Differentiating consistency of meningioma based on grey-level histogram analysis of T2WI

Objective To observe the value of grey-level histogram analysis based on T2WI for differentiating consistency of meningioma.Methods Data of 109 patients with meningioma were retrospectively analyzed.The patients were divided into hard group(n=71)and soft group(n=38)according to the consistency of tumors.Tumor ROI was outlined on axial T2WI showing the largest tumor section,gray levels were extracted and histogram analysis was performed.The value of each histogram parameter were compared between groups.Then receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficiency for differentiating soft and hard meningioma.Results P 1,P 10,P 50,P 90,P 99 and the mean grey levels on T2WI in soft group were all higher than those in hard group(all P<0.05),while the variance,the kurtosis and the skewness were not significantly different between groups(all P>0.05).The differentiating efficiency of P 1,P 10,P 50,P 90,P 99 and the mean grey levels on T2WI were all fine,with AUC of 0.774 to 0.833,and no significant difference was found(all P>0.05).Conclusion Parameters of grey-level histogram analysis such as P 1,P 10,P 50,P 90,P 99 and the mean values based on T2WI were all valuable for differentiating soft and hard meningioma.

Safety and efficacy of posterior approach for resection of spinal meningioma:Impact of dural attachment location

BACKGROUND Spinal meningiomas(SMs)are common benign tumors that are typically treated with surgical resection.The choice of surgical approach may vary depending on the location of dural attachment of the SM,with a posterior approach being the traditional preference.However,there is limited research available on the impact of dural attachment location on outcomes following posterior approach for SM resection.The average age of the included 34 patients’(10 males and 24 females)age was 62.09 years.Mean follow-up duration was 22.65 months.The location of SM was the thoracic spine in 32 cases,with only 2 in the cervical spine.On average,intraoperative blood loss was 520.59 mL,and operating time was 176.76 minutes.Thirty three cases had successful outcomes while only 1 experienced an unexpe-cted outcome.The tumor recurrence rate was 2.9%.After surgery,there were 3 cases of cerebral spinal fluid leakage,1 case of pneumonia,and 1 case of urinary tract infection.Dural attachments were predominantly found dorsal or dorso-lateral(13 cases),followed by ventral or ventrolateral(14 cases),and lateral(7 cases).The outcomes among these subgroups were similar.CONCLUSION The posterior approach for SM resection is safe and effective,yielding comparable surgical and neurological outcomes regardless of the dural attachment location.

Meningioma originating from the superior petrosal vein without dural attachment:A case report

BACKGROUND Meningioma in the cerebellopontine angle(CPA)without dural attachment is extremely rare.We report a unique case of meningioma derived from the superior petrosal vein without dural attachment.CASE SUMMARY A 44-year-old right-handed woman presented with a two-month history of headache and tinnitus.Brain magnetic resonance imaging showed a well-defined contrast-enhancing lesion in the right CPA without a dural tail sign.Tumor resection was performed using a right retro sigmoid approach.A dural attachment was not seen at the tentorium or posterior surface of the petrous pyramid.The tumor was firmly adherent to the superior petrosal vein.The origin site was cauterized and resected with the preservation of the superior petrosal vein.A diagnosis of meningothelial meningioma was made.The patient’s headache and tinnitus gradually disappeared,and a recurrence was not observed five years after the surgery.CONCLUSION The rare occurrence of meningioma without dural attachment makes it difficult to determine dural attachment before surgery.The absence of dural attachment makes it easy to completely resect such tumors.Vessels related to tumors should be removed carefully,considering the possible presence of tumor stem cells in the microvessels.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Bilateral Middle Fossa Floor Meningiomas Invading the Middle Ear

This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.

Surgical Management of a Collision Tumor: The Association of Intracranial Meningioma and Macroadenoma

Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.

