• Radiation Oncology Journal
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• 제12권2호
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• pp.159-164
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• 1994

Purpose : To evaluate the role of postoperative radiotherapy in the management of primary or recurrent intracranial meningiomas. Methods and Materials : A retrospective review of 34 intracranial meningioma patients referred to the Yonsei Cancer Center for postoperative radiotherapy between 1981 and 1990 was undertaken. Of the 34 patients, 24 patients received elective postoperative radiotherapy after total or subtotal resection(Group 1), and 10 patients received postoperative radiotherapy as a salvage treatment for recurrent tumors(Group 2). Ten patients received postoperative radiotherapy after total resection, and twenty-four after subtotal resection. Ten patients who had total tumor resection were referred for radiotherapy either because of angioblastic or malignant histologic type(4 patients in Group 1) or because of recurrent disease after initial surgery(6 patients in Group 2). Radiation dose of 50-56 Gy was delivered over a period of 5-5.5 weeks using 4MV LINAC or Co-60 teletherapy unit. Results : Overall actuarial progression free survival(PFS) at 5 years was $80\%$. Survival was most likely affected by histologic subtypes. Five year PFS rate was $52\%$ for benign angioblastic histology as compared with $100\%$ for classic benign histology. For malignant meningiomas, 5 year PFS rate was $44\%$. The recurrence rates of classic, angioblastic, and malignant type were $5\%(1/21),\;80\%(4/5)$, and $50\%(4/8)$, respectively. The duration between salvage post-operative radiotherapy and recurrence was longer than the duration between initial surgery and recurrence in the patients of group 2 with angioblastic or malignant histology. Conclusion . Postoperative radiotherapy of primary or recurrent intracranial meningiomas appears to be effective modality, especially in the patients with classic meningiomas. In angioblastic or malignant histologies, a more effective approach seems to be needed for decreasing recurrence rate.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.217-223
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• 2007

Objective : The apparent increase in the incidence of the intracranial meningiomas in the elderly is due in part to improved diagnostic tools and improved span of life. The authors carried out a retrospect study to validate the use of the Clinical-Radiological Grading System [CRGS] as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival. Methods : From January 1997 to January 2006, the authors consecutively recruited and surgically treated 20 patients older than 65 years of age with radiologic findings of intracranial meningiomas and a preoperative evaluation based on the CRGS. Results : High CRGS score was associated with a higher probability of good outcome [p=0.004] and a lower probability of postoperative complications [p=0.049]. Among the different subset items of the CRGS score, larger maximum tumor diameters [$D{\geqq}4cm$] and the presence of a severe peritumoral edema were associated with incidence rate of postoperative poor outcome and complications [p<0.05]. Additionally, the critical location of the tumor was also correlated with poor outcome [p<0.05]. Conclusion : A CRGS score higher than 13 is a good prognostic indication of survival. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial meningiomas as surgical candidates.

• Journal of Korean Neurosurgical Society
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• 제52권2호
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• pp.98-102
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• 2012

Objective : To study the clinical significance and relevant factors of radiation-induced intratumoral necrosis (RIN) and peritumoral edema (PTE) after Gamma knife radiosurgery (GKRS) for intracranial meningiomas. Methods : We retrospectively analyzed the data of 64 patients who underwent GKRS for intracranial meningioma. The mean lesion volume was 4.9 cc (range, 0.3-20), and the mean prescription dose of 13.4 Gy (range, 11-18) was delivered to the mean 49.9% (range, 45-50) isodose line. RIN was defined as newly developed or enlarged intratumoral necrosis after GKRS. Results : RIN and new development or aggravation of PTE were observed in 21 (32.8%) and 18 (28.1%) cases of meningioma, respectively during the median follow-up duration of $19.9{\pm}1.0$ months. Among various factors, maximum dose (>25 Gy) and target volume (>4.5 cc) were significantly related to RIN, and RIN and maximum dose (>24 Gy) were significantly related to the development or aggravation of PTE. In 21 meningiomas with development of RIN after GKRS, there was no significant change of the tumor volume itself between the times of GKRS and RIN. However, the PTE volume increased significantly compared to that at the time of GKRS (p=0.013). The median interval to RIN after GKRS was $6.5{\pm}0.4$ months and the median interval to new or aggravated PTE was $7.0{\pm}0.7$ months. Conclusion : A close observation is required for meningiomas treated with a maximum dose >24 Gy and showing RIN after GKRS, since following or accompanying PTE may deteriorate neurological conditions especially when the location involves adjacent critical structures.

