İntrakranial Menenjioma Olgularının Değerlendirilmesi: 72 Hastanın Analizi

Amaç: Kliniğimizde 2012–2018 yıllarında ameliyat olmuş ve menenjiom tanısı almış olan 72 hasta retrospektif olarak klinik, radyolojik ve patolojik bulgularıyla incelenerek literatür eşliğinde tartışıldı. Yöntemler: Hastaların yaşları, cinsiyetleri, klinik bulguları, radyolojik görüntüleri, yerleşim yerleri, ameliyat kayıtları ve patolojik olarak aldıkları tanıları incelendi. Bulgular: 72 intrakranial menenjiomalı hastanın 47 (%65,3)’i kadın, 25 (%34,7)’i erkektir. Kadın/Erkek oranı: 1.88’dir. Olgular 19-78 yaş aralığında olup, yaş ortalaması 44.7’dir. Sıklık sırasına göre başvurma nedenleri ve nörolojik muayene bulguları: Baş ağrısı (%72,2), bulantı-kusma (%37,5), epilepsi (%25,0), motor defisit (%20,8)’dir. En sık yerleştikleri lokalizasyonlar: konvexite 17 (%23,7), parasagital 14 (%19,5), sfenoid kanat 9 (%12,59 bölgesidir. Cerrahi tedavideki rezeksiyonumuzun Simpson klasifikasyonuna göre; hastaların 57 (%79,2)’i grade I, 8 (%11,1)’i grade II, 2 (%2,8)’i grade III, 4 (%5,5)’i grade IV ve 1 (%1,4)’i grade V olarak değerlendirilmiştir. Histopatojik tanıları ise sıklık sırasına göre; 29 (%40,3) meningotelyomatöz, 13 (%18,1) fibröz, 9 (%12,5) transisyonel, 6 (%8,3) oranında psammomatöz tip şeklinde tespit edildi. Sonuç: İntrakranial menenjiomalar malign tipleri dışında; genellikle benign karekterde yavaş büyüyen, erken tanı konup, total çıkarıldığında tam kür sağlanan, rekürrens oranı çok düşük olan tümörlerdir. Menenjiomalarda cerrahi kararın verilmesinde ve sürvide; hastaların yaşı, preoperatif performans skalası, tümörün lokalizasyonu, büyüklüğü, rezeksiyon derecesi, histopatolojik özellikleri gibi birçok faktör rol oynamaktadır. Asemptomatik, küçük boyutta, ameliyata uygun olmayan, yaşlı, kafa tabanı, kavernöz sinüs gibi ulaşılması zor lokalizasyonlarda bulunan hastalarda seri görüntülemelerle yakın takip ve radyocerrahi tercih edilebilir. MRG takibi 3. ay, 6. ay ve sonrasında yıllık takipler şeklinde ve takipte gerek görülürse, büyüme olursa cerrahi/radyocerrahi önerilir. Genç olan ve kalsifikasyonu bulunmayanlarda hızlı büyüme riski nedeniyle cerrahi düşünülmelidir

Assessment of Cases with Intracranial Meningioma: Analysis of 72 Patients

Objective: 72 patients, operated and diagnosed as meningioma in our clinic, are discussed retrospectively with the clinical, radiological and histopathological findings in the enlightenment of literature. Methods: Patients' ages, sex, clinical findings, radiological images, tumors’ locations, operative records and histopathological diagnosis were reviewed. Results: Of 72 patients with intracranial meningioma, 47 (65.3%) were female and 25 (34.7%) were male. The female / male ratio is 1.88. The cases are between 19 and 78 years old and the average age is 44.7. Causes and neurological examination findings were as follows: Headache (72.2%), nausea and vomiting (37.5%), epilepsy (25.0%) and motor deficit (20.8%). The most common localizations were: convexity 17 (23.7%), parasagittal 14 (19.5%), sphenoid wing 9 (12.59%). According to Simpson classification of resection in surgical treatment; 57 (79,2%) patients were grade I, 8 (11.1%) were grade II, 2 (2.8%) were grade III, 4 (5.5%) were grade IV and 1 (%1.4) grade V .Histopathologic diagnoses are according to frequency; 29 (40.3%) meningothelial, 13 (18.1%) fibrous, 9 (12.5%) transitional and 6 (8.3%) psammomateous type were detected. Conclusion: Apart from malignant types of intracranial meningioma; usually benign tumors that grow slowly, when they are diagnosed early and removed totally are fully cured, and have very low recurrence rates. About deciding on surgery and estimating the survival rates the patient's age, preoperative performance scale, the tumor location, size, degree of resection, histopathological features and as many factors play roles. Close follow-up with serial imaging and radio surgery may be preferred for tumors which area symptomatic, small in size, or difficult to reach due to localizations like skull base or cavernous sinus, in elderly patients who are inappropriate for surgery. MRI follow-up is recommended at 3rd month, at 6th month, and afterwards annual follow-ups are recommended. Surgery should be considered in young patients and in those tumors without calcification because of the risk of rapid growth.

