cell meningiomas. We report here the first case of a fibrous meningioma with non-dural attachment. The patient was a 49-year-old female, who complained of numbness in the legs and a gait disturbance. Magnetic resonance imaging revealed a $1.7{\times}1.4-cm$ mass in the C7-T1 intra-dural extramedullary space, showing peripheral gadolinium enhancement without a "dural tail sign". A complete microsurgical resection was performed. The mass was covered with a white membrane but was not adhered to the dura, and its appearance was consistent with a neurilemmoma. The histopathological diagnosis was fibrous-type meningioma. The recovery of the patient was uneventful. No surgical complications and no recurrence of the tumor had occurred at the 6-month follow-up.

• Journal of Korean Neurosurgical Society
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• 제59권4호
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• pp.405-409
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• 2016

Meningiomas are typically diagnosed by their characteristic appearance on conventional magnetic resonance imaging (MRI). However, detailed image findings regarding peri- and intra-tumoral anatomical structures, tumor consistency and vascularity are very important in pre-surgical planning and surgical outcomes. At the 7.0 T MRI achieving ultra-high resolution, it could be possible to obtain more useful information in surgical strategy. Four patients who were radiologically diagnosed with intracranial meningioma in 1.5 T MRI underwent a 7.0 T MRI. Three of them underwent surgery afterwards, and one received gamma knife radiosurgery. In our study, the advantages of 7.0 T MRI over 1.5 T MRI were a more detailed depiction of the peri- and intra-tumoral vasculature and a clear delineation of tumor-brain interface. In the safety issues, all patients received 7.0 T MRI without any adverse event. One disadvantage of 7.0 T MRI was the reduced image quality of skull base lesions. 7.0 T MRI in patients with meningiomas could provide useful information in surgical strategy, such as the peri-tumoral vasculature and the tumor-brain interface.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.821-826
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• 2020

Objective : Hyperostosis in meningiomas can be present in 4.5% to 44% of cases. Radical resection should include aggressive removal of invaded bone. It is not clear however to what extent bone removal should be carried to achieve pathologically free margins, especially that in many cases, there is a T2 hyperintense signal that extends beyond the hyperostotic bone. In this study we try to investigate the perimeter of tumour cells outside the visible nidus of hyperostotic bone and to what extent they are present outside this nidus. This would serve as an initial step for setting guidelines on dealing with hyperostosis in meningioma surgery. Methods : This is a prospective case series that included 14 patients with convexity meningiomas and hyperostosis during the period from March 2017 to August 2018 in two university hospitals. Patients demographics, clinical, imaging characteristics, intraoperative and postoperative data were collected and analysed. In all cases, all visible abnormal bone was excised bearing in mind to also include the hyperintense diploe in magnetic resonance imaging (MRI) T2 weighted images after careful preoperative assessment. To examine bony tumour invasion, five marked bone biopsies were taken from the craniotomy flap for histopathological examinations. These include one from the centre of hyperostotic nidus and the other four from the corners at a 2-cm distance from the margin of the nidus. Results : Our study included five males (35.7%) and nine females (64.3%) with a mean age of 43.75 years (33-55). Tumor site was parietal in seven cases (50%), fronto-parietal in three cases (21.4%), parieto-occipital in two cases (14.2%), frontal region in one case and bicoronal (midline) in one case. Tumour pathology revealed a World Health Organization (WHO) grade I in seven cases (50%), atypical meningioma (WHO II) in five cases (35.7%) and anaplastic meningioma (WHO III) in two cases (14.2%). In all grade I and II meningiomas, bone biopsies harvested from the nidus revealed infiltration with tumour cells while all other bone biopsies from the four corners (2 cm from nidus) were free. In cases of anaplastic meningiomas, all five biopsies were positive for tumour cells. Conclusion : Removal of the gross epicentre of hyperostotic bone with the surrounding 2 cm is adequate to ensure radical excision and free bone margins in grade I and II meningiomas. Hyperintense signal change in MRI T2 weighted images, even beyond visible hypersototic areas, doesn't necessarily represent tumour invasion.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.696-700
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• 2000

The authors report a case of atypical meningioma in the fourth ventricle. Intraventricular meningioma is not uncommon intracranial neoplasm, especially that in the trigone of lateral ventricle, however, those in the third and fourth ventricle are very rare. There are only two cases of atypical meningiomas in the fourth ventricle among 29 cases of fourth ventricular meningiomas reported 17 literature. The clinical features, findings of magnetic resonance image and operation of our case, and review of literature are presented.

