Giant meningiomas: a detailed analysis of 40 cases

Öz

Purpose: Meningiomas greater than 6 centimetres (cm) are called giant meningiomas. This report discussed the surgical, pathological and radiological features of 40 cases with giant meningiomas.
Materials and methods: Patients radiologically and pathologically diagnosed with giant meningiomas between 2015-2019 were retrospectively evaluated in terms of the age, gender, localization of the lesion, symptoms and signs, treatment, follow-up, recurrence, morbidity and mortality.
Results: A total of 40 cases were enrolled in the study. Thirty cases (75%) were female, and 10 (25%) were male gender. The mean age of patients was 55.77.33 (mean  Standard deviation-SD) (min:39, max:72). The most common localization of lesions was convexity, with a rate of 32% (13 patients). The most common symptom was headache, with a rate of 42.5%. In 7 patients (17.5%) Simpson Grade I, in 16 patients (40%) Simpson Grade II, in 2 patients (5%) Simpson Grade III and 15 patients (37.5%), Simpson Grade IV surgical resection were performed. Pathological diagnoses were reported as Grade I meningioma in 32 patients (80%), Grade II in 6 patients (15%) and Grade III in 2 patients (5%). The mean follow-up period was 22 months (min:12, max:44), the recurrence rate was 7.5%. In our series, the rates of morbidity and mortality were 30% and 0%, respectively.
Conclusion: This study demonstrated that the localization and the size of the tumour significantly influence the total resection rate, mortality and morbidity. Surgical treatment of giant meningiomas requires attention and experience and is essential in the management. 

Anahtar Kelimeler

• Meningioma
• giant
• gamma knife
• surgery

Dev meningiomlar: 40 olgunun detaylı analizi

Öz

Amaç: Çapı 6 santimetreden (cm) büyük meningiomlar dev meningiomlar olarak isimlendirilir. Bu çalışmada cerrahi uyguladığımız 40 dev meningiom olgusunun klinik, patolojik ve radyolojik özellikleri ile tedavi yaklaşımlarını tartıştık.
Gereç ve yöntem: 2015-2019 yılları arasında çapı 6 cm’den büyük olan ve patolojik tanısı meningiom olarak rapor edilen hastalar yaş, cinsiyet, lokalizasyon, semptom ve bulgular, tedavi, takip süresi, nüks, morbidite ve mortalite açısından incelenmiştir.
Bulgular: Çalışmada toplam 40 vaka olup, vakaların 30 tanesi (%75) kadın, 10 tanesi ise (%25) erkek cinsiyette idi. Ortalama yaş 55,77,33 (ortalama  Standart Sapma-SS) (min:39, maks:72) olarak saptandı. En sık konveksite yerleşimliydi (13 hasta, %32). En sık semptom %42,5 ile baş ağrısıydı. Hastaların 7’sinde (%17,5) Simpson Evre I, 16 hastada (%40) Evre II, 2 hastada (%5) Evre III ve 15 hastada ise (%37,5) Evre IV cerrahi rezeksiyon uygulandı. Patolojik tanı 32 olguda (%80) Evre I, 6 olguda (%15) Evre II ve 2 olguda ise (%5) Evre III meningiom olarak raporlandı. Hastaların ortalama takip süresi 225,24 (min:12, maks:44), nüks oranı %7,5 oranında görüldü. Serimizde morbidite %30, mortalite %0 olarak saptandı.
Sonuç: Tümörün mevcut lokalizasyonu ve boyutu total rezeksiyon oranını, mortalite ve morbiditeyi önemli oranda etkilemektedir. Dev meningiomların yönetiminde cerrahi tedavi esas olup, dikkat ve deneyim gerektiren özellikli bir tedavi şeklidir.

