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Rationale and Objectives: To explore the value of diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), neurite orientation dispersion and density imaging (NODDI), and mean apparent propagator (MAP) magnetic resonance imaging histogram analysis in evaluating the grade and proliferative activity of meningiomas., Materials and Methods: A total of 134 meningioma patients were prospectively included and underwent magnetic resonance diffusion imaging. The whole-tumor histogram parameters were extracted from multiple functional maps. Mann-Whitney U test was used to compare the histogram parameters of high- and low-grade meningiomas. The receiver operating characteristic (ROC) curve and multiple logistic regression analysis were used to evaluate the diagnostic efficacy. The correlation between histogram parameters and the Ki-67 index was analyzed. The diffusion model was further validated with an independently validation set (n = 33)., Results: Among single histogram parameters, the variance of NODDI-ISOVF (isotropic volume fraction) showed the highest AUC of 0.829 in grading meningiomas. For the combined models, the DKI model had the best performance in the diagnosis (AUC=0.925). Delong test showed the DKI combined model showed superior diagnostic performance to those of DTI, NODDI and MAP models (P < 0.05 for all). Moreover, moderate to weak correlations were found between various diffusion parameters and the Ki-67 labeling index (rho=0.20-0.45, P < 0.05 for all). In the validation set, the DKI model still showed higher performance (AUC, 0.85) than other diffusion models, thus demonstrating robustness., Conclusions: Whole-tumor histogram analyses of DTI, DKI, NODDI, and MAP are useful for evaluating the grade and cellular proliferation of meningiomas. DKI combined model has higher diagnostic accuracy than DTI, NODDI and MAP in meningioma grading., Competing Interests: Declaration of Competing Interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: N-butyl cyanoacrylate (n-BCA) is often utilized for preoperative transarterial embolization (TAE) of meningiomas. However, factors affecting the embolization effect with n-BCA remain unclear. This study aimed to clarify the factors associated with the embolization rate after TAE using n-BCA in meningioma, from the aspect of feeder architecture., Materials and Methods: We retrospectively analyzed 62 patients with meningioma who underwent preoperative TAE with n-BCA between 2016 and 2021. Patient variables, including characteristics, intraoperative findings, and outcomes, were collected. Feeder architecture was classified into seven groups: 1) internal maxillary artery, 2) occipital artery, 3) ascending pharyngeal artery, 4) posterior meningeal artery, 5) infraclinoidal internal carotid artery, 6) ophthalmic artery (OphA), and 7) pial feeder group, based on preoperative angiography. We set primary outcome as the embolization rate, representing the reduction rate of the gadolinium-enhanced lesion volume observed on contrast-enhanced magnetic resonance imaging. Angiographic findings following n-BCA injection were classified as feeder occlusion (FO) or intratumoral embolization (IE). We analyzed the factors associated with the embolization rate., Results: The OphA feeder group showed a decrease in the embolization rate (P = 0.008). The number of feeder groups with IE showed a robust positive correlation (r = 0.557). The OphA feeder group showed an increase in the number of feeder groups (P < 0.001) and larger tumor volume (P = 0.005)., Conclusion: The OphA feeder group was associated with a lower embolization rate. Our study suggested that the vascular architecture in meningioma affected the efficacy of TAE with n-BCA., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Dural hemangiomas are a relatively rare form of intracranial mass, as hemangiomas tend to present in bone or as intraparenchymal lesions and only around 5%-13% have been reported to originate from the dura mater. Here, the authors present the case of a 46-year-old female who underwent craniotomy for a suspected convexity meningioma resection, which was unexpectedly found to be a dural capillary hemangioma., Observations: The patient was a 46-year-old female who presented with a left frontal intracranial mass found incidentally and showed significant growth over 4 years. The mass was suspected to be a meningioma as it was homogeneously enhancing, extra-axial, and exhibited findings of a broad base with a dural tail along the dura of the superior frontal lobe. This was excised en bloc and found to be a purplish-red mass firmly attached to the dura, which was diagnosed as a capillary hemangioma on histopathology., Lessons: Dural hemangiomas, particularly at the convexity, are quite rare and can mimic meningiomas on imaging, sometimes even demonstrating homogeneous enhancement with a broad base and dural tail. These are an important part of the differential diagnosis when diagnosing dural-based masses and should be considered when planning operative or radiation treatment. https://thejns.org/doi/10.3171/CASE24476.

This multicenter retrospective study evaluated the effects of a time delay and steroids on the volume of peritumoral edema (VPTE) in dogs with extra-axial brain tumours. The hypothesis is that VPTE will decrease between the diagnostic (MRI-1) and RT planning (MRI-2) MRIs following the administration of steroids. Inclusion required paired MRI acquisitions within 3 months, with VPTE contouring for each MRI registered to the RT planning CT. No edema was defined as < 0.2 cm 3 , increased edema was > 30% VPTE increase and decreased edema was > 30% VPTE decrease. Forty-four dogs of which 34 (77%) received steroids between MRIs were included. The median time between the MRIs was 22 days (range: 8-74 days). Nine (20%) had no edema on both MRIs. The median MRI-1/VPTE: 0.83 cm 3 (IQR: 0.15-2.06 cm 3 ) and median MRI-2/VPTE: 0.40 cm 3 (IQR: 0.06-1.12 cm 3 ) were significantly different (p = 0.048). Compared to MRI-1/VPTE: 17 (39%) VPTE decreased, eight were stable and 10 increased. The median VPTE difference was -21%, range: -100 to +6287. With steroids, VPTE decreased in 15/34 (44%) and increasedin 6/34 (18%) (median VPTE diff: -60%) compared to no steroids (median VPTE diff: +25%). Steroids use was associated with change in VPTE (p = 0.009). Two dogs had clinical deterioration and were on steroids with documented VPTE increase (+86% and +1880%) without tumour progression. The change in VPTE is highly variable but reduction is associated with steroids. Notably, subjective improvement of clinical signs can be seen without significant decrease to the VPTE on imaging., (© 2024 The Author(s). Veterinary and Comparative Oncology published by John Wiley & Sons Ltd.)

