Browsing by Author "Villa, Alessandro (56817946700)"

Background Primary intraventricular meningiomas (IVMs) make up 0.5%–5% of all intracranial meningiomas and represent one of the most challenging lesions in neurosurgery. Methods Between 1990 and 2013, 42 patients (30 female, 12 male; mean age, 43.6 years) underwent resection of their IVM. The removal was performed by a posterior parietal approach in 19 of the 40 lateral ventricle tumors, and 1 third ventricle meningioma. The transcallosal approach was used for 3 meningiomas, and patients with other lesions underwent temporal (7 cases) and temporoparietal approaches (12 patients), respectively. Results The most common presenting signs were increased intracranial pressure (83.3%), visual impairment (78.6%) and cognitive changes (50%). Forty lesions (95.2%) arose in the lateral ventricles, and 2 (4.8%) in the third ventricle, ranging in size from 3 to 10 cm. Total removal was achieved in 39 cases and the pathology report disclosed World Health Organization grade I lesions in 41 cases. Hydrocephalus, cerebrospinal fluid leakage, and cerebral edema were the postoperative complications (7.15%); 1 patient died of respiratory problems not directly related to surgery. Thirty-five patients (83.3%) showed a 6-month Glasgow Outcome Scale of 5. One patient, who underwent partial resection, presented a recurrence after 1 year that remained stable until last follow-up. Conclusions IVMs usually reach a large size before being diagnosed. Surgical treatment is the most suitable option and total removal should represent the main goal of the procedure. The posterior parietal transulcal approach and the temporoparietal approach are the most common surgical routes used in our series. © 2016

Objective: Atypical and anaplastic meningiomas (World Health Organization classification grade II and III) represent a small and heterogeneous subgroup of meningiomas that has a more aggressive biological nature and higher frequency of recurrence. The atypical form accounts for 4.7%-7.2%, whereas the anaplastic type accounts for 1%-2.8% of all meningiomas. The aim of this study is to evaluate the role of postoperative radiotherapy on overall survival and progression-free survival in patients operated for atypical and anaplastic meningiomas. Methods: A retrospective analysis of the patients operated at the Clinic of Neurosurgery, Clinical Center of Serbia, Belgrade, between January 1, 1995 and December 31, 2006 was performed. In that period 88 lesions met the histologic criteria for atypical (75) and anaplastic (13) meningiomas. Postoperative radiotherapy was conducted in 63.6% of patients. Results: At a median follow-up of 67.4 months the overall survival was 68 months and the 5-year survival was about 54.5%. The median survival was 76 months with surgery and adjuvant radiotherapy and 40 months with surgery alone (log rank = 7.4; P = 0.006). Recurrent disease occurred in 58 patients (65.9%). Median time between first surgery and tumor recurrence in patients undergoing radiotherapy was 51 months, whereas in the nonirradiated group it was 24 months (log rank = 17.7; P < 0.001). Multivariate analysis identified as recurrence-predicting factors anaplastic histotype (hazard ratio = 2.9; P = 0.003) and postoperative radiotherapy (hazard ratio = 4.5; P < 0.001). Conclusions: The addition of adjuvant radiotherapy to surgery for atypical and anaplastic meningiomas resulted in a clinically meaningful and statistically significant survival benefit. © 2015 Elsevier Inc. All rights reserved.