Anahtar Kelimeler

• meninjioma
• dev
• gama knife
• cerrahi

Kaynakça

1. 1. Jung JJ, Warren FA, Kahanowicz R. Bilateral visual loss due to a giant olfactory meningioma. Clin Ophthalmol. 2012;6:339-342. https://doi.org/10.2147/OPTH.S30283
2. 2. Wei CP, Wang AD, Tsai MD. Resection of giant olfactory groove meningioma with extradural devascularization. Skull Base. 2002;12:27-31. https://doi.org/ 10.1055/s-2002-21570-1
3. 3. Gousias K, Schramm J, Simon M. The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. J Neurosurg. 2016;29:1-10. https://doi.org/ 10.3171/2015.9.JNS15754
4. 4. Chan RC, Thompson GB. Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg. 1984;60:52-60. https://doi.org/ 10.3171/jns.1984.60.1.0052
5. 5. Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg. 1985;62:18-24. https://doi.org/ 10.3171/jns.1985.62.1.0018
6. 6. Ojemann RG. Management of cranial and spinal meningiomas. Clin Neurosurg. 1993;40:321-383.
7. 7. Tuna M, Göçer AI, Gezercan Y, et al. Huge meningiomas: a review of 93 cases. Skull Base Surg. 1999;9:227-238. https://doi.org/ 10.1055/s-2008-1058151
8. 8. Guidetti B, Ciappetta P, Domenicucci M. Tentorial meningiomas: surgical experience with 61 cases and long-term results. J Neurosurg. https://doi.org/ 1988;69:183-187. 10.3171/jns.1988.69.2.0183

