Factors affecting peritumoral brain edema in meningioma: special histological subtypes with prominently extensive edema

Osawa, Tadashi; Tosaka, Masahiko; Nagaishi, Masaya; Yoshimoto, Yuhei

doi:10.1007/s11060-012-0989-y

Cited by 101 publications

(76 citation statements)

References 45 publications

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“…23 The edema index has been previously used to study edema response around benign and malignant tumors including meningiomas and metastases. 7,17,19 At each time point for which an MR image was available, the mean edema index for a tumor was computed as follows: mean edema index = (volume of peritumoral edema)/(volume of tumor).…”

Section: Tumor and Edema Volumetric Assessmentmentioning

confidence: 99%

“…7,17,18,21 Peritumoral edema associated with parasagittal or parafalcine meningiomas is common, with some series showing edema in 48% of patients. 17 At times, the edema may be symptomatic and necessitate medical therapy such as steroids to lessen or relieve symptoms. However, in other cases, the edema may be seen as T2-weighted changes on MRI, but the patient may remain asymptomatic.…”

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confidence: 99%

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Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Sheehan

Lee²,

Xu³

et al. 2015

JNS

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OBJECT Stereotactic radiosurgery (SRS) has been shown to offer a high probability of tumor control for Grade I meningiomas. However, SRS can sometimes incite edema or exacerbate preexisting edema around the targeted meningioma. The current study evaluates the incidence, timing, and degree of edema around parasagittal or parafalcine meningiomas following SRS. METHODS A retrospective review was undertaken of a prospectively maintained database of patients treated with Gamma Knife radiosurgery at the University of Virginia Health System. All patients with WHO Grade I parafalcine or parasagittal meningiomas with at least 6 months of clinical follow-up were identified, resulting in 61 patients included in the study. The median radiographic follow-up was 28 months (range 6–158 months). Rates of new or worsening edema were quantitatively assessed using volumetric analysis; edema indices were computed as a function of time following radiosurgery. Statistical methods were used to identify favorable and unfavorable prognostic factors for new or worsening edema. RESULTS Progression-free survival at 2 and 5 years was 98% and 90%, respectively, according to Kaplan-Meier analysis. After SRS, new peritumoral edema occurred or preexisting edema worsened in 40% of treated meningiomas. The median time to onset of peak edema was 36 months post-SRS. Persistent and progressive edema was associated with 11 tumors, and resection was undertaken for these lesions. However, 20 patients showed initial edema progression followed by regression at a median of 18 months after radiosurgery (range 6–24 months). Initial tumor volume greater than 10 cm3, absence of prior resection, and higher margin dose were significantly (p < 0.05) associated with increased risk of new or progressive edema after SRS. CONCLUSIONS Stereotactic radiosurgery offers a high rate of tumor control in patients with parasagittal or parafalcine meningiomas. However, it can lead to worsening peritumoral edema in a minority of patients. Following radiosurgery, transient edema occurs earlier than persistent and progressive edema. Longitudinal follow-up of meningioma patients after SRS is required to detect and appropriately treat transient as well as progressive edema.

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Section: Tumor and Edema Volumetric Assessmentmentioning

confidence: 99%

mentioning

confidence: 99%

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Sheehan

Lee²,

Xu³

et al. 2015

JNS

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“…Histological subtype is associated with brain edema; some reports indicate the prominence of peritumoral edema in uncommon WHO Grade I meningiomas, including angiomatous, microcystic, secretory, and lymphoplasmacyte-rich meningiomas. [27][28][29] In our results, the number of special histological subtypes of meningioma is too small (2 secretory meningiomas) to investigate an association with peritumoral brain edema. Further examination is required to understand the exact pathogenesis of this association.…”

Section: -12mentioning

confidence: 64%

The Rim Pattern of Meningioma on 3D FLAIR Imaging: Correlation with Tumor-brain Adhesion and Histological Grading

et al. 2014

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Purpose: We evaluated the rim patterns of intracranial meningiomas on nonenhanced (NE) and contrast-enhanced (CE) 3-dimensional fluid-attenuated inversion recovery (3D FLAIR) imaging on 3-tesla magnetic resonance (MR) imaging to clarify the associated imaging and pathological findings and the value of the rims in predicting tumor cleavability.Methods: Thirty-two patients with meningioma underwent tumor excision. We classified the rim patterns on 3D FLAIR, subdivided into "rim-NE," a rim with relatively low signal intensity on NE 3D FLAIR and "rim-CE," a rim with relatively high signal intensity on CE 3D FLAIR, into 4 grades by their extent from 0 (no rim visible) to 3 (rim visible over most of the tumor-brain interface) and correlated them with tumor size, grade of peritumoral brain edema, presence/absence of pial supply, grade of tumor-brain adhesion, and histological findings.Results: On NE 3D FLAIR, "rim-NE" was graded 0 in 5 patients, one in 5, 2 in 6, and 3 in 16. On CE 3D FLAIR, "rim-CE" was graded 0 in one patient, one in 13, 2 in 4, and 3 in 14. The grade of "rim-NE" correlated negatively with the grade of brain edema (P = 0.023) and positively with surgical tumor-brain cleavability (P < 0.001). It also correlated with the amount of connective tissue at the tumor-brain interface histologically (P = 0.041). Furthermore, a lower grade of "rim-NE" was more often seen in atypical than benign meningioma (P = 0.003). Although "rim-CE" was more prominent in tumors with pial supply on digital subtraction angiography (DSA) (P = 0.002), it was not useful in predicting tumor-brain adhesion or histological tumor grading.Conclusion: The rim pattern of meningioma on NE 3D FLAIR can predict surgical cleavability and histological tumor grading. A higher grade of rim pattern on CE 3D FLAIR suggests prominent pial supply to the tumor but has no added value in predicting tumor-brain adhesion and histological tumor grading.

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“…VEGF'in indüklediği pial damarlanma ve tümör vaskülaritesinin peritümöral beyin ödemi ile ilişkili olduğu sanıl-maktadır. Pial damarlarda proliferasyon olması ve araknoid membrandan geçerek menenjioma uzanması sonucu beyin bariyeri bozulur ve beyne menenjiom invazyonu olur [19,24,25]. Tümör vaskülaritesi de ödem boyutu ile koreledir.…”

Section: Menenjiomunclassified

Ekstraaksiyel Beyin Tumorleri

Cakir¹

2016

Trd Sem

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Factors affecting peritumoral brain edema in meningioma: special histological subtypes with prominently extensive edema

Cited by 101 publications

References 45 publications

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

The Rim Pattern of Meningioma on 3D FLAIR Imaging: Correlation with Tumor-brain Adhesion and Histological Grading

Ekstraaksiyel Beyin Tumorleri

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