Treatment of meningioma

Meningoma is a primary intracranial tumor commonly found in adults, with an annual incidence rate of 83 per 100,000 people.
incidence increased with age, with 0.14 per 100,000 aged 0-19 and 3775/100,000 aged 75-84.
80% to 90% of meningiomas are benign tumors (WHO I.grade) that can be followed up for long periods of time or cured by surgery and radiotherapy.
atypical meningioma (WHO II.grade) and mesodiogenic meningioma (WHO III. grade or "malignant meningioma"), surgery, radiotherapy and chemotherapy are not ideal.
, of the Department of Neurology at Tianjin TEDA Hospital, reviewed the literature on the treatment of meningioma and reviewed it online in August 2020 in Frontiers in Oncology.
follow-up observation: For small asymptomatic meningomas ≤ 3 cm in diameter, MRI examinations can be performed regularly.
follow-up observation is also suitable for elderly patients with severe compulsive disorder or poor physical condition.
European Society of Neuro-Oncology (EANO) recommends MRI-enhanced scans every six months after initial diagnosis to assess changes in tumor dynamics for asymptomatic or small meningomas.
an MRI every year after 5 years of follow-up to an asymptomatic meninges.
if the tumor expands significantly or develops symptoms during follow-up, active treatment is recommended.
tumor diameter ≥3cm, tumor peripheral edema (PTE), age <60 years old, tumor noncalcification and MRI-T2 weighted high signal all indicate tumor progression.
surgery: Choose surgical treatment for meningiomas with symptoms.
to relieve tumor symptoms, alter the natural process of tumors, and improve quality of life.
the tumor should be surgically removed in patients with significant intracranial excision effects and increased intracranial pressure.
risk assessment is mainly based on the patient's general condition, tumor location, age, tumor size and symptoms, of which tumor location is particularly important.
surgery to remove convex meninges is relatively simple and the risk is low.
fully exposed, careful separation of the tumor envelope can maximize the removal of the tumor and protect the vascular structure, improve the surgical removal rate of convex meninges, reduce the rate of disability.
meningoma surgery, which is located in the olfactory groove, next to the sinuses, in the brain room, in the corners of the epidural bridge and in the brain, is moderate risk.
removing meningococcial tumors that affect the sinuses, blood vessels or cranial nerves can be challenging.
risk of meningoma surgery with pre-bed protrusions, sponge sinuses and saddle nodules.
rock diagonal meningioma is adjacent to multiple groups of cranial nerves, cervical artery spongium sinus segments, substrate arteries, epidural arteries and brain back arteries junction, saddle nodule meningiomas and optic nerves and brain aneurysm complex, surgery should pay special attention to protect the complex and important structure closely linked to the tumor.
may damage the veins when they are affected by meningococctomy (GTR), which affects the cortivine veins or sinuses.
the sinuses are not completely closed, a secondary total excision (STR) can be performed.
the upper sinuses, but does not affect the smooth flow of sinuses, it is recommended to remove only the tumor outside the sinuses, and then regularly follow up the residual tumors in the sinuses.
if follow-up finds that the tumor is enlargement, it is recommended to remove the tumor after radiotherapy.
if the sinuses are completely closed and the side branch circulation is established, the closed sinuses can be removed after a detailed assessment of the lateral branch circulation, and the lateral veins should be protected during surgery.
surgically injured sinuses that are not closed may cause complications such as cerebral infarction, cerebral hemorrhage, vision loss, infection, etc.
, it is important to know the anatomy and compensation of the side veins and the degree of sinus injury before surgery.
the application of surgical microscope, neural navigation, intraoperative neuroelectronic monitoring, intraoperative imaging, adaptive hybrid surgery and ultrasound attractors greatly improve the success rate of surgery.
surgery for a meningococral tumor at the base of the skull is difficult.
, even with the latest technology, meningococids at the base of the skull may not be fully cut.
the nasal path to reach the abdominal side of the deep tumor at the base of the skull, avoid pulling brain tissue during surgery, safely remove lesions, and even reach Thespon I. level.
the nasal path is suitable for removing small meningococcial tumors that grow next to or below the crossroads.
nasal path is not suitable for large, asymmetric meningococcuses that envesp important blood vessels and optic nerves.
narrow surgical space increases the risk of meningoma surgery in important anatomical locations.