An Alternative Mechanism for the Instant Removal of Hypervascular Anaplastic Meningioma with Recovery of Mentality with NaCl + KCl

Background: There is limited information regarding adjuvant treatment for malignant meningiomas. Although external whole-brain irradiation is recommended, the patient’s family in our case rejected this modality. Notably, traditional chemotherapy was ineffective. Aim: I speculated if the exfoliation of graphene could disassemble the three-dimensional (3D) structures of the graphene because the tumor mass or the blood clots including the graphene consisted of inhomogeneous materials. Therefore, I aimed to explore another possible mechanism for the instant removal of inhomogeneous materials. Method: Herein, I report a case of anaplastic papillary meningioma. A 59- year-old man presented with partial complex seizures and recurrent headaches following craniotomy for the removal of a mass with a right frontotemporal convexity 10 years ago. Computed tomography (CT) and magnetic resonance imaging demonstrated a right frontotemporal mass with diffuse contrast enhancement and extensive surrounding edema. A right frontotemporal flap was performed. The tumor and the infiltrated dura were removed, but massive intraoperative bleeding occurred and the right middle cerebral artery was clipped at the M2 territory. Postoperatively, the follow-up CT scan revealed hydrocephalus. Accordingly, a ventriculoperitoneal shunt was placed. The patient suffered from left hemiplegia as a sequela of intraoperative bleeding. Four months later, the follow-up CT scan showed chronic epidural hematoma in the right frontotemporoparietal region. The patient also had an altered level of consciousness. Results: The patient’s level of consciousness was restored after infusion of a NaCl + KCl solution with instant disappearance of the mass. Conclusion: There may be another mechanism for disassembling the inhomogeneous graphene-containing complex, such as quantum fluctuation of the graphene exfoliation with pair annihilation or relation to tissue engineering by the graphene.

Multivariate Analysis of Recurrence in Meningioma

Objective: To evaluate the clinical and radiological factors that affect therecurrence of the meningioma patient so as to effectively prevent and cure recurrence of meningiomapatients more earlier. Methods: The clinical features and radiological aspects in 145 cases ofmeningiomas undergoing operation during 1993-1997 were retrospectively studied. The data of only 83cases of all 145 cases were available. The factors were evaluated with univariate and multivariateanalysis. Results: With univariate analysis, 7 factors showed highly significance to recurrence ofmeningiomas: tumor size, tumor location, tumor shape, edema, extent of resection, pathologicalgrade, CT enhancement. With multivariate analysis, 4 factors showed significant danger to recurrenceof meningiomas: pathological grade, extent of resection, tumor shape and CT enhancement.Conclusion: The main factors that affect the recurrence of meningioma patients are pathologicalgrade, extent of resection, tumor shape and CT enhancement.

Application of 3D-computed tomography angiography technology in large meningioma resection

Objective:To discuss the role of 3D-computed tomography angiography(3D-CTA) technology in reducing injuries of large meningioma surgery.Methods:3D-CTA preoperative examinations were done in 473 patients with large meningioma(simulated group).The images were analyzed by 30 post-processing workstation.By observing the major intracranial blood vessels,venous sinus,and the compression and invasion pattern in the nerve region,assessing risk level of the surgery,simulating the surgical procedures,the surgical removal plan,surgical routes and tumor blood-supplying artery embolisation plan were performed.Two hundred and fifty seven large meningioma patients who didn’t underwent 3D-CTA preoperative examination served as control group.The incidence of postoperative complications,intraoperative blood transfusion and the operation time were compared between these two groups.Results:Compared with the control group,the Simpson’s grade 1 and 11 resection rate was 80.3%(380/473),similar with that of the control(81.3%,209/257).The incidence of postoperative complications in 3D-CTA simulated group was 37.0%which was significantly lower than that(48.2%) of the control(P【0.01). The intraoperative blood supply for simulated group and the control was(523.4±208.1) mL and (592.0±263.3) mL,respectively,with significant difference between two groups(P【0.01).And the operation time[(314.8±106.3)]min was significantly lower in simulated group than that in the control[(358.4±147.9) min](P【0.01).Conclusions:Application of 3D-CTA imaging technology in risk level assessment before large-scaled meningioma resection could assist in the rational planning of tumor resectin,surgical routes,and is helpful in reducing injuries and complications and enhancing the prognosis of the patients.

