Meningiomas - Management and Surgery

146 Pages·2012·10.75 MB·English

by  D. Monleon

MENINGIOMAS –
MANAGEMENT AND
SURGERY

Edited by Daniel Monleon
Meningiomas – Management and Surgery
Edited by Daniel Monleon

Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia

Copyright © 2012 InTech
All chapters are Open Access distributed under the Creative Commons Attribution 3.0
license, which allows users to download, copy and build upon published articles even for
commercial purposes, as long as the author and publisher are properly credited, which
ensures maximum dissemination and a wider impact of our publications. After this work
has been published by InTech, authors have the right to republish it, in whole or part, in
any publication of which they are the author, and to make other personal use of the
work. Any republication, referencing or personal use of the work must explicitly identify
the original source.

As for readers, this license allows users to download, copy and build upon published
chapters even for commercial purposes, as long as the author and publisher are properly
credited, which ensures maximum dissemination and a wider impact of our publications.

Notice
Statements and opinions expressed in the chapters are these of the individual contributors
and not necessarily those of the editors or publisher. No responsibility is accepted for the
accuracy of information contained in the published chapters. The publisher assumes no
responsibility for any damage or injury to persons or property arising out of the use of any
materials, instructions, methods or ideas contained in the book.

Publishing Process Manager Maja Kisic
Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team

First published February, 2012
Printed in Croatia

A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from [email protected]

Meningiomas – Management and Surgery, Edited by Daniel Monleon
p. cm.
978-953-51-0175-8

Contents

Preface VII
Part 1 Management of Meningiomas 1
Chapter 1 Management of Malignant Meningiomas 3
Danijela Levačić, David Nochlin,
Thomas Steineke and Joseph C. Landolfi
Chapter 2 Management of Lumbar Spinal Meningioma:
A Systematic Review 35
Hiroki Hirabayashi
Chapter 3 Radiation Therapy in the Management of Meningiomas 45
Frederik Vernimmen
Part 2 Surgery of Meningioma 63
Chapter 4 Neuronavigation for Intracranial Meningiomas 65
Erasmo Barros da Silva Jr., Jerônimo Buzetti Milano,
Luis Fernando Moura da Silva Jr., Lucas Alves Aurich and
Ricardo Ramina
Chapter 5 Surgical Management of
Skull Base Meningiomas – An Overview 85
Bernhard R. Fischer and Benjamin Brokinkel
Chapter 6 Dural Reconstruction in Meningioma Surgery 103
Ciro Parlato, Roberto Granata, Aldo Moraci and Marina Accardo
Chapter 7 Surgical Approaches for
Lateral Ventricular Trigone Meningioma 125
Takafumi Nishizaki

Preface

The initial diagnosis of a brain tumour causes fear and insecurity in patients, their
families and friends. The appropriate diagnosis, treatment and management requires
the best skills that the neurosurgeons developed as a result of years of experience and
research. The treatment of brain tumours, especially surgical, has improved greatly
over the past decades. The ideal management involves many different techniques and
expertise, even for the most benign forms.
Meningiomas are neoplasms that arise from the leptomeningeal covering of the brain
and spinal cord, representing around one fourth of all Central Nervous System
tumours. They are the second most common primary neoplasm of the central nervous
system and display a remarkably wide spectrum of biological and histological
properties. This heterogeneity has fascinated surgeons and pathologists since the word
meningioma was first used by Harvey Cushing in 1922. Although the majority of these
tumours are histologically benign, some meningiomas show signs of malignancy such
as marked vascularity, loss of organoid structure, mitotic figures, nuclear
pleomorphism, prominent nucleoli, focal necrosis, or infiltration to the adjacent brain.
On the other hand, their positioning in the central nervous system can cause serious
morbidity and/or mortality. The World Health Organization (WHO) classifies
meningiomas into three histologic grades: Grade I (benign), Grade II (atypical), and
Grade III (anaplastic), according to the clinical prognosis.
The management of patients with meningioma is usually a compromise between
definitive removal of the tumor and minimization of neurologic damage. Initial
management for patients with a benign meningioma typically consists of surgery,
surgery plus radiation therapy, or radiation therapy alone. On the contrary, surgeons
may choose to simply monitor patients showing asymptomatic or minimally
symptomatic slow growing lesions for evidence of tumor growth, deferring initial
treatment. In these cases, personalized follow-up schedules are of the utmost
importance for proper patient management.
As a consequence, the most relevant aspects in the management of meningioma
patients are therefore the surgical approach for initial treatment and a proper follow
up strategy. During the preparation of this book, these aspects have been taken as
primary targets in different chapters and sections. The book includes chapters
VIII Preface

dedicated to surgery, from neuronavigation to dural reconstruction, as well as those
dedicated to management, including radiation therapy strategies and management of
most malignant cases. We all think that the outcome is an extensive but focused
manual that will be of high value during management of meningioma patient.

Dr. Daniel Monleon
Head of the Molecular Imaging and Metabolomics Lab of the Clinical Research
Foundation, Hospital Clínico Universitario de Valencia,
Lecturer in Cell Biology at the Department of Pathology of the University of Valencia,
Spain