• Journal of Korean Neurosurgical Society
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• 제30권11호
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• pp.1263-1270
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• 2001

Objective : To analyze the radiosurgical results of intracranial meningiomas after Gamma Knife radiosurgery (GKS) and to assess the possible factors related to the outcome and complications in treating meningiomas. Patients and Methods : We retrospectively reviewed the clinical and radiological data in 179 patients(194 lesions) treated with GKS for intracranial meningiomas between May 1992 and October 2000. Radiosurgical responses were categorized as shrinkage, stasis and enlargement, and we defined the shrunken and static group as a radio-logical control. A Cox proportional hazards model was used to evaluate the correlation between the radiosurgical outcomes and various factors such as location and size of tumor, age and gender of patients, relation to venous sinus, pre-GKS degree of edema, treatment modality, radiosurgical parameters, and pathologic findings. Results : Patients were grouped into skull base meningiomas(57.7%), non-skull base tumor including convexity, parasagittal, and falx meningiomas(37.1%), and others(5.2%) according to the location of tumors. The mean maximum dose and the margin dose of tumor was 30.0Gy(19-45Gy) and 15.1Gy(9.5-24.5Gy), respectively. The mean volume of the tumors was 9.4cc(0.003-45.0cc). The radiologic control rate was 97.1%. The radiation induced imaging change with or without neurologic deficit was the most common complication(23.6%). There were seen mostly in convexity, parasagittal, and falx meningiomas which were deeply embedded in cortex. Conclusion : GKS for intracranial meningioma seems to be safe and effective treatments. However, GKS should be considered very cautiously in non-skull base tumor such as convexity, parasagittal, or falx meningiomas with regards to patient's age and general condition, size and location of tumor, pattern of embedding into cortex, presenting symptoms and patient's preference.

• Journal of Korean Neurosurgical Society
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• 제52권1호
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• pp.14-20
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• 2012

Objective : Intracranial meningiomas are primarily benign tumors with a good prognosis. Although WHO grade II meningiomas are rare (2-10%), WHO grade II meningiomas have higher recurrence and mortality rates than benign. We evaluated the patient recurrence rate and investigated the prognostic factors of WHO grade II meningiomas. Methods : Between 1993 and 2005, 55 patients were diagnosed with WHO grade II meningiomas in our hospital. WHO grade II meningiomas (n=55) were compared with other WHO grades meningiomas (I, n=373; and III, n=20). The patients had a median age of 48.4 years (range, 14-17 years), a male-to-female ratio of 26 : 29, and a mean follow-up time of 45 months (range, 3-175 months). Results : In WHO grade II meningiomas, only the extent of resection was a significant prognostic factor. Post-operative radiotherapy had no significant influence on tumor recurrence (p=0.053). The relative risk of recurrence was significantly higher in WHO grade II meningiomas with incomplete resection (10/27, RR=37%) than in WHO grade II meningiomas with complete resection (4/28, RR=14%) regardless of post-operative radiotherapy. In the incomplete resection group, Simpson grade III or IV had a significantly high risk of recurrence regardless of post-operative RT (n=3, RR=100%) However, if the degree of resection was Simpson grade II, the recurrence rate was similar to the complete resection group even though post-operative RT was not performed. Conclusion : Complete resection was the most powerful independent predictive factor of the recurrence rate in WHO grade II meningiomas. Post-operative adjuvant RT was not a significant factor in this study.

• 대한두경부종양학회지
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• 제26권2호
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• pp.259-261
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• 2010

The meningiomas are slowly growing tumors arising from meningoepithelial cells and they generally occur in the intracranial space. Tumor extension to the extracranial structures occurred in about 20 percent of intracranial meningiomas. Meningiomas extending to the cervical area are uncommom. Beacuse these patients complain of localized symptoms, sometimes those tumors have been operated as cervical tumors. In this report, we incidentally found a meningioma in the left parapharyngeal space in a 63-year-old female, who was confirmed by histopathologic diagnosis to have meningioma. We report herewith this case with the review of literatures.

• Journal of Yeungnam Medical Science
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• 제5권2호
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• pp.195-200
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• 1988

본 영남대학교 의과대학 신경외과학 교실에서는 다발성 뇌수막종 1예를 수술 치험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1215-1221
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• 2000