Background: Asymptomatic patients with meningiomas are increasingly detected, where management can be challenging in terms of surgery versus watchful waiting. Health-related quality of life (HRQoL) is an important factor in clinical decision-making, albeit not greatly studied in this patient group. The aim of this paper is to map the HRQoL among patients with surgically removed asymptomatic meningioma as compared to the general population., Methods: Patients with first-time surgically treated asymptomatic meningioma between 2007 and 2013 were identified. Patients were invited in 2017 to answer a survey regarding different aspects of quality of life, using EuroQoL (EQ)-5D-3L, perceived health, lifestyle, and occupancy. Data from electronic patient records was obtained. The patients were matched based on age and gender with data from the Stockholm Region Public Health Cohort database., Results: There was no difference in EQ-5D-3L or visual analog scale between the patients and their matched controls. Patients and controls experienced ill health to the same extent, but patients felt to a greater extent that this impacted their way of life. In 36% of patients, preoperative occupation was not resumed, mostly due to cognitive symptoms. Additionally, the study suggested social detachment in this cohort, as significantly more patients were living alone and had less emotional support compared to controls., Conclusions: Although surgically treated patients with asymptomatic intracranial meningioma have similar overall HRQoL compared to the general population, surgery has an impact on return to work and cognitive function., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)

Purpose: Meningiomas are the most frequent primary intracranial malignancy. While surgical resection can confer long term tumor control, stereotactic radiosurgery (SRS) is often used for small, asymptomatic tumors in the adjuvant setting. Frailty has been associated with increased rates of peri-operative morbidity but has yet to be defined in the setting of SRS for meningiomas. We therefore sought to examine the relationship between frailty and clinical/radiographic outcomes of patients with meningiomas who have undergone SRS., Methods: A single-center, retrospective cohort study classified patients by their 5-factor modified frailty index (mFI-5) score into pre-frail (0-1) and frail (2-5) at the time of SRS treatment. Evaluations of overall survival (OS), progression free survival (PFS), local control (LC), and distant control (DC) were performed using Kaplan-Meier analysis. Cox proportional hazards regression analysis was used to further define factors associated with OS/PFS., Results: 94 patients met inclusion criteria and underwent SRS for meningioma treatment from 2019 to 2023. Analyses compared prefrail (0-1) and frail (2-5) individuals. Kaplan-Meier analysis demonstrated a near significant association between frailty and OS (HR 3.66, 95% CI 0.49-26.8 p = 0.05) with 3-year OS rates of 75.4% in the pre-frail versus 36.6% in the frail group. However, a significant relationship was demonstrated between frailty and PFS (HR: 2.95 95% CI 1.12-7.81, p = 0.02) with 3-year PFS rates of 90.5% in the pre-frail group versus 49.2% in the frail group. Univariable regression analysis demonstrated that frailty, prior surgical excision, and cumulative tumor volume predicted PFS., Conclusion: Frailty, as assessed by the mFI-5, did not independently predict OS but did predict PFS in individuals with meningioma undergoing SRS., Competing Interests: Declarations Competing interest The authors declare no competing interests., (© 2024. The Author(s).)

SMARCB1 encodes a core subunit of the SWI/SNF chromatin remodeling complex, which plays a crucial role in the regulation of gene expression. Germline mutations in the SMARCB1 gene have been linked to early childhood Coffin-Siris syndrome type 3 (CSS3), a rare congenital malformation syndrome characterized by severe developmental delay and intellectual disability. In this study, we report a family of two adult CSS3 patients with a novel missense SMARCB1 mutation (c.1091A>C, p.Lys364Thr) identified through whole-exome sequencing (WES). Both patients exhibit selective difficulties in verbal learning and experience language delays. Additionally, the development of meningioma is confirmed in one of the patients. Mechanistic studies suggest that this missense mutation may abnormally activate the MAPK signaling pathway, which is implicated in the pathogenesis of tumor progression and neurodevelopmental disorders. This is the first reported case of a germline mutation in the SMARCB1 gene associated with both CSS3 and meningioma, thereby expanding the phenotypic spectrum of SMARCB1-related disorders.