Clinicopathological analysis of metaplastic meningioma: report of 15 cases in Huashan Hospital

Objective： Metaplastic meningioma is a rare subtype of benign meningiomas, classified as WHO grade I with well prognosis. Here we presented our experiences on 15 cases of metaplastic meningioma, to investigate the clinicopathological features, therapies and prognosis of these cases. Methods： 15 patients underwent surgical treatment for intracranial metaplastic meningioma between 2001 and 2010 at Neurosurgery Department of Huashan Hospital, Shanghai, China. The clinical data, radiological manifestation, treatment strategy, pathological findings and prognosis of all patients were analyzed retrospectively. Results： Among the 15 cases （10 males and 5 females）, the age ranged from 22 to 74 years old （the mean age was 50.67-year old）. The clinical manifestations include headache, dizziness, seizure attack, vision decrease, and weakness of bilateral lower limbs. All the patients received surgical treatment, combined with radiotherapy in some cases. In the follow-up period, recurrence occurred in 2 cases, of which 1 patient died of other system complications. Conclusions： Metaplastic meningiomas are characterized by focal or widespread mesenchymal differentiation with formation of bone, cartilage, fat, and xanthomatous tissue elements. Surgical removal is the optimal therapy, and the overall prognosis is well. But recurrence may occur in some cases, thus radiotherapy is necessary for such kind of patients.

Expression levels ofβcatenin and galectin-3 in meningioma and their effect on brain invasion and recurrence:a tissue microarray study

Objective:Meningiomas are neoplasms that arise from the meninges of the central nervous system(CNS).They constitute about25.6%of CNS tumors diagnosed in Egypt.Some morphological variants of meningiomas display aggressive behavior,leading to brain-invasive growth pattern.Although meningiomas are usually treated by complete surgical excision,the risk of postoperative recurrence remains.Hence,additional biomarkers for predicting aggressive behavior must be discovered.This study aims to explore the clinical and biological relevance of the protein expression levels ofβ-catenin and galectine-3 in meningioma and to understand the pathobiology of this neoplasm.Methods:This retrospective study was carried out on 153 cases of meningioma by using tissue microarrays and immunohistochemistry forβ-catenin and galectine-3.Results:Highβ-catenin expression was significantly associated with transitional and meningiotheliomatous meningiomas,low tumor grade,low recurrence rate,and low incidence of brain invasion.Meanwhile,high galectin-3 expression was associated with brain invasion,recurrence,high tumor grade,and tumor type.Logistic regression analysis indicated that among all variables included in the model,β-catenin and galactin-3 expression levels were significant predictors of tumor recurrence(P<0.001).Conclusions:Galectin-3 andβ-catenin are involved in meningioma recurrence but not in brain invasion.These molecules could be important potential therapeutic targets and predictors for meningiomas.

Analyses on the misdiagnoses of 25 patients with unilateral optic nerve sheath meningioma

AIM：To investigate clinical features of optic nerve sheath meningioma（ONSM） that was misdiagnosed,and to find methods to reduce the misdiagnoses.METHODS：Retrospective series study.Twenty-five misdisgnosed patients with unilateral ONSM were collected from Jan.2008 to Jan.2015 and the clinical records reviewed.RESULTS：Patients were misdiagnosed with acute papillitis most frequently（P=17）,immediately followed by optic atrophy（P=8）,ischemic optic neuropathy（P=5）,acute retrobulbar optic neuritis（P=5）,optic disc vasculitis（P =3）.For each patient,the minimum frequency of misdiagnoses was once and the maximum was 4 times.As for the lasting time of being misdiagnosed,the shortest was 1.5mo and the longest was 45 mo.Twentyone cases（84%） were once treated with glucocorticoids,and its side effects was found in seventeen patients.Twenty patients（80%） complained with varying degree of vision loss.When a definite diagnosis was made,sixteen cases（64%） showed slight exophthalmos and eighteen cases（72%） had the tubular ONSM.CONCLUSION：ONSM without loss obvious exophthalmos is easily misdiagnosed in clinic,and for most of these ONSMs are tubular.