목 적 : 양성 뇌수막종에 비하여 이형성 및 악성 뇌수막종이 나쁜 임상적인 예후 및 양상을 보이는 것은 잘 알려져 있으나, 양성 뇌수막종에 있어서 각각의 병리조직학적 아형에 따른 생물학적 양상의 차이에 대해서는 잘 알려지지 않거나 일부 논란이 되고있다. 본 연구에서는 이형성 뇌수막종 및 양성 뇌수막종의 각각의 병리조직학적 아형에 따른 증식능의 차이여부를 알아보고자 PCNA와 Ki-67표지지수를 분석하였다. 방 법 : 본원에서 뇌수막종으로 수술을 시행하여 얻은, 재발을 보여 재수술을 시행한 2례를 포함하여, 파라핀에 포매시킨 27개의 조직을 대상으로 병리학적인 증식능을 분석하기 위해, PCNA에 대한 단일항체 및 MIB-1 단일항체를 이용한 면역조직화학적 염색을 시행하였다. 조직학적 분류상 meningothelial type이 8례, transitional type이 9례, fibroblastic type이 5례였으며, 이형성 수막종이 5례였다. 결 과 : PCNA표지지수의 평균값은 양성 수막종에서 meningothelial type이 $4.82{\pm}5.10%$, transitional type이 $9.01{\pm}4.25%$, fibroblastic type이 $5.66{\pm}5.32%$를 보였으나 이형성 수막종에서는 $27.62{\pm}19.67%$의 높은 지수를 나타냈고, Ki-67 표지지수의 평균값은 양성 수막종의 아형에서 각각 $0.43{\pm}0.85%$, $0.44{\pm}1.08%$, $0.24{\pm}0.18%$를 보이고, 역시 이형성 수막종에서는 $0.84{\pm}0.59%$의 높은 지수를 보였다. 즉, 양성 수막종에서 각각의 아형에 따른 PCNA 및 Ki-67 표지지수는 통계학적으로 의미있는 차이는 없었으나(p>0.05), 이형성 수막종에서는 의미있는 높은 표지지수를 보여(p<0.05) 양성 수막종에서 보다 높은 증식능을 보임을 알 수 있었다. 결 론 : PCNA 및 Ki-67 표지지수를 이용한 증식능의 비교결과, 양성 뇌수막종에서는 각각의 아형에 따른 생물학적 양상이나 예후는 차이가 없을것으로 생각되나, 이형성 수막종에서는 높은 증식능을 보여 이에 대한 예후를 예상할 수 있을것으로 생각되며, 또한 이러한 표지지수가 병리조직학적으로 양성과 이형성의 감별에 많은 도움이 될것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.379-384
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• 2015

Objective : To investigate the risks and pattern of evolution of peritumoral brain edema (PTE) after stereotactic radiosurgery (SRS) for asymptomatic intracranial meningiomas. Methods : A retrospective study was conducted on 320 patients (median age 56 years, range 24-87 years) who underwent primary Gamma Knife radiosurgery for asymptomatic meningiomas between 1998 and 2012. The median tumor volume was 2.7 cc (range 0.2-10.5 cc) and the median follow-up was 48 months (range 24-168 months). Volumetric data sets for tumors and PTE on serial MRIs were analyzed. The edema index (EI) was defined as the ratio of the volume of PTE including tumor to the tumor volume, and the relative edema indices (rEIs) were calculated from serial EIs normalized against the baseline EI. Risk factors for PTE were analyzed using logistic regression. Results : Newly developed or increased PTE was noted in 49 patients (15.3%), among whom it was symptomatic in 28 patients (8.8%). Tumor volume larger than 4.2 cc (p<0.001), hemispheric tumor location (p=0.005), and pre-treatment PTE (p<0.001) were associated with an increased risk of PTE. rEI reached its maximum value at 11 months after SRS and decreased thereafter, and symptoms resolved within 24 months in most patients (85.7%). Conclusion : Caution should be exercised in decision-making on SRS for asymptomatic meningiomas of large volume (>4.2 cc), of hemispheric location, or with pre-treatment PTE. PTE usually develops within months, reaches its maximum degree until a year, and resolves within 2 years after SRS.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.297-306
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• 2022

Objective : Intracranial atypical meningiomas have a poor prognosis and high rates of recurrence. Moreover, up to one-third of the recurrences undergo high-grade transformation into malignant meningiomas. We aimed to investigate the clinical factors that can predict the propensity of malignant transformation from atypical to anaplastic meningiomas. Methods : Between 2001 and 2018, all patients with atypical meningioma, in whom the tumors had undergone malignant transformation to anaplastic meningioma, were included. The patients' medical records documenting the diagnosis of atypical meningioma prior to malignant transformation were reviewed to identify the predictors of transformation. The control group comprised 56 patients with atypical meningiomas who were first diagnosed between January 2017 and December 2018 and had no malignant transformation. Results : Nine patients in whom the atypical meningiomas underwent malignant transformation were included. The median time interval from diagnosis of atypical meningioma to malignant transformation was 19 months (range, 7-78). The study group showed a significant difference in heterogeneous enhancement (77.8% vs. 33.9%), bone invasion (55.6% vs. 12.5%), mitotic index (MI; 14.8±4.9 vs. 3.5±3.9), and Ki-67 index (20.7±13.9 vs. 9.5±7.1) compared with the control group. In multivariate analysis, increased MI (odds ratio, 1.436; 95% confidence interval, 1.127-1.900; p=0.004) was the only significant factor for predicting malignant transformation. Conclusion : An increased MI within atypical meningiomas might be used as a predictor of malignant transformation. Tumors at high risk for malignant transformation might require more attentive surveillance and management than other atypical meningiomas.