Background: Meningiomas are the most common primary intracranial tumours in adults. Several studies proposed new stratification systems with a more accurate risk prediction than the WHO grading, e.g. based on methylation and copy number variations (CNVs). Yet, common shortcomings in these analyses are either a lack of stratification by sex of patients or excluding the gonososmes from CNV assessment., Methods: Within this study, DNA methylation array data from 7,424 meningioma samples as well as targeted sequencing, clinical annotations and morphology subtyping of 796 samples were examined for differences between females and males regarding mutations, methylation classes, copy number variations and histology., Results: Meningiomas from females accounted for about 53 % of the malignant tumours and present a loss of one X chromosome in 57 % of these malignant cases. In the group of benign tumours, females comprised about 75 % of the patients. Therein, a loss of one X chromosome was detected in only about 10 % of the cases but was associated with a significantly worse progression free survival., Conclusion: Although genomic instability is a common feature of malignant meningiomas, particularly loss of the X chromosome in tumours of female patients in otherwise histologically and molecularly low-risk tumours confers higher risk. Hence, the gonosomal copy number status can be leveraged for increased diagnostic accuracy., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: Existing literature on adjuvant radiation after subtotal resection (STR) of WHO II meningiomas is limited by heterogenous patient cohorts, combining adjuvant and salvage radiation, gross total resection (GTR) and STR, primary radiation treatment vs. re-treatment, or grade II and III meningiomas, all of which have different expected outcomes. Tumor control estimates in a large homogenous patient cohort are needed to accurately counsel patients., Methods: A retrospective review of patients that had immediate post-operative imaging-confirmed residual WHO grade II meningioma followed by either adjuvant intensity-modulated radiation therapy (IMRT) or stereotactic radiosurgery (SRS) between 1996 and 2020 was conducted. Kaplan-Meier survival analysis and log-rank test was used to assess progression-free survival (PFS)., Results: Thirty-nine patients met inclusion criteria (IMRT = 32; SRS = 7). Overall, the 3-, 5-, and 10-year PFS was 81.1%, 61.2%, and 44.6%, respectively. Median follow-up time was 37 months. When comparing IMRT and SRS cohorts, baseline characteristics did not differ significantly between groups, but significantly larger residual tumor volumes were treated with IMRT (22.2 cm 3 vs. 6.3 cm 3 , p = 0.004). PFS was not significantly different between IMRT and SRS at 3 years (81.1% vs. 80.0%) or 5 years (65.5% vs. 40%) (p = 0.19). There was no significant difference in radiation necrosis between groups (IMRT = 3/32 patients vs. SRS = 0/7 patients, p = 0.32)., Conclusion: Our homogenous patient cohort displayed acceptable control rates at 3 years using SRS or IMRT as adjuvant therapy. No significant difference in PFS or radiation necrosis was noted between patients treated with adjuvant IMRT versus SRS., Competing Interests: Declarations Conflict of interest Varun Kshettry is a consultant for Integra and Stryker. Pablo Recinos is a consultant for Stryker. Samuel Chao received honorariums from Varian Medical Systems and Blue Earth Diagnostics, as well as receives research support from Blue Earth Diagnostics. John Suh is consultant for Philips, Novocure, Neutron Therapeutics, and EmpNia. All other authors do not have any conflicts of interest to disclose. Ethical approval The study was approved by the Cleveland Clinic Foundation Institutional Review Board., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Intracranial angioleiomyoma (IALM) is a rare neoplasm mimicking meningioma. We aimed to explore the clinical and molecular characteristics of IALMs. We included 40 patients with IALMs who had tumor resection at our center from 2009 to 2022. Clinicopathological and radiological characteristics were extracted and analyzed thoroughly. GJA4 mutation status was detected and correlated with clinical characteristics. IALMs accounted for about 10% of all angioleiomyoma and had a significant male predominance compared to extracranial angioleiomyoma (p=0.04). However, there was no age difference between extracranial angioleiomyomas and IALMs. In our IALM cohort, orbital (35%) were the most common tumor location, followed by tentorium (25.0%), cavernous sinuous (17.5%). Vision decrease, diplopia and exophthalmos (40%) were the most common symptom. The radiological characteristics of ILAMs were similar to meningiomas; 20 patients (57.1%) in our cohort were misdiagnosed as meningioma preoperatively. Gross total resection was achieved in all patients. The postoperative pathology showed median Ki-67 index was 1% (range: 0-10%). Vision improvement or exophthalmos relief was achieved in 12 of 16 patients (75.0%). During the long-term follow-up (mean 70.3 months, range 30 - 128 months), no patient experienced tumor recurrence or died of tumor progression, indicating that IALM was clinically benign. GJA4 mutation (p. Gly41Cys) was detected in 17 (42.5%) patients. Of note, the correlations analysis revealed that orbital and cavernous sinus areas (64.7%) were the leading location that harbor GJA4 mutations. Tumors with mutant GJA4 were associated with positive progesterone receptor (PR) expression (p=0.02). This first large case series demonstrated that IALM predominantly affected males, was located in the cavernous sinus and orbital areas, and often manifested visual impairment and diplopia. IALM had favorable outcome. Notably, IALMs frequently exhibited a GJA4 mutation, which was linked to the cavernous sinus and orbital locations, as well as PR expression., Competing Interests: Declarations Ethics approval and consent to participate This study used publicly available datasets and the ethics approval and consent to participate was not applicable. Consent for publication The authors consent for publication. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Meningiomas are the most common intracranial tumors and their diagnosis relies mostly on neuroimaging and histology. However, the histology grades cannot predict the outcome exactly and some meningiomas tend to recur after resection of even benign tumors. Therefore, it is necessary to explore prognostic and diagnostic molecular targets., Methods: Differential expression analysis between meningiomas and meninges was performed based on the merged data of GSE43290 and GSE84263. Next, we performed gene set enrichment analysis (GSEA), immune cell infiltration analysis, protein-protein interaction analysis, and survival analysis using public data. The expression level of Synaptosome-associated-protein-25kDa (SNAP25) was verified by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) and Western blotting in meningioma tissues., Results: There were 263 upregulated and 592 downregulated genes identified in meningiomas by differential expression analysis. GSEA results revealed that meningiomas were negatively related to the pathway of soluble N-ethylmaleimide sensitive factor attachment protein receptor interactions in vascular transport and chemokine signaling. SNAP25 was characterized as a hub gene and downregulated in meningiomas. The Kaplan-Meier plot indicated that high expression of SNAP25 is a favorable factor., Conclusion: SNAP25 was downregulated and identified as a potential prognostic marker in meningioma., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background and Purpose: Chlormadinone acetate (CMA) is a synthetic progestin for which cases of intracranial meningioma have been reported following prolonged exposure., Method: An observational cohort study was conducted based on the French national health data system. Women aged 10-70 years and who started CMA between 2007 and 2017 were included. Participants were considered to be exposed if they had received a cumulative dose >360 mg of CMA during the first 6 months and very slightly exposed (control group) when they had received a cumulative dose ≤360 mg. The outcome was surgery or radiotherapy for one or more intracranial meningioma(s). Poisson models assessed the relative risk (RR) of meningioma., Results: In total, 828,499 women were included: 469,976 in the exposed group (mean age 39.1 years, SD 10.1) and 358,523 in the control group (38.3 years, SD 11.0). Surgery or radiotherapy for intracranial meningioma between 2007 and 2017 was recorded for 164 and 104 women in the exposed and control groups, respectively. The incidence of meningioma was 18.5 and 6.8 per 100,000 person-years for the exposed and control groups respectively (crude RR = 2.7, 95% confidence interval [CI] 2.1-3.5; age-adjusted RR = 3.1, 95% CI 2.4-4.0). Meningioma incidence reached almost 47 cases/100,000 person-years in the most exposed group (>8.64 g), giving an age-adjusted RR of 6.9, 95% CI 5.1-9.2, relative to the control group., Conclusions: A strong dose-effect relationship was observed between prolonged use of CMA and risk of meningiomas. As with other progestogens, meningiomas associated with CMA are more likely to be found at the base of the skull., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background: We previously developed a DNA methylation-based risk predictor for meningioma, which has been used locally in a prospective fashion since its original publication. As a follow-up, we validate this model using a large prospective cohort and introduce a streamlined next-generation predictor compatible with newer methylation arrays., Methods: Genome-wide methylation profiles were generated with the Illumina EPICArray. The performance of our next-generation predictor was compared with our original model and standard-of-care 2021 WHO grade using time-dependent receiver operating characteristic curves. An nomogram was generated by incorporating our methylation predictor with WHO grade and extent of resection., Results: A total of 1347 meningioma cases were utilized in the study, including 469 prospective cases from 3 institutions and an external cohort of 100 WHO grade 2 cases for model validation. Both the original and next-generation models significantly outperform 2021 WHO grade in predicting early postoperative recurrence. Dichotomizing patients into grade-specific risk subgroups was predictive of outcome within both WHO grades 1 and 2 tumours (p<0.05), while all WHO grade 3 tumours were considered high-risk. Multivariable Cox regression demonstrated benefit of adjuvant radiotherapy in high-risk cases specifically, reinforcing its informative role in clinical decision making. Finally, our next-generation predictor contains nearly 10-fold fewer features than the original model, allowing for targeted arrays., Conclusions: This next-generation DNA methylation-based meningioma outcome predictor significantly outperforms 2021 WHO grading in predicting time to recurrence. We make this available as a point-and-click tool which will improve prognostication, inform patient selection for RT, and allow for molecularly-stratified clinical trials., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.)

Prostate adenocarcinoma metastasis to brain has been reported to occur only up to 0.6% of patients and these are mostly diagnosed in autopsy series. In the setting of biochemical recurrence of prostate cancer, a suspected PSMA-avid (prostate-specific membrane antigen) lesion in the brain is still strongly suggestive of an intracranial metastasis of prostate cancer. This needs, however, a thoroughly recurrency work-up due to other potentially PSMA-avid cranial lesions, as PSMA initially was developed for the imaging of primary CNS tumours. We report of a challenging clinical case of a 71-year-old-patient with a strongly PSMA-avid lesion at the skull base. Given the medical history of a meningioma at the skull base, the further diagnostic work-up with MRI could still not rule out a malignancy, so that the patient needed to undergo a surgical excision of the tumour mass. The histological and immunohistochemical examinations revealed a relapsed CNS WHO grade 1 meningioma. From the aspect of molecular imaging and critical analysis of regular clinical care in a third-level university hospital, we consider this result very intriguing. Hence, we analyse the decision-making process and clinical course of this case in the light of molecular imaging findings., Competing Interests: F.L.G. has patent application for [18F]PSMA-1007 and is an advisor at ABX, Telix, Alpha Fusion, and SOFIE Biosciences. The other authors declare no conflict of interest regarding this manuscript., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology.)