• Journal of Korean Neurosurgical Society
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• 제39권2호
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• pp.136-140
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• 2006

The authors report three microcystic meningiomas with its characteristic immunohistochemical findings and chromosomal pattern. Three patients with surgically treated microcystic meningioma were studied for its radiological, histopathological findings, and chromosomal analysis was done in the one patient. Tumors were convexity meningioma in the frontal area. The tumors were enhanced homogenously in the two, and enhanced in homogenously with multiple small cysts in the other one on preoperative magenetic resonance image. Pathological examination showed marked nuclear pleomorphism, many small cysts, hyaline thickening in blood vessel wall, and mucinous background, compatable to microcystic type. EMA and vimentin were positive on the immunohistochemical stain. Chromosomal analysis showed tetrasomies of chromosome 5, 13, 17, and 20, and trisomies of chromosome 6, 7, 9, 11, 12, 16, 19, and 21, which are quite different from those of benign meningioma.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.423-427
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• 2006

Objective : Postoperative brain swelling after resection of olfactory groove meningiomas by bifrontal interhemispheric transbasal approach is a knotty subject. Pathogenesis and predictive factors were investigated to prevent the problem. Methods : Eighteen patients of olfactory groove meningiomas who had undergone surgery were enrolled and retrospectively analyzed using their clinical and radiological data. Bifrontal inter hemispheric transbasal approach was used in all patients. Magnetic resonance imaging and transfemoral cerebral angiography were available for investigation in 18 and 14 patients respectively. Postoperative clinical course, tumor volume, peritumoral edema, tumor supplying vessels, and venous drainage patterns were carefully investigated in relation to postoperative brain swelling. Results : Seven patients [39%] developed clinically overt brain swelling after surgery. Among them, 4 patients had to undergo decompression surgery. In three patients, attempted bone flap removal was done by way of prevention of increased intracranial pressure resulted from intractable brain swelling and two of them eventually developed brain swelling which could be recovered without sequellae. Abnormal frontal base venous channel observed in preoperative angiography was significant predictive factor for postoperative brain swelling [p=0.031]. However, tumor volume, peritumoral edema, and existence of pial tumor supplying vessels from anterior cerebral arteries were failed to show statistical significances. Conclusion : To prevent postoperative brain swelling in olfactory groove meningioma surgery, unilateral approach to preserve frontal base venous channels or temporal bone flap removal is recommended when it is indicated.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.584-589
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• 2016

Objective : A rare subtype of meningioma, sclerosing meningioma is not included in the current World Health Organization classification of meningiomas and is classified into the category of other morphological variation subtypes. Sclerosing meningioma is often misdiagnosed to other non-benign meningioma or malignant neoplasm, so it is important to diagnose sclerosing type correctly. We analyzed the radiological and clinical characteristics of a series of sclerosing meningiomas. Methods : Twenty-one patients who underwent surgery in one institute with a histopathologically proven sclerosing meningioma were included from 2006 to 2014. Eighteen tumors were diagnosed as a pure sclerosing-type meningioma, and 3 as mixed type. Magnetic resonance image was taken for all patients including contrast enhancement image. Computed tomography (CT) scan was taken for 16 patients. One neuroradiologist and 1 neurosurgeon reviewed all images retrospectively. Results : In the all 16 patients with preoperative CT images, higher attenuation was observed in the meningioma than in the brain parenchyma, and calcification was observed in 11 (69%). In 15 of the 21 patients (71%), a distinctive very low signal intensity appeared as a dark color in T2-weighted images. Nine of these 15 tumors (60%) exhibited heterogeneous enhancement, and 6 (40%) exhibited homogeneous enhancement that was unlike the homogeneous enhancing pattern shown by conventional meningiomas. Ten patients had a clear tumor margin without peritumoral edema. Conclusion : Although these peculiar radiological characteristics are not unique to sclerosing meningioma, we believe that they are distinctive features that may be helpful for distinguishing sclerosing meningioma from other subtypes.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6337-6340
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• 2013

Through retrospective analysis of 13 cases of magnetic resonance image (MRI) manifestations of atypical meningiomas confirmed by operation and pathology in the First Affiliated Hospital of Xinxiang Medical University, the objective of this study was to evaluate the diagnostic value of MRI in order to improve the accuracy rate of preoperative diagnosis. In this retrospective analysis of MRI findings for atypical meningiomas in First Affiliated Hospital of Xinxiang Medical University from January to July in 2012, the location, morphology and tumor signals and other tumor imaging characteristics were covered. In 13 cases of atypical meningioma patients of this group, most tumors were located at typical sites (10/13), mainly the falx cerebri, parasagittal, convexity, saddle area. Only two cases were at atypical locations, 1 in the cerebellar hemisphere and 1 in a lateral ventricle. Most of the tumors showed T1 and T2 isointensity signals, and necrosis, calcification, and peritumoral edema were always featured. DWI showed isointensity in 11 cases (11/13), and hyperintensity in 2. Some 9 cases had dural tail signs, 12 had accurate positioning (12/13), and 2 were postoperative recurrences. MRI has high value in the diagnosis of atypical meningiomas, with important roles in early clinical diagnosis, treatment and prognosis evaluation.