Intraoperative ultrasound assistance in resection of intracranial meningiomas

Objective： Intracranial meningiomas, especially those located at anterior and middle skull base, are difficult to be completely resected due to their complicated anatomy structures and adjacent vessels. It＇s essential to locate the tumor and its vessels precisely during operation to reduce the risk of neurological deficits. The purpose of this study was to evaluate intraoperative ultrasonography in displaying intracranial meningioma and its surrounding arteries, and evaluate its potential to improve surgical precision and minimize surgical trauma. Methods： Between December 2011 and January 2013, 20 patients with anterior and middle skull base meningioma underwent surgery with the assistance of intraoperative ultrasonography in the Neurosurgery Department of Shanghai Huashan Hospital. There were 7 male and 13 female patients, aged from 31 to 66 years old. Their sonographic features were analyzed and the advantages of intraoperative ultrasonography were discussed. Results： The border of the rneningioma and its adjacent vessels could be exhibited on intraoperative ultrasonography. The sonographic visualization allowed the neurosurgeon to choose an appropriate approach before the operation. In addition, intraoperative ultrasonography could inform neurosurgeons about the location of the tumor, its relation to the surrounding arteries during the operation, thus these essential arteries could be protected carefully. Conclusions： Intraoperative ultrasonography is a useful intraoperative technique. When appropriately applied to assist surgical procedures for intracranial meningioma, it could offer very important intraoperative information （such as the tumor supplying vessels） that helps to improve surgical resection and therefore might reduce the postoperative morbidity.

Angioarchitecture and CD133^+ tumor stem cell distribution in intracranial hemangiopericytoma A comparative study with meningioma

Angioarchitecture plays an important role in the malignant development of intracranial hemangiopericytoma. It remains poorly understood whether high frequency of hemorrhage during clinical surgery for intracranial hemangiopericytoma is associated with angioarchitecture. The present study utilized hematoxylin-eosin staining, and immunohistochemical staining with epithelial membrane antigen, vimentin, CD34, von Willebrand factor （vWF） and CD133 to observe characteristics of angioarchitecture. In addition, silver stains were used to demonstrate changes in reticular fibers in the wall of vessel channels in intracranial hemangiopericytoma and meningioma. Five patterns of angioarchitecture were identified in intracranial hemangiopericytoma, namely tumor cell islands, vasculogenic mimicry, mosaic blood vessels, sprouting angiogenesis, and intussusceptive angiogenesis. Several CD133＋ tumor cells were found to form tumor cell islands. A connection between vWF ^＋ and vWF channels was detected in the pattern of intussusceptive angiogenesis, and some vimentin^＋ tumor cells were embedded in the periodic acid-Schiff positive channel wall. Incomplete threads of reticular fibers formed the walls of larger pseudo-vascular channels and some tumor clumps or scattered tumor cells were detected ＂floating＂ in them. The angioarchitecture, specific markers and reticular fibers of intracranial hemangiopericytoma were significantly different from meningioma. Angioarchitecture provides a functional vascular network for vascular evolution in intracranial hemangiopericytoma and contributes to significant intra-operative bleeding.