Most meningiomas are dural-based extra-axial tumors in close contact with the brain. Expression of genes and proteins at the tumor-brain interface in brain-invasive meningioma is basically unknown. Using the NanoString pan-cancer panel, differential expression of genes in the invasive edge versus main tumor body was determined in 12 invasive meningiomas (comprising the discovery cohort), and 6 candidate genes: DTX1, RASGRF1, GRIN1, TNR, IL6, and NR4A1, were identified. By immunohistochemistry, DTX1 and RASGRF1 expression correlated with gene expression, and were studied in an expanded cohort of 21 invasive and 15 noninvasive meningiomas, together with Ki-67. Significantly higher expression of DTX1, RASGFR1, and Ki-67 was found in the invasive edge compared with the main tumor body. Increased expression of RASGRF1 and Ki-67 was more clearly associated with brain invasion. The situation with DTX1 was less definitive since increased expression was observed in meningiomas both at the invasive edge and when in close contact with brain but without invasion. Pathway analyses identified significant links between DTX1 and RASGRF1 and key biological processes, including cell-cell adhesion, and signaling pathways including Notch, RAS, MAPK, and Rho. Higher expression of DTX1, RASGRF1, and Ki-67 in the brain-invasive area of meningiomas suggests that these proteins play a role in the process of brain invasion., (© 2024 Wiley Periodicals LLC.)

Background: Postoperative progressive cerebral edema and hemorrhage (PPCEH) are major complications after meningioma resection, yet their preoperative predictive studies are limited. The aim is to develop and validate a multiparametric MRI machine learning model to predict PPCEH after meningioma resection., Methods: This retrospective study included 148 patients with meningioma. A stratified three-fold cross-validation was used to split the dataset into training and validation sets. Radiomics features from the tumor enhancement (TE) and peritumoral brain edema (PTBE) regions were extracted from T1WI, T2WI, and ADC maps. Support vector machine constructed different radiomics models, and logistic regression explored clinical risk factors. Prediction models, integrating clinical and radiomics features, were evaluated using the area under the curve (AUC), visualized in a nomogram., Results: The radiomics model based on TE and PTBE regions (training set mean AUC: 0.85 (95% CI: 0.78-0.93), validation set mean AUC: 0.77 (95%CI: 0.63-0.90)) outperformed the model with TE region solely (training set mean AUC: 0.83 (95% CI: 0.76-0.91), validation set mean AUC: 0.73 (95% CI: 0.58-0.87)). Furthermore, the combined model incorporating radiomics features, and clinical features of preoperative peritumoral edema and tumor boundary adhesion, had the best predictive performance, with AUC values of 0.87 (95% CI: 0.80-0.94) and 0.84 (95% CI: 0.72-0.95) for the training and validation set., Conclusions: We developed a novel model based on clinical characteristics and multiparametric radiomics features derived from TE and PTBE regions, which can accurately and non-invasively predict PPCEH after meningioma resection. Additionally, our findings suggest the crucial role of PTBE radiomics features in understanding the potential mechanisms of PPCEH., (© 2024. The Author(s).)

Exchanges in medical practice are necessary for training. The use of movies for promoting medical practice was introduced in the late 19th century. The authors analyzed an unidentified movie titled Trepanation for Rolandic Zone Tumor (Trépanation pour tumeur de la zone rolandique) stored at the Établissement de Communication et de Production Audiovisuelle de la Défense of the French Ministry of Armed Forces. This silent black-and-white movie, lasting 15 minutes and depicting the removal of a meningioma, did not contain information or a legend. The surgical tools used were those developed by Thierry de Martel. The furniture and interior design shown in the film corresponded with the Vercingétorix Clinic that this surgeon had acquired in Paris. A publication from 1922 contained 14 pictures taken from the movie presented in this paper and referred to a movie directed in 1911 by Thierry de Martel. This is strong circumstantial evidence that the film was directed and the surgery was performed by Thierry de Martel at the Vercingétorix Clinic in Paris, France, in 1911 while using the technology of the Gaumont company. This is a contemporary testimony to what surgical practice was over a century ago, and it illustrates how movies were, and remain, a unique way to learn and teach medicine.

Objective: Sphenoid wing meningiomas (SWMs) often cause occlusion or stenosis of the superficial middle cerebral vein (SMCV) by tumor compression. This study aimed to analyze the correlation between SMCV compression and peritumoral brain edema (PTBE) in SWM patients and to clarify the importance of surgical preservation of the SMCV in SWM surgery., Methods: This retrospective study included 31 patients who underwent surgery for SWM at our institution from April 2011 to March 2022. Patient demographics, tumor characteristics, PTBE size, and SMCV patency before and after surgery were evaluated using preoperative and postoperative MRI or digital subtraction angiography., Results: Of the 31 patients, 24 (77.4 %) exhibited PTBE, with varying degrees of severity: mild (32.3 %), moderate (25.8 %), and severe (41.9 %). Preoperative MRI showed SMCV patency in 14 patients (45.2 %) and SMCV compression in 17 patients (54.8 %). There was a significant association between PTBE severity and SMCV compression (p = 0.002). Postoperatively, SMCV recanalization was observed in 4 out of 16 patients (25.0 %) with preoperative SMCV compression. These patients had significantly smaller tumors (p = 0.013) and larger preoperative PTBE volumes (p = 0.042) compared to those without recanalization., Conclusions: Our study demonstrates a significant correlation between SMCV compression and severe PTBE in SWM patients. A subset of patients showed postoperative SMCV recanalization, particularly those with smaller tumors and more pronounced PTBE. These findings highlight the importance of SMCV preservation during SWM surgery to potentially improve postoperative outcomes., Competing Interests: Declaration of Competing Interest None of the authors has any conflict of interest to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Theranostic approaches combining prostate-specific membrane antigen (PSMA)-PET/CT or PET/MRI with PSMA-targeted radionuclide therapy have improved clinical outcomes in patients with prostate cancer (PCa) especially metastatic castrate resistant prostate cancer. Dural metastases in PCa are rare but can pose a diagnostic challenge, as meningiomas, a more common dural based lesions have been shown to express PSMA. The aim of this study is to compare PSMA PET parameters between brain lesions classified as dural metastases and meningiomas in prostate cancer patients., Methods: A retrospective analysis of PSMA PET/CT scans in patients with PCa and intracranial lesions was conducted. Brain lesions were categorized as dural metastases or meningiomas based on MRI characteristics, longitudinal follow-up, and histopathological characteristics. Standardized uptake values (SUVmax) of each brain lesion were measured, along with SUV ratio referencing parotid gland (SUVR). SUVs between lesions classified as metastases and meningiomas, respectively, were compared using Mann-Whitney-test. Diagnostic accuracy was evaluated using ROC analysis., Results: 26 male patients (median age: 76.5 years, range: 59-96 years) met inclusion criteria. A total of 44 lesions (7 meningiomas and 37 metastases) were analyzed. Median SUVmax and SUVR were significantly lower in meningiomas compared to metastases (SUVmax: 2.7 vs. 11.5, p = 0.001; SUVR: 0.26 vs. 1.05, p < 0.001). ROC analysis demonstrated AUC 0.903; the optimal cut-off value for SUVR was 0.81 with 81.1 % sensitivity and 100 % specificity., Conclusion: PSMA PET has the potential to differentiate meningiomas from dural-based metastases in patients with PCa, which can optimize clinical management and thus improve patient outcomes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: 1. Investigator initiated trial grant, funding paid to institution (Weill Cornell Medicine) from Novartis Pharmaceuticals. 2. Investigator initiated trial grant, funding paid to institution (Weill Cornell Medicine) from GE Healthcare. 3. Investigator initiated trial grant, funding paid to institution (Weill Cornell Medicine) from Curium Pharma. Other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study aims to develop and evaluate radiomics-based machine learning (ML) models for predicting meningioma grades using multiparametric magnetic resonance imaging (MRI). The study utilized the BraTS-MEN dataset's training split, including 698 patients (524 with grade 1 and 174 with grade 2-3 meningiomas). We extracted 4872 radiomic features from T1, T1 with contrast, T2, and FLAIR MRI sequences using PyRadiomics. LASSO regression reduced features to 176. The data was split into training (60%), validation (20%), and test (20%) sets. Five ML algorithms (TabPFN, XGBoost, LightGBM, CatBoost, and Random Forest) were employed to build models differentiating low-grade (grade 1) from high-grade (grade 2-3) meningiomas. Hyperparameter tuning was performed using Optuna, optimizing model-specific parameters and feature selection. The CatBoost model demonstrated the best performance, achieving an area under the receiver operating characteristic curve (AUROC) of 0.838 [95% confidence interval (CI): 0.689-0.935], precision of 0.492 (95% CI: 0.371-0.623), recall of 0.838 (95% CI: 0.689-0.935), F1 score of 0.620 (95% CI: 0.495-0.722), accuracy of 0.729 (95% CI: 0.650-0.800), an area under the precision-recall curve (AUPRC) of 0.620 (95% CI: 0.433-0.753), and Brier score of 0.156 (95% CI: 0.122-0.200). Other models showed comparable performance, with mean AUROCs ranging from 0.752 to 0.784. The radiomics-based ML approach presented in this study showcases the potential for non-invasive and pre-operative grading of meningiomas using multiparametric MRI. Further validation on larger and independent datasets is necessary to establish the robustness and generalizability of these findings., (© 2024. The Author(s).)