9. 9. Morokoff AP, Zauberman J, Black PM. Surgery for convexity meningiomas. Neurosurgery 2008;63:427-433. https://doi.org/ 10.1227/01.NEU.0000310692.80289.28
10. 10. Yamasaki F, Yoshioka H, Hama S, Sugiyama K, Arita K, Kurisu K. Recurrence of meningiomas. Cancer. 2000;89:1102-1110. https://doi.org/ 10.1002/1097-0142(20000901)89:5<1102::aid-cncr20>3.0.co;2-l
11. 11. Schick U, Hassler W. Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry. 2005;76:977-983. https://doi.org/ 10.1136/jnnp.2004.039974
12. 12. Seol HJ, Park HY, Nam DH, et al. Clinical outcomes of tuberculum sellae meningiomas focusing on reversibility of postoperative visual function. Acta Neurochir (Wien). 2013;155:25-31. https://doi.org/ 10.1007/s00701-012-1551-6
13. 13. Chen G, Wang Z, Zhou D. Lateral supraorbital approach applied to sellar tumors in 23 consecutive patients: the Suzhou experience from China. World J Surg Oncol. 2013;11:41. https://doi.org/ 10.1186/1477-7819-11-41
14. 14. Palani A, Panigrahi MK, Purohit AK. Tuberculum sellae meningiomas: a series of 41 cases; surgical and ophthalmological outcomes with proposal of a new prognostic scoring system. J Neurosci Rural Pract. 2012;3:286-293. https://doi.org/ 10.4103/0976-3147.102608
15. 15. Andrews BT, Wilson CB. Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome. J Neurosurg. 1988;69:523-528. https://doi.org 10.3171/jns.1988.69.4.0523
16. 16. Kadis GN, Mount LA, Ganti SR. The importance of early diagnosis and treatment of the meningiomas of the planum sphenoidale and tuberculum sellae: a retrospective study of 105 cases. Surg Neurol. 1979;12:367-371.
17. 17. Colli BO, Carlotti CG Jr, Assirati JA Jr, et al. Olfactory groove meningiomas: surgical technique and follow-up review. Arq Neuropsiquiatr. 2007;65:795-799. https://doi.org/ 10.1590/s0004-282x2007000500012
18. 18. Musluman AM, Yilmaz A, R TC, Cavusoglu H, Kahyaoglu O, Aydin Y. Unilateral frontal interhemispheric transfalcial approaches for the removal of olfactory groove meninjiomas. Turk Neurosurg. 2012;22:174-182.
19. 19. Bassiouni H, Asgari S, Stolke D. Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir (Wien). 2007;149:109-121. https://doi.org/ 10.1007/s00701-006-1075-z
20. 20. Nakamura M, Struck M, Roser F, Vorkapic P, Samii M. Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery. 2008;62:1224-1232. https://doi.org/ 10.1227/01.neu.0000333788.83349.1e
21. 21. Tamaki N, Yin D. Giant olfactory groove meningiomas: advantages of the bilateral fronto-orbitonasal approach. J Clin Neurosci. 1999;6:302-305. https://doi.org/ 10.1054/jocn.1998.0057
22. 22. Tomasello F, Angileri FF, Grasso G, Granata F, De Ponte FS, Alafaci C. Giant olfactory groove meningiomas: extent of frontal lobes damage and long-term outcome after the pterional approach. World Neurosurg. 2011;76:311-317; discussion 255-258. https://doi.org/ 10.1016/j.wneu.2011.03.021
23. 23. Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurg Rev. 2008;31:19-32; discussion 32-33. https://doi.org/ 10.1007/s10143-007-0097-1
24. 24. Talacchi A, Biroli A, Soda C, Masotto B, Bricolo A. Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case series and review of the literature. Neurosurg Rev. 2012;35:359-367; discussion 367-368. https://doi.org/ 10.1007/s10143-012-0381-6
25. 25. Komotar RJ, Zacharia BE, McGovern RA, Sisti MB, Bruce JN, D'Ambrosio AL. Approaches to anterior and anterolateral foramen magnum lesions: A critical review. J Craniovertebr Junction Spine. 2010;1:86-99. https://doi.org/ 10.4103/0974-8237.77672
26. 26. Li PL, Mao Y, Zhu W, Zhao NQ, Zhao Y, Chen L. Surgical strategies for petroclival meningioma in 57 patients. Chin Med J (Engl). 2010;123:2865-2873.
27. 27. Yang J, Liu YH, Ma SC, et al. Subtemporal transtentorial petrosalapex approach for giant petroclival meningiomas: analyzation and evaluation of the clinical application. J Neurol Surg B Skull Base. 2012;73:54-63. https://doi.org/? 10.1055/s-0032-1304557
28. 28. Jiang YG, Xiang J, Wen F, Zhang LY. Microsurgical excision of the large or giant cerebellopontine angle meningioma. Minim Invasive Neurosurg. 2006;49:43-48. 10.1055/s-2005-919151
29. 29. Liu W, Yang X, Li G. The surgical treatment for cerebellopontine angle meningioma. Zhonghua Zhong Liu Za Zhi. 2001;23:434-435.
30. 30. Jung SH, Ferrer AD, Vela JS, Granados FA. Spheno-orbital meningioma resection and reconstruction: the role of piezosurgery and premolded titanium mesh. Craniomaxillofac Trauma Reconstr. 2011;4:193-200. https://doi.org/ 10.1055/s-0031-1286113
31. 31. Boari N, Gagliardi F, Spina A, Bailo M, Franzin A, Mortini P. Management of spheno-orbital en plaque meningiomas: clinical outcome in a consecutive series of 40 patients. Br J Neurosurg. 2013;27:84-90. https://doi.org/ 10.3109/02688697.2012.709557
32. 32. Mariniello G, Bonavolontà G, Tranfa F, Maiuri F. Management of the optic canal invasion and visual outcome in spheno-orbital meningiomas. Clin Neurol Neurosurg. 2013;115:1615-1620. https://doi.org/ 10.1016/j.clineuro.2013.02.012
33. 33. Schick U. Sphenoorbital meningiomas: results in long-term treatment. HNO. 2010;58:37-43. https://doi.org/ 10.1007/s00106-009-2024-y
34. 34. Bonnal J, Brotchi J. Surgery of the superior sagittal sinus in parasagittal meningiomas. J Neurosurg. 1978;48:935-945. https://doi.org/ 10.3171/jns.1978.48.6.0935
35. 35. Lynch JC, Schiavini H, Bomfim C, Fonseca JF, Pereira C. Microsurgical ressection for parasagittal meningiomas with preservation of the parasagittal sinus and excelent neurovascular control. Arq Neuropsiquiatr. 2013;71:301-306. https://doi.org/ 10.1590/0004-282x20130025
36. 36. Colli BO, Carlotti CG Jr, Assirati JA Jr, Dos Santos MB, Neder L, Dos Santos AC. Parasagittal meningiomas: follow-up review. Surg Neurol. 2006;66:S20-27; discussion S27-28. https://doi.org/ 10.1016/j.surneu.2006.08.023
37. 37. Sindou MP, Alvernia JE. Results of attempted radical tumor removal and venous repair in 100 consecutive meningiomas involving the major dural sinuses. J Neurosurg. 2006;105:514-525. https://doi.org/ 10.3171/jns.2006.105.4.514
38. 38. Quiñones-Hinojosa A, Kaprealian T, Chaichana KL, et al. Pre-operative factors affecting resectability of giant intracranial meningiomas. Can J Neurol Sci. 2009;36:623-630. https://doi.org/ 10.1017/s0317167100008143
39. 39. Wara WM, Sheline GE, Newman H, Townsend JJ, Boldrey EB. Radiation therapy of meningiomas. Am J Roentgenol Radium Ther Nucl Med. 1975;123:453-458. https://doi.org/ 10.2214/ajr.123.3.453