PDF

___

Chamberlain MC, Tsao-Wei DD, Groshen S. Salvage chemotherapy with CPT-11 for recurrent meningioma. J Neurooncol. 2006; 78: 271-6.
Chamberlain MC, Tsao-Wei DD, Groshen S. Temozolomide for treatment-resistant recurrent meningioma. Neurology. 2004; 62: 1210-2.
Gupta V, Su YS, Samuelson CG et al. Irinotecan: a potential new chemotherapeutic agent for atypical or malignant meningiomas. J Neurosurg. 2007; 106: 455-62
Kyritsis AP. Chemotherapy for meningiomas. J Neurooncol. 1996; 29: 269-72.
Ojemann SG, Sneed PK, Larson DA et al. Radiosurgery for malignant meningioma: results in 22 patients. J Neurosurg. 2000; 93 Suppl 3: 62-7.
Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg. 2002; 97: 65-72.
Hastürk AE, Basmacı M, Canbay S et al. Intracranial Meningiomas: Analysis of 56 Patients. Türk Nöroşirürji Dergisi 2011, Cilt: 21, Sayı: 1, 1-7 1. 2011; 21: 1-7.
Paiva-Neto MA, Tella OI, Jr. Supra-orbital keyhole removal of anterior fossa and parasellar meningiomas. Arq Neuropsiquiatr. 2010; 68: 418-23.
Shukla D, Behari S, Jaiswal AK, Banerji D, Tyagi I, Jain VK. Tentorial meningiomas: operative nuances and perioperative management dilemmas. Acta Neurochir (Wien). 2009; 151: 1037-51
Landeiro JA, Goncalves MB, Guimaraes RD et al. Tuberculum sellae meningiomas: surgical considerations. Arq Neuropsiquiatr. 2010; 68: 424-9
Ichinose T, Goto T, Ishibashi K, Takami T, Ohata K. The role of radical microsurgical resection in multimodal treatment for skull base meningioma. J Neurosurg. 2010; 113: 1072-8.
Louis DN, Perry A, Reifenberger G et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016; 131: 803-20.
Pereira-Filho Nde A, Soares FP, Chemale Ide M, Coutinho LM. Peritumoral brain edema in intracranial meningiomas. Arq Neuropsiquiatr. 2010; 68: 346-9.
Saloner D, Uzelac A, Hetts S, Martin A, Dillon W. Modern meningioma imaging techniques. J Neurooncol. 2010; 99: 333-40
Buhl R, Nabavi A, Wolff S et al. MR spectroscopy in patients with intracranial meningiomas. Neurol Res. 2007; 29: 43-6
Braunstein JB, Vick NA. Meningiomas: the decision not to operate. Neurology. 1997; 48: 1459-62.
Jaaskelainen J. Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol. 1986; 26: 461-9.
Bozkurt M, Göcmez C, Okçu M et al. Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature. Dicle Medical Journal. 2014; 41: 210-3.
Bollag RJ, Vender JR, Sharma S. Anaplastic meningioma: progression from atypical and chordoid morphotype with morphologic spectral variation at recurrence. Neuropathology. 2010; 30: 279-87.
Rao S, Sadiya N, Doraiswami S, Prathiba D. Characterization of morphologically benign biologically aggressive meningiomas. Neurol India. 2009; 57: 744-8.
Sanson M, Cornu P. Biology of meningiomas. Acta Neurochir (Wien). 2000; 142: 493-505
Phillips LE, Koepsell TD, van Belle G, Kukull WA, Gehrels JA, Longstreth WT, Jr. History of head trauma and risk of intracranial meningioma: population-based case-control study. Neurology. 2002; 58: 1849-52.
Newton HB, Slivka MA, Stevens C. Hydroxyurea chemotherapy for unresectable or residual meningioma. J Neurooncol. 2000; 49: 165-70.
Jhawar BS, Fuchs CS, Colditz GA, Stampfer MJ. Sex steroid hormone exposures and risk for meningioma. J Neurosurg. 2003; 99: 848-53.
Chamberlain MC, Glantz MJ, Fadul CE. Recurrent meningioma: salvage therapy with long-acting somatostatin analogue. Neurology. 2007; 69: 969-73.
Kaba SE, DeMonte F, Bruner JM et al. The treatment of recurrent unresectable and malignant meningiomas with interferon alpha-2B. Neurosurgery. 1997; 40: 271-5.
Claus EB, Black PM, Bondy ML et al. Exogenous hormone use and meningioma risk: what do we tell our patients? Cancer. 2007; 110: 471-6.
Black PM. Hormones, radiosurgery and virtual reality: new aspects of meningioma management. Can J Neurol Sci. 1997; 24: 302-6.
Firsching RP, Fischer A, Peters R, Thun F, Klug N. Growth rate of incidental meningiomas. J Neurosurg. 1990; 73: 545-7.
Alexiou GA, Gogou P, Markoula S, Kyritsis AP. Management of meningiomas. Clin Neurol Neurosurg. 2010; 112: 177-82.
Apra C, Peyre M, Kalamarides M. Current treatment options for meningioma. Expert Rev Neurother. 2018; 18: 241-9.
Niiro M, Yatsushiro K, Nakamura K, Kawahara Y, Kuratsu J. Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry. 2000; 68: 25-8.
Colakoglu N, Demirtas E, Oktar N, Yuntem N, Islekel S, Ozdamar N. Secretory meningiomas. J Neurooncol. 2003; 62: 233-41
Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol. 2010; 99: 307-14.
Nakasu S, Fukami T, Jito J, Nozaki K. Recurrence and regrowth of benign meningiomas. Brain Tumor Pathol. 2009; 26: 69-72.
Longstreth WT, Jr., Dennis LK, McGuire VM, Drangsholt MT, Koepsell TD. Epidemiology of intracranial meningioma. Cancer. 1993; 72: 639-48.
Bondy M, Ligon BL. Epidemiology and etiology of intracranial meningiomas: a review. J Neurooncol. 1996; 29: 197-205.