Background: The Ki-67 index is a histopathological marker that has been reported to be a crucial factor in the biological behavior and prognosis of meningiomas. Several studies have developed artificial intelligence (AI) models to predict the Ki-67 based on radiomics. In this study, we aimed to perform a systematic review and meta-analysis of AI models that predicted the Ki-67 index in meningioma., Methods: Literature records were retrieved on April 27th, 2024, using the relevant key terms without filters in PubMed, Embase, Scopus, and Web of Science. Records were screened according to the eligibility criteria, and the data from included studies were extracted. The quality assessment was performed using the QUADAS-2 tool. The meta-analysis, sensitivity analysis, and meta-regression were conducted using R software., Results: Our study included six studies. The mean Ki-67 ranged from 2.7 ± 2.97 to 4.8 ± 40.3. Of six studies, five utilized an ML method. The most used AI method was the least absolute shrinkage and selection operator (LASSO). The AUC and ACC ranged from 0.83 to 0.99 and 0.81 to 0.95, respectively. AI models demonstrated a pooled sensitivity of 87.5% (95% CI: 75.2%, 94.2%), a specificity of 86.9% (95% CI: 75.8%, 93.4%), and a diagnostic odds ratio (DOR) of 40.02 (95% CI: 13.5, 156.4). The summary receiver operating characteristic SROC curve indicated an AUC of 0.931 for the prediction of Ki-67 index status in intracranial meningiomas., Conclusion: AI models have demonstrated promising performance for predicting the Ki-67 index in meningiomas and can optimize the treatment strategy., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We report the history of a woman who developed four intracranial meningiomas during 11 years of therapy with the synthetic progesterone agonist megestrol. After discontinuation of the drug at age 75 years, she improved clinically and a CT scan showed near complete regression of the meningiomas by 78 years. Autopsy was performed at 83 years of age following an accidental death. At the tumor sites, we found both collagenous tissue with small islands of low grade meningioma having strong nuclear immunoreactivity for progesterone receptor and lipomatous tissue. A literature review showed similar cases of radiologic meningioma regression following discontinuance of progestins. Our case is the first one with histopathologic characterization of the end point., Competing Interests: The authors have no conflicts of interest to report.

Radiotherapy, including conventionally fractionated external beam radiation therapy, stereotactic radiosurgery, and fractionated stereotactic radiotherapy, is a cornerstone in the interdisciplinary management of meningiomas. Recent advances in radiation oncology and also in other fields, such as neuropathology and imaging, have various implications for meningioma radiotherapy. This review aims to summarize current and anticipated developments, as well as active clinical trials related to the use of radiotherapy for meningiomas. In imaging, positron emission tomography has proven valuable for assessing the spatial extension of meningiomas and may enhance target delineation, treatment response monitoring, and recurrence assessment after radiotherapy. Particle therapy, including protons and carbon ions, as well as stereotactic radiosurgery and radiotherapy, allow for conformal treatments that permit dose escalation in selected patients with high-grade meningiomas. Additionally, emerging integrated molecular and genetic classifications offer superior risk stratification and may refine patient selection for radiotherapy. However, there is a paucity of active meningioma trials directly investigating or refining the use of radiotherapy. In summary, significant advances in functional imaging, molecular and genetic diagnostics, and radiation treatment techniques hold the potential to improve patient outcomes and to avoid over- and undertreatment. Collaborative efforts and further clinical trials are essential to optimize meningioma radiotherapy., Competing Interests: Declaration of competing interest Felix Ehret has received honoraria and travel support from ZAP Surgical Systems, Inc. Sara C. Erridge is a consultant for Servier. Maximilian Niyazi has honoraria from Brainlab und Astra Zeneca. Matthias Preusser has received honoraria for lectures, consultation, or advisory board participation from the following for-profit companies: Bayer, Bristol-Myers Squibb, Novartis, Gerson Lehrman Group, CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, BMJ Journals, MedMedia, Astra Zeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dome, Tocagen, Adastra, Gan & Lee Pharmaceuticals, Janssen, Servier, Miltenyi, Böhringer-Ingelheim, Telix, Medscape. Giuseppe Minniti has received honoraria from Brainlab and is a member of the advisory board of Servier. Helen A. Shih is a section editor and writer for UpToDate, a writer for MedLink Neurology, received research support to the institution from AbbVie, is on the advisory board of Advanced Accelerator Applications, and is a consultant for Servier. All other authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Meningiomas are among the most common primary tumors of the central nervous system. In the past several decades, many researchers have emphasized the importance of radiographic findings and their possible role in predicting the various aspects of the meningioma biology. One of the factors most commonly analyzed with respect to the lesions' clinical behavior is peritumoral brain edema (PTBE), not only one of the most common signs associated with meningiomas, but also a significant clinical problem. Radiographic predictors of PTBE are usually noted as being the size of the tumor, its location, irregular margins, heterogeneity, and the peritumoral arachnoid plane with its pial vascular recruitment. Here, we review the available literature on the topic of these radiographic predictors of PTBE formation, we analyze the methodology of the research conducted, and we highlight the many controversies still present. Indeed, the evidence about PTBE pathogenesis, predictive factors, and clinical significance still seems to be mostly inconclusive, despite intense research in the area. We believe that by highlighting the many inconsistencies in the methodology used, we can showcase how little is actually known about the pathogenesis of PTBE, which in turn has important clinical implications. Additionally, we provide several MR images of intracranial meningiomas from our own practice which, we believe, showcase the unpredictable nature of PTBE, and demonstrate vividly the topics we discuss., (© 2024. The Author(s).)