-cranial meningioma is mainly blood supply from blood vessels on the abdominal side.
through the nasal path can give priority to the display of the tumor base at the bottom of the epidural and surface of the blood vessels.
the nasal path under the endoscope has a standard endoscope through the nasal intrusion path (SEEA) and the enlargement of the endoscope under the nasal intrusion path (EEEA) two categories.
EEEA can avoid pulling brain tissue, minimize optic nerve damage, reduce brain tissue hemorrtizing, edema.
endocranial meningiomas suitable for endoscopic therapy include olfactory groin meningiomas, saddle nodule meningiomas, rock oblique meningiomas, and pillow bone large-hole meningiomas.
the incidence of early neurological complications through the nasal path under the endoscope was lower than in open cranial surgery.
saddle nodule meningioma often grows into the optic neural tube through the inner edge of the optic nerve tube, which is the main cause of recurrence after surgery.
saddle nodule meningoma and the preferred endoscope of the optic neural tube through the nasal path, after surgery can significantly improve vision.
major complications of nasal intrusion were cerebrospinal fluid leakage (9.5%), infection (5.4%), cranial nerve damage (4.1%) and vascular damage (2.7%).
addition, the biggest problem with this path is subcranial reconstruction, especially wide-substrate meninges, where the risk of cerebrospinal fluid leakage is as high as 30%.
currently using multi-layer repair with diaphragm valves in the vascular nose can reduce the rate of cerebrospinal fluid leakage to <5%.
, the microscope combined endoscope can complement each other, which is the direction of the technical reform of meningoma surgery.
key to meningoma surgery is to protect normal brain tissue around the tumor.
it is difficult to completely remove tumors that are tightly adhered to sinuses or nerve vessels at the base of the skull, STR is a strategy to protect the integrity of veins and nerve functions and avoid serious complications.
now, more and more doctors have accepted the option.
meningioma blood supply is abundant, preoperative selective embolism blood supply arteries help to remove meningioma, control bleeding, shorten surgery time, improve the full cut rate, reduce complications.
preoperative embolism is used in tumors with complex blood vessels, PTE effects to identify tumor boundaries, tumors adjacent to functional areas, tired sinuses, scalp and skull.
the incidence of preoperative embolism complications was 2.6-12%, the main causes of severe neuro dysfunction due to embolism were distant vascular closure, embolism reflow leading to ischemic or bleeding of peripheral brain tissue.
, the benefits and risks of embolism must be carefully assessed before surgery.
incidence of hemorrhagic complications after embolism is higher than that of ishedic complications.
the time between embolism and surgery is 1 day to 1 week, embolism ≥1 week may be re-opened or formed side support, so most medical centers operate within 7 days of embolism.
postoperative complications including cerebral hemorrhage, infection, neurological deficiency, cerebral edema and epilepsy.
the occurrence of intracranial hemorrhage after surgery was about 2.6%, due to abnormal clotting function, excessive pulling of brain tissue damage to small blood vessels, bleeding from surgical wounds or fluctuations in blood pressure after surgery.
of infection after surgery was 2.7%.
tumor location is a predicted indicator of infection, and the risk of postcranial meningoma is four times higher than that of noncranial meningococcia.
surgery increases the risk of infection.
can reduce the infection rate by regulating surgical operation, fully flushing the surgical cavity and applying antibiotics preventively.
surgery directly results in a neurofunctional defect rate of 2-30%, often depending on the location of the tumor and the scope of removal.
non-functional area meningococcial tumors can usually be completely removed with fewer complications.
surgery on a subcranial meninges may damage the cranial nerve.
tumor invades the sinuses, the surgery damages the sinuses and plate barrier veins, resulting in intravenous infarction.
46%-92% of meningiomas have varying degrees of PTE, and corticosteroid hormones are the main drug used to treat PTE.
hyperbaric oxygen therapy after surgery can reduce PTE and neurological dysfunction.
12%-19% of epilepsy after meningoblastoma.
predictors of poor prognostic prognostication of postoperative epilepsy were PTE range, WHO II. and III. tumors, and small excision range (Simpson III.-V. level).
brain tissue or vascular damage during surgery can reduce postoperative neurodefuncative defects and epilepsy.
, left, and gaba spray have good effects on postoperative epilepsy.
: Radiotherapy (RT) is suitable for WHO II.grade or III. meningiomas, meningioma STR postoperative, inoperable or relapsed and inoperable meningiomas.