Basic Fibroblast Growth Factor and Fibroblast Growth Factor Receptor-1 in Human Meningiomas

The expression of basic fibroblast growth factor (bFGF) and fibroblast growth factor receptor-1 (FGFR-1) in human meningiomas and the relationships between their expression and the tumors' histological features and angiogenesis were investigated by means of immunohistochemical technique. The expression of bFGF and FGFR-1 was detected by antibody of bFGF or FGFR-1. The tumors' angiogenesis was evaluated by microvascular density (MVD) and, which was observed by use of CD34-antibody immunohistochemically. The results showed that there were varied degrees of the expression of bFGF and FGFR-1 proteins in meningiomas. The expression was correlated with the tumors' histological characters and angiogenesis. It was concluded that bFGF and FGFR-1 might play important roles in meningiomas' angiogenesis and proliferation. The expression positive rate of bFGF and FGFR-1 may provide an indication of evaluating the histological and malignant degree of the tumor.

Clinical and pathological features in 49 elderly patients with meningiomas

BACKGROUND： As aging in elderly people, their brain tissue has degeneration and brain atrophy of different severity, and the volume of cranial cavity is relatively enlarged, it has greater compensatory ability to the space occupying lesion, and it is difficult to detect the meningioma because it grows to expand slowly, the tumor locates in non-functional region, and there are atypical symptoms and deficiency of localization signs. OBJECTIVE： To investigate the clinicopathologic features of senile meningiomas. DESIGN： A retrospective analysis. SETTING： Affiliated Hospital of Hebei University. PARTICIPANTS： Forty-nine elderly patients with meningioma were selected from the Department of Neurosurgery, Affiliated Hospital of Hebei University from May 1999 to March 2005, including 15 males and 34 females, 60-74 years of age, and they were all diagnosed by CT and MRI. METHODS： The sites of tumors were identified by CT and MRI examinations in all the patients. The tumors were partially or totally resected according to their own conditions. The types of the resected tumor were pathologically observed. The conditions of postoperative recovery were observed after 1, 3 and 6 months, and without new neurological dysfunction or complication was considered as good outcome. MAIN OUTCOME MEASURES： ① Sites and pathological types of the tumor; ② Postoperative outcomes and complications. RESULTS： All the 49 patients were involved in the analysis of results. ① The tumors had wide distributions with a main location in brain convexity. Among the 49 cases of meningioma, there were 25 cases of fibrocystic type, 12 cases of meningothelial type, 6 cases of psammomatous type, 4 cases of angiomatous type and 2 cases of microcystic type. ② Among the 49 patients, 35 had good outcome, 8 had self-care ability, 4 required care by others, 2 （4.1%） died postoperatively. No long-term complication related to the operation was observed during the follow-up postoperatively. CONCLUSION： Meningioma has a main location in brain convexity, and its pathological type is mainly fibrocystic one, and there is good operative outcome.

Application of CUSA Excel ultrasonic aspiration system in resection of skull base meningiomas

Background： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University（PU） models. The accuracy of each model was assessed using area under the receiver operating characteristics（ROC） and calibration curves.Results： The area under the ROC curve of the PU model [0.800; 95% confidence interval（CI）： 0.708-0.891] was higher than that of the Mayo model（0.753; 95% CI： 0.650-0.857） or VA model（0.728; 95% CI： 0.623-0.833）; however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.Conclusions： The three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.Background： Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.Methods： Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old（the mean age was 48.5 years old）. Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.Results： All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.Conclusions： This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.Background： The purposes of this study were to explore the effects of high mobility group protein box 1（HMGB1） gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. Methods： The expressions of HMGB1 in glioma cells（U251, U-87 MG and LN-18） and one control cell line（SVG p12） were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected： the expression of HMGB1 in human glioma cell lines U251 and U-87 MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87 MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. Results： As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells（U251, U-87 MG, and LN-18） in comparison with the control cell line（SVG p12）; the vitality, proliferation and invasive capabilities of U251 and U-87 MG cells in the HMGB1 siR NA-transfected group were significantly lower than those in the blank control group and negative control（NC） siR NA group（P〈0.05） but showed no significant difference between the blank control group and NC siR NA group. The percentage of apoptotic U251 and U-87 MG cells was significantly higher in the HMGB1 siR NA-transfected group than in the blank control group and NC siR NA group（P〈0.05） but was similar between the latter two groups. The HMGB1 siR NA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87 MG cells and significantly higher expression of Bax protein than in the blank control group and NC siR NA group（P〈0.05）; the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siR NA group. Conclusions： HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.