Background: Numerous studies have demonstrated a strong association between traumatic brain injury (TBI) and an increased risk of meningioma. However, this correlation remains controversial. This study utilized Mendelian randomization to explore this relationship from the perspective of genetic evidence., Methods: We employed 6 TBI genome-wide association study datasets from the integrative epidemiology unit genome-wide association study database. Summary statistics for meningioma were sourced from the FinnGen R10 database. We assessed heterogeneity and horizontal pleiotropy within the analyzed data. The primary method was inverse variance weighting (IVW) to investigate the causal relationship between TBI and meningioma, excluding cases with horizontal pleiotropy. Four supplementary analysis methods were also used, with abnormal results excluded based on leave-one-out sensitivity analysis., Results: All 6 Mendelian randomization analyses indicated no causal relationship between TBI and meningiomas (focal brain injury IVW P value = 0.98; diffuse brain injury IVW P value = 0.41; TBI without concussion IVW P value = 0.45; intracranial trauma IVW P value = 0.34; traumatic subdural hemorrhage IVW P value = 0.80; traumatic subarachnoid hemorrhage IVW P value = 0.92)., Conclusions: The Mendelian randomization study revealed that TBI does not increase the risk of meningioma based on genetic evidence., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Spontaneous spinal intradural hematoma is uncommon. It can mimic vascular or hemorrhagic neoplasms, as certain imaging features overlap. The distinction between spinal hematoma and neoplasm is crucial for the approach to management and might determine the outcome. The purpose of this report is to outline the radiological and pathological features of spinal hematoma. We present a case of a 62-year-old male patient presented with a short history of lower-limb weakness, back pain and both fecal and urinary incontinence. An examination revealed that his lower limb power was 0/5 bilaterally with his sensory level at T6. An enhanced MRI of the spine revealed a hemorrhagic posterior extramedullary mass at the level of T6-T7, which was thought to be a hemorrhagic meningioma or angiolipoma. Laminectomy and spinal cord decompression were performed with excision of the presumed tumor. The final pathology results revealed spinal hematoma. This case highlights that spinal hematoma should be considered in the differential diagnosis of hemorrhagic spine neoplasms, as the imaging features can overlap., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

The purpose of this research was to summarize the clinical and prognostic features of pineal region meningiomas, evaluate treatment strategies and long-term prognoses, and improve the management of pineal region meningiomas. We retrospectively studied the data of 37 patients who received surgical resection for pineal region meningiomas at West China Hospital of Sichuan University from 2009 to 2021. Adjuvant gamma knife radiosurgery (GKRS) was conducted according to the extent of resection (EOR). Progression-free survival (PFS), Karnofsky performance status (KPS) scores and recovery of neurological function were adopted to assess a comprehensive management strategy for pineal region meningiomas. The most common symptom was headache associated with intracranial hypertension (75.7%). The occipital transtentorial approach (40.5%) and supracerebellar infratentorial approach (29.7%) were performed in most cases. Gross total resection (GTR) was achieved in 27 patients (73.0%) and the remaining patients were treated with subtotal resection (STR) combined with postoperative GKRS. With a mean follow-up period of 87.0 months, the progression rate was 10.0%, the 5-year PFS rate was 92.9%, and the ΔKPS was 16.3. Multivariate analysis revealed that the STR + GKRS and supracerebellar infratentorial approach were beneficial to the recovery of quality of life of patients. Pineal region meningiomas are sporadic but challenging. It is necessary to select the most appropriate surgical approach, EOR, and hydrocephalus treatment strategy for patients with pineal region meningiomas. Maximal safe resection to protect neurovascular function combined with postoperative GKRS can significantly improve the quality of life of patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Peptide receptor radionuclide therapy (PRRT) is a treatment option for patients with advanced meningioma. Recently, intraarterial application of the radiolabeled somatostatin receptor agonists has been introduced as an alternative to standard intravenous administration. In this study, we assessed the safety and efficacy of intraarterial PRRT in patients with advanced, progressive meningioma. Methods: Patients with advanced, progressive meningioma underwent intraarterial PRRT with [ 177 Lu]Lu-HA-DOTATATE. The safety of PRRT was evaluated according to the Common Terminology Criteria for Adverse Events version 5.0. Treatment response was assessed according to the proposed Response Assessment in Neuro-Oncology criteria for meningiomas and somatostatin receptor-directed PET/CT. Results: Thirteen patients (8 women, 5 men; mean age, 65 ± 13 y) with advanced meningioma underwent 1-4 cycles (median, 4 cycles) of intraarterial PRRT with [ 177 Lu]Lu-HA-DOTATATE (mean activity per cycle, 7,428 ± 237 MBq; range, 6,000-7,700 MBq). Treatment was well tolerated with mainly grade 1-2 hematologic toxicity. Ten of 13 patients showed radiologic disease control at follow-up after therapy (1/10 complete remission, 1/10 partial remission, 8/10 stable disease), and 9 of 13 patients showed good control of clinical symptoms. Conclusion: Intraarterial PRRT in patients with advanced meningioma is feasible and safe. It may result in improved radiologic and clinical disease control compared with intravenous PRRT. Further research to validate these initial findings and to investigate long-term outcomes is highly warranted., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Meningiomas are the most common intracranial tumors, but it's uncommon in the pediatric and adolescent populations. Pediatric meningiomas differ from adult meningiomas by a higher rate of malignant change, atypical location, male predominance and a higher recurrence rate. The most common presenting symptoms in supratentorial pediatric meningiomas are the signs and symptoms of high intracranial pressure (headache, vomiting, and nausea) and seizures. The most common presenting symptoms in infratentorial pediatric meningiomas are signs of cranial nerve deficits. Magnetic resonance imaging of the brain is the gold standard modality for diagnosis. The mainstay of management is surgical resection with the aim of gross total resection, as it is the strongest independent prognostic factor. In this report, we describe an extremely rare case of gradual onset, progressive motor developmental delay in a 21-month-old girl with a huge right frontotemporal meningioma that was treated with surgical resection that, to the best of our knowledge, is the youngest in the literature., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hafiz et al.)

