Significance of skull osteoporosis to the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

Lee, Ryang Hun; Kim, Jae Min; Cheong, Jin Hwan; Ryu, Je Il; Kim, Young Soo; Han, Myung Hoon

doi:10.1371/journal.pone.0226312

Cited by 3 publications

(6 citation statements)

References 27 publications

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“…Previously, it was revealed that arachnoid trabeculae and granulations are composed of type 1 collagen [ 27 ]. Based on the above concept, we have previously reported clinical studies that suggest a possible association between osteoporotic conditions and arachnoid trabeculae integrity because bone and arachnoid trabeculae are composed of type 1 collagen [ 7 , 17 , 28 ]. Therefore, because osteoporosis is more common with increasing age, it is possible to postulate that the elderly may have a greater chance of having weakened arachnoid trabeculae integrity which constitutes the brain-meningioma interface compared to younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…Tumor-brain barrier disruption in meningioma is crucial for PTBE formation [ 1 ]. We recently reported a possible association between PTBE and the brain-meningioma interface and meningioma volume after radiation therapy [ 7 ]. In that study, because radiation may aggravate the damaged tumor-brain contact interface, we hypothesized that greater damage to the tumor-brain interface due to large tumor volume would be associated with a higher probability of tumor-brain barrier disruption leading to PTBE after radiation therapy [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between tumor size and peritumoral brain edema in patients with convexity and parasagittal meningiomas

et al. 2021

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Background and purpose Peritumoral brain edema (PTBE) is a common complication in meningioma and disruption of the tumor-brain barrier in meningioma is crucial for PTBE formation. To evaluate the association between meningioma size and PTBE, we measured meningioma volumes using the 3D slicer in patients with convexity and parasagittal meningiomas. Methods Receiver operating characteristic curve analysis was used to determine the optimal cut-off meningioma volume values for predicting PTBE occurrence. Logistic regressions were used to estimate the odds ratios for PTBE occurrence in patients with convexity and parasagittal meningiomas according to several predictive factors. Results A total of 205 convexity or parasagittal meningioma patients with no other brain disease who underwent one or more contrast-enhanced brain MRIs were enrolled in this 10-year analysis in two hospitals. The optimal cut-off meningioma volume value for prediction of PTBE in all study patients was 13.953 cc (sensitivity = 76.1%; specificity = 92.5%). If a meningioma is assumed to be a complete sphere, 13.953 cc is about 2.987 cm in diameter. Conclusions Our study suggests a cut-off value of 3 cm meningioma diameter for prediction of PTBE in patients with convexity and parasagittal meningiomas. We believe that we have revealed why the meningioma diameter of 3 cm is clinically meaningful.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between tumor size and peritumoral brain edema in patients with convexity and parasagittal meningiomas

et al. 2021

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“…This study included patients from the NOVALIS registry. The NOVALIS registry was designed for prospective research of patients who received radiation treatment in our hospital [ 8 ]. We investigated all consecutive patients with intracranial meningioma from the registry who underwent linear accelerator (LINAC)-based radiation treatment for the first time at our hospital from July 7, 2014 to September 30, 2020.…”

Section: Methodsmentioning

confidence: 99%

“…The detailed radiation technique in our hospital was previously described [ 8 ]. The NOVALIS Tx system (Varian Medical Systems, CA, USA; Brainlab, Feldkirchen, Germany) was used to treat all meningioma patients.…”

Section: Methodsmentioning

confidence: 99%

Effect of osteoporotic conditions on the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

et al. 2021

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Purpose Disruption of the tumor-brain barrier in meningioma is a crucial factor in peritumoral brain edema (PTBE). We previously reported the possible effect of osteoporosis on the integrity of the arachnoid trabeculae because both the bone and the arachnoid trabeculae are composed of type 1 collagen. We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation treatment in patients with meningioma. Methods A receiver operating characteristic curve analysis was used to identify the optimal cut-off values of mean skull Hounsfield unit for predicting osteopenia and osteoporosis in patients from our registry. Multivariate Cox regression analysis was used to determine whether possible osteoporosis independently predicted PTBE development in patients with meningioma after radiation. Results A total of 106 intracranial meningiomas were included for the study. All patients received linear accelerator-based radiation therapy in our hospital over an approximate 6-year period. Multivariate Cox regression analysis identified that hypothetical osteoporosis was an independent predictive factor for the development of PTBE in patients with meningioma after linear accelerator-based radiation treatment (hazard ratio 5.20; 95% confidence interval 1.11–24.46; p = 0.037). Conclusions Our study suggests that possible osteoporotic conditions may affect PTBE development after linear accelerator-based radiation treatment for intracranial meningioma. However, due to the study’s small number of patients, these findings need to be validated in future studies with larger cohorts, before firm recommendations can be made. Graphic abstract

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“…Birnbaum BA et al reported that variations in HU values are very small (range of 0-20 HU) between five CT scanners including Philips and Siemens [12]. We previously reported detailed methods for measuring HU values at each of four lines on the frontal cancellous bone between the right and left coronal sutures on axial CT slices at the point where the lateral ventricles disappear (Fig 1A) [13,14].…”

Section: Measurement Of Frontal Skull and Iop Humentioning

confidence: 99%

Does the skull Hounsfield unit predict shunt dependent hydrocephalus after decompressive craniectomy for traumatic acute subdural hematoma?

et al. 2020

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Background and purposePosttraumatic hydrocephalus affects 11.9%-36% of patients undergoing decompressive craniectomy (DC) after traumatic brain injury and necessitates a ventriculo-peritoneal shunt placement. As bone and arachnoid trabeculae share the same collagen type, we investigated possible connections between the skull Hounsfield unit (HU) values and shunt-dependent hydrocephalus (SDHC) in patients that received cranioplasty after DC for traumatic acute subdural hematoma (SDH). MethodsWe measured HU values in the frontal bone and internal occipital protuberance from admission brain CT. Receiver operating characteristic curve analysis was performed to identify the optimal cut-off skull HU values for predicting SDHC in patients receiving cranioplasty after DC due to traumatic acute SDH. We investigated independent predictive factors for SDHC occurrence using multivariable logistic regression analysis. ResultsA total of 162 patients (>15 years of age) were enrolled in the study over an 11-year period from two university hospitals. Multivariable logistic analysis revealed that the group with simultaneous frontal skull HU �797.4 and internal occipital protuberance HU �586.5 (odds ratio, 8.57; 95% CI, 3.05 to 24.10; P<0.001) was the only independent predictive factor for SDHC in patients who received cranioplasty after DC for traumatic acute SDH. ConclusionsOur study reveals a potential relationship between possible low bone mineral density and development of SDHC in traumatic acute SDH patients who had undergone DC. Our

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Significance of skull osteoporosis to the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

Cited by 3 publications

References 27 publications

Association between tumor size and peritumoral brain edema in patients with convexity and parasagittal meningiomas

Association between tumor size and peritumoral brain edema in patients with convexity and parasagittal meningiomas

Effect of osteoporotic conditions on the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

Does the skull Hounsfield unit predict shunt dependent hydrocephalus after decompressive craniectomy for traumatic acute subdural hematoma?

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