Magnetic resonance diffusion tensor imaging-based evaluation of optic-radiation shape and position in meningioma

Employing magnetic resonance diffusion tensor imaging, three-dimensional white-matter imaging and conventional magnetic resonance imaging can demonstrate the tumor parenchyma, peritumoral edema and compression on surrounding brain tissue. A color-coded tensor map and three-dimensional tracer diagram were applied to clearly display the optic-radiation location, course and damage. Results showed that the altered anisotropy values of meningioma patients corresponded with optic-radiation shape, size and position on both sides. Experimental findings indicate that the magnetic resonance diffusion tensor imaging technique is a means of tracing and clearly visualizing the optic radiation.

Expression of Androgen Receptor in Meningiomas

In order to investigate the expression of androgen receptor in meningiomas and its relation to tumor proliferative potential, we examined the expression of AR and proliferating cell nuclear antigen by avidine biotin complex immunohistochemistry in 39 cases of meningiomas. Of the 39 cases of meningiomas, 20 showed positive AR immunoreactivity. The AR expression positivity rates were 31 % in benign meningiomas, 58 % in atypical meningiomas, 87.5 % in malignant meningiomas, respectively. In addition to the tumor cells, cells of microvascular endothelial proliferation were frequently AR positive. Malignant meningiomas had a significantly higher percentage of AR positive cells compared with atypical and benign meningiomas . The mean proliferating cell nuclear antigen labeling index was significantly higher in the malignant meningiomas when compared with atypical meningiomas and benign meningiomas . AR positive meningiomas had higher PCNA LI than AR negative meningiomas . The expression of AR in tumor tissues was significantly related with PCNA LI. These data indicated that AR in the meningiomas was correlated with histological grade and AR might participate in the growth of these tumors and tumor angiogenesis. The measurement of AR in these tumors may indirectly represent tumor growth potential.

Coexistence of meningioma and other intracranial benign tumors in non-neurofibromatosis type 2 patients:A case report and review of literature

BACKGROUND The coexistence of meningioma and other intracranial primary benign tumors is rare,especially in non-neurofibromatosis type 2,and there is limited guidance for the management of such patients.Here,we report a series of 5 patients with concomitant meningioma and other intracranial benign tumors,including subependymoma and pituitary adenoma.CASE SUMMARY Five non-neurofibromatosis type 2 patients with simultaneous occurrence of meningioma and other intracranial benign tumors were retrospectively reviewed.The patients had no history of previous irradiation.The clinical features,pre-and postoperative imaging,surgical procedure and pathological findings were extracted from electronic medical records.There were 4 female patients(80%)and 1 male patient(20%).The mean age was 42.8 years(range:29-52 years).The coexisting tumors included subependymoma in 1 case(20%)and pituitary adenoma in 4 cases(80%).The most common clinical symptom was headache(3/5,60%).Four patients(80%)underwent craniotomy.One patient(20%)underwent transsphenoidal surgery followed by transcranial operation.All tumor diagnoses were confirmed by histopathological examination.The mean follow-up was 38.8 mo(range:23-96 mo),and all 5 patients were in a stable condition at the last follow-up.CONCLUSION The simultaneous occurrence of meningioma and other intracranial benign tumors is a rare clinical event.Histological examination is necessary for the accurate diagnosis.Neurosurgeons should select the appropriate surgical strategy according to the clinical features of each patient,which may provide a more favorable prognosis for individual patients.