Background: Brain tumors are highly complex, making their detection and classification a significant challenge in modern medical diagnostics. The accurate segmentation and classification of brain tumors from MRI images are crucial for effective treatment planning. This study aims to develop an advanced neural network architecture that addresses these challenges. Methods: We propose L-net, a novel architecture combining U-net for tumor boundary segmentation and a convolutional neural network (CNN) for tumor classification. These two units are coupled such a way that the CNN classifies the MRI images based on the features extracted by the U-net while segmenting the tumor, instead of relying on the original input images. The model is trained on a dataset of 3064 high-resolution MRI images, encompassing gliomas, meningiomas, and pituitary tumors, ensuring robust performance across different tumor types. Results: L-net achieved a classification accuracy of up to 99.6%, surpassing existing models in both segmentation and classification tasks. The model demonstrated effectiveness even with lower image resolutions, making it suitable for diverse clinical settings. Conclusions: The proposed L-net model provides an accurate and unified approach to brain tumor segmentation and classification. Its enhanced performance contributes to more reliable and precise diagnosis, supporting early detection and treatment in clinical applications.

Progestin-associated meningioma is a rare complication of cyproterone acetate (CPA), an anti-androgen commonly prescribed in feminizing hormone therapy regimens for transgender and gender-diverse individuals. A dose-response association has been observed, particularly with longer-term exposure to doses ≥ 50 mg daily; however, the dose below which CPA use is safe remains unclear. We herein report the cases of 2 transgender women using CPA who developed meningioma. Novel aspects of our cases include: (i) the presence of symptomatic giant meningiomas (> 5 cm), including multiple meningiomas in one patient, requiring urgent surgical intervention; (ii) meningioma development with both high-dose, long duration and low-dose, shorter duration CPA; and (iii) the presence of a PIK3CA missense variant in one patient, which may play a role in the pathogenesis of progestin-associated meningioma. Our cases highlight the real-world risk of this likely underreported adverse effect and underscore the importance of clinician vigilance for neurological sequelae. We suggest using the lowest dose of CPA that maintains adequate androgen suppression, with consideration of alternative anti-androgens where appropriate., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background: Meningioma risk factors include older age, female sex, and African-American race. Limited data explore how meningioma risk in African-Americans varies across the lifespan, interacts with sex, and differs by tumor grade., Methods: The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry covering the entire U.S. population. Meningioma diagnoses from 2004-2019 were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) compared to non-Hispanic white individuals (NHW) across 10-year age intervals, and stratified by sex and by WHO tumor grade in this retrospective study., Results: 53,890 NHB individuals and 322,373 NHW individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the NHB-to-NHW IRR was elevated for both grade 1 and grade 2/3 tumors. The IRR peaked in the seventh decade of life regardless of grade, and was higher for grade 2/3 tumors (IRR = 1.57; 95% CI: 1.46-1.69) than grade 1 tumors (IRR = 1.27; 95% CI: 1.25-1.30) in this age group. The NHB-to-NHW IRR was elevated in females (IRR = 1.17; 95% CI: 1.16-1.18) and was further elevated in males (IRR = 1.28; 95% CI: 1.26-1.30), revealing synergistic interaction between NHB race/ethnicity and male sex (PInteraction=0.001)., Conclusions: Relative to NHW individuals, NHB individuals are at elevated risk of meningioma from young adulthood through old age. NHB race/ethnicity conferred greater risk of meningioma among men than women, and greater risk of grade 2/3 tumors. Population-level differences in meningioma incidence and tumor behavior suggest potential disparities in the geographic, socioeconomic, and racial distribution of meningioma risk factors within the U.S., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background and Purpose: Early diagnosis and the refinement of treatment of patients with intracranial meningiomas have brought quality of life (QoL) and neurocognitive functioning as outcome measures into focus. The aim of this study is a comprehensive assessment of neurocognitive function, quality of life and the presence of depression in meningioma patients before and after surgery., Methods: Patients with MRI diagnosis of intracranial meningioma and indication for surgery were prospectively included. A clinical neuropsychologist performed neurocognitive assessments within 3 months before and 12 months after surgery. The test battery included investigation of selective and divided attention, verbal and figural memory, executive functioning, and word fluency. Self-report questionnaires to assess depressive symptoms, QoL, and disease coping were administered. Raw values and t-values were compared pre-and postoperatively. Outcome was stratified by tumor- and peritumoral brain edema (PTBE) volumes, postoperative resolution of PTBE and WHO grade. The study included 18 predominantly female patients (83%) with a median age of 59 years and mostly CNS WHO grade 1 meningiomas (83%)., Results: There was a significant postoperative improvement in the ability to selectively react under stress, in working memory and improved delayed reproduction of verbal and visual memory content. QoL improved regarding a reduction in physical problems, an improvement in energy, and social functioning. There was a trend towards worse preoperative scores in all tests, and greater postoperative improvement in patients with PTBE. Tumor volume had no effect on the measured outcome. The patients did not suffer from depressive symptoms before the surgery but improved postoperatively and most patients had an active, problem-oriented coping strategy., Conclusion: Resection of intracranial meningiomas leads to an improvement in multiple neurocognitive domains and QoL. There is a trend towards poorer preoperative neurocognitive functioning and greater postoperative improvement in patients with PTBE. Depression appears to play a minor role in the context of neurocognitive functioning and disease coping., (© 2024. The Author(s).)

Parkinsonism can be caused by a variety of factors, such as drugs, vascular disease, toxicity, infection, and autoimmune, neoplastic, metabolic and functional diseases. Parkinsonism is associated with both motor and nonmotor clinical symptoms. Notably, the accurate diagnosis of Parkinson's disease and parkinsonism remains challenging. Meningioma is the most common type of extraparenchymal brain tumor, which typically presents with headaches, focal symptoms and cranial nerve symptoms. Parkinsonism is a rare initial symptom of meningioma. The present report describes an unusual case of a 70-year-old man who presented with tremors, pill-rolling tremors and left-sided rigidity. In addition, the patient exhibited asymmetrical bradykinesia (left > right) and mild postural instability. Magnetic resonance imaging (MRI) revealed a homogeneously enhanced cerebral falx meningioma and dilated tortuous veins. Dopamine transporter single-photon emission computed tomography revealed decreased 123 I-ioflupane uptake in the right striatum. The patient underwent two surgical interventions due to tumor growth and symptom deterioration. Pathological examination revealed transitional meningioma. Postoperatively, the symptoms of the patient improved, and MRI revealed a residual tumor without basal ganglia mechanical compression or venous congestion. It was hypothesized that involuntary movements, including parkinsonism in the present case, were associated with the disruption of the cortico-cerebellar-cortical and the dentato-rubro-olivary pathways (the Guillain-Mollaret triangle) due to tumor mechanical compression and venous congestion. Meningioma, which is a type of extraparenchymal tumor, is more likely to cause mechanical compression and venous congestion than the infiltration of the basal ganglia circuit, leading to symptom improvement after surgical removal. This case highlights the importance of considering meningioma as a rare cause of lateral parkinsonism and its potential for symptom improvement after surgical intervention., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024, Spandidos Publications.)

Background: Surgical resection of intracranial meningioma carries the risk of several complications, including intraoperative blood loss. The objective of this study was to investigate preoperative clinical and radiographic factors predictive of intraoperative estimated blood loss (EBL)., Methods: This case-control study evaluated EBL for all adults who underwent intracranial meningioma resection from January, 2010 to December, 2021 at our institution. Fifty cases of high EBL (i.e., ≥500 mL) and 75 instances of low EBL (i.e., <500 mL) were randomly selected. Patients were excluded if they had a recurrent meningioma, preoperative embolization, or lack of imaging data. A multivariable logistic regression model of high EBL likelihood was created., Results: A total of 92 patients met eligibility criteria, with 48 (52%) cases of high EBL. Bivariable analyses identified maximal tumor diameter, intratumoral flow voids, skull base location, and dural venous sinus invasion as potential predictors of high EBL. Multivariable regression found intratumoral flow voids (adjusted odds ratio [aOR] = 5.68 [1.52-21.23], P = 0.009), maximal tumor diameter (aOR = 1.58 [1.11-2.25] per 1-cm increase, P = 0.01), and skull base location (aOR = 3.35 [1.19-9.41], P = 0.02) to be independent predictors of high EBL., Conclusions: Intratumoral flow voids, larger maximal tumor diameter, and skull base location were independently predictive of EBL ≥500 mL. Intratumoral flow void presence was the strongest predictor, with 5.68 times the odds of high EBL. Each 1-cm increase in tumor diameter had 58% greater odds of high EBL. Skull base location was associated with 3.35 times the odds of high EBL. These results can inform preoperative patient counseling and blood management preparation., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Biomarker-based clinical trials investigating targeted treatments for brain tumors have surged due to better access to biomarker testing and a deeper grasp of the molecular basis of tumor development. The design of clinical trials is crucial for evaluating safety, confirming effectiveness, and affirming the clinical advantage of novel agents, with the goal of approval by regulatory authorities to expand patient treatment options. Given some challenges unique to brain tumors, early-stage clinical trials for novel targeted agents must integrate pharmacokinetics and tissue-based pharmacodynamic assessments to establish timely go-no-go decisions for larger studies. Surgical window-of-opportunity trials can allow for the comparison of treated and untreated tumor samples, verifying target engagement and its modulatory effects for evidence of biological activity. Due to the challenges of achieving the required sample sizes to power efficacy analyses, later-stage trials of targeted therapies can include basket trials which test one drug on multiple tumor types, while umbrella trials evaluate several biomarkers within a single histology. Platform trials can also be leveraged to investigate multiple biomarker-driven hypotheses within a unified protocol and can incorporate Bayesian algorithms for adaptive randomization. Selecting appropriate endpoints, such as progression-free survival or overall response rate, is crucial and novel response assessment criteria need to be considered in the context of the tumor and therapy being investigated. Lastly, inclusivity in trials is essential to address health disparities and engage diverse patient populations to ensure real-world impact. Future trials should build upon the knowledge gained from both initial achievements and past setbacks in the field., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Meningiomas are benign, slow-growing tumors of the central nervous system (CNS) that arise from the arachnoid matter. It comprises one of the most common primary tumors of the CNS, occurring mostly in and after the fifth decade of life with a female gender predilection. Diagnosis is facilitated by imaging computed tomography (CT) or magnetic resonance imaging (MRI); however, atypical forms exist which augments the risk of missing the diagnosis. This is a case of a meningioma that mimics a hematoma on imaging, the diagnosis of which was only confirmed following histopathology., Case Description: A 36-year-old patient presented with a 9-month history of intermittent moderate-intensity headaches associated with photophobia, tinnitus, and dizziness. There was no previous history of trauma. There were no focal neurological deficits on examination. Both contrast-enhanced and noncontrast-enhanced brain CT scans showed features suggestive of an intraparenchymal hematoma. She had a control CT scan 2 months and 9 months later due to the persistence of symptoms despite remaining stationary, which revealed no changes in the lesion as seen in the previous CT scans. The patient did not benefit from an MRI scan due to the socioeconomic status of the country and the patient herself. A decision to operate was made, and the sample was sent for histopathology. Histopathology confirmed the lesion to be a psammomatous meningioma., Conclusion: Although CT findings of meningiomas are quite often typical, it is important to note that atypical forms exist as well. Knowledge of the atypical forms, such as lesions that look like an intraparenchymal hemorrhage initially but remain unchanged over a period of time, would decrease the risk of missing the diagnosis in such instances., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Introduction: Distinguishing meningiomas from other intracranial neoplasms is clinically relevant as the prognostic and therapeutic implications differ greatly and influence clinical decision making. Dynamic contrast-enhanced MRI (DCE-MRI) is an imaging technique that assists with characterisation of physiologic alterations such as blood flow and tissue vascular permeability. Quantitative pharmacokinetic analysis utilising DCE-MRI has not been studied in canine neuro-oncology., Methods: A retrospective study was performed in canine patients that underwent DCE-MRI with an imaging diagnosis of an intracranial meningioma and surgery for histopathological diagnosis. Kinetic parameters Ktrans and cerebral blood flow were measured and compared to assess whether differences could be identified between meningiomas and other intracranial neoplasms., Results: Six dogs with meningiomas and 3 dogs with other intracranial neoplasms were included for statistical analysis. Cerebral blood flow values were found to be statistically higher within meningiomas compared to other intracranial neoplasms. Ktrans values were higher within meningiomas than in other types of intracranial tumours, however this difference did not reach statistical significance., Discussion: Based on the results of this study cerebral blood flow measurement can be utilised to differentiate canine intracranial meningiomas from other similar appearing intracranial tumours., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Choi, Brighi and Long.)

Meningiomas are the most common primary intracranial tumors in adults and are increasing in incidence due to the aging population and increased access to neuroimaging. While most exhibit nonmalignant behavior, a subset of meningiomas are biologically aggressive and are associated with treatment resistance, resulting in significant neurologic morbidity and even mortality. In recent years, meaningful advances in our understanding of the biology of these tumors have led to the incorporation of molecular biomarkers into their grading and prognostication. However, unlike other central nervous system (CNS) tumors, a unified molecular taxonomy for meningiomas has not yet been established and remains an overarching goal of the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official World Health Organization (cIMPACT-NOW) working group. Additionally, clinical equipoise still remains on how specific meningioma cases and patient populations should be optimally managed. To address these existing gaps, members of the International Consortium on Meningiomas including field-leading experts, have prepared this comprehensive consensus narrative review directed toward clinicians, researchers, and patients. Included in this manuscript are detailed overviews of proposed molecular classifications, novel biomarkers, contemporary treatment strategies, trials on systemic therapies, health-related quality-of-life studies, and management strategies for unique meningioma patient populations. In each section, we discuss the current state of knowledge as well as ongoing clinical and research challenges to road map future directions for further investigation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.)

Background: This preliminary study evaluates the safety and efficacy of CyberKnife radiosurgery (CKRS) for large-volume meningiomas (≥10 cm³), where surgical options may be limited due to tumor location or patient health conditions., Methods: We retrospectively analyzed 18 patients with meningiomas treated with CKRS at Gyeongsang National University Hospital between 2010 and 2020. Tumor control and survival rates were evaluated, with follow-up imaging performed regularly., Results: CKRS achieved a 5-year overall survival rate of 92.3% and a 5-year tumor control rate of 93.8%. Symptomatic peritumoral edema occurred in 61.1% of patients, with 16.7% requiring surgical intervention., Conclusion: CKRS appears to be a promising option