RT aims to reduce tumor proliferation.
the rt increases the to-dosage of important intracranial structures, such as the view path, and minimizes side effects.
that the division of RT after STR and relapsed meninges can significantly control tumor progression.
currently using frameless technology for repeated segmentation therapy.
stereotactic radiotherapy (SRT) is a single large dose of radiation to specific targets, with little radioactive damage to the surrounding normal brain tissue.
Stereotactic Radiosurgery (SRS) combines RT with stereotactic technology for meningococcies ≤3cm in diameter and ≥3mm in distance-sensitive structures such as the optic nerve.
low recurrence rate after WHO I. meninges GTR surgery, no RT required.
high rate of recurrence after WHO I. meningococid STR surgery, and if it is still not fully cut, RT is recommended.
WHO II. and III. meninges are invasive, and even if surgical removal reaches Simpson I. level, recurrence rates are still high, with tumor recurrence rates of 30%-40% and 50%-80%, respectively, after five years.
, initial treatment is usually performed surgically in union with RT.
addition, it is recommended that WHO CLASS III meningioma be routine RT after surgery.
affect the efficacy of meningoma SRS are WHO classification, tumor location and size, patient age, SRS interval, tumor removal degree, and radiation dose.
tumor volume > 8cm3 is the most important factor for poor SRS prognosis of meningococ.
adverse reactions to RT were epilepsy (12.0%), cranial nerve damage (5.5%) and PTE (5.3%).
recommends that small asymptomatic meningomas be observed first, and if the tumor progresses, RT.
: Chemotherapy is suitable for meningiomas that cannot be operated on and RT.
there are currently a variety of chemotherapy drugs and molecularly targeted drugs that can be used to treat non-benign meningiomas, such as alkanes, tyrosine kinase inhibitors, endocrine drugs and interferons.
hydroxyurea (HU) is a CYT reductase inhibitor that induces meningioma apoptosis and has been used as an auxiliary treatment for meningiomas that cannot be fully cut or relapsed.
TMZ is an alkane agent that does not extend PFS for relapsed meningococytes.
is a topological isomerase I inhibitor that can cause DNA double-stranded fractures.
preclinical studies have found that elitricon inhibits the growth of meningococ.
, the subsequent Phase II trial failed to demonstrate its clinical efficacy.
recombinant interferon α-2b is effective in a small number of patients with malignant meningoma.
study found that mutations such as NF2, TRAF7, KLF4, AKT1, SMO, PI3KCA and POLAR2A play an important role in the development of meningoma.
NF2 mutation occurs in 50%-60% of meningococcoma patients.
NF2 gene product merlin is a tumor suppressor that inhibits cell proliferation.
high expression of plateplate-based growth factor (PDGFR) was closely related to malignant meningoma and atypical meningoma.
Imatiny combined HU is used to treat relapsed or infused meningiomas.
is a small molecule tyrosine kinase inhibitor that targets vascular endotrophic growth factors and PDGF.
VEGF is expressed in 84% of meningococ, while VEGFR is expressed in 67% of meningococc?
expression levels of VEGF and VEGFR in meningococral tumors increased with tumor levels.
inhibition of VEGF and VEGFR has anti-tumor effects.
beva monoant is a VEGF inhibitor that improves the survival rate of meningoencephaloma patients.
Vatalanib is effective in inhibiting VEGFR and PDGFR and has anti-tumor activity in WHO II. and III. meningococids.
mTORC1 weakens the RTK signal through the PI3K and Akt paths, creating a negative feedback loop.
inhibitors such as Temsirolimus and Everolimus can be effective in preventing meningoencephaloma progression.
addition, in vitro studies have shown that retinol-like compounds, such as Fenretinide, can induce apoptosis of meningococcus with a retinic acid subject (RAR).
: Gene therapy is the introduction of genetic material (DNA or RNA) into cells to correct or compensate for genetic defects and abnormalities for therapeutic purposes.
study found that adenovirus and herpes viruses can be effectively transducted into meningoma cells.
herpes simplex virus is effective in treating meningioma.
prognosis and recurrence: The most reliable indicator of meningoma prognosis is WHO grading and degree of excision (Simpson rating).
the prognosis of the inner side, sponge sinuses and slope meningioma were poor, the surgical mortality rate was higher, the postoperative complications were more, and the quality of life was poor.
recurrence rate after meningococral tumor surgery was 13%-40%.
recurrence of meningococids is closely related to Simpson grading.
The Simpson I. rate is 9 percent, Simpson II is 19 percent, and Simpson III is 29 percent.
follow-up after surgery, as relapse rates increase over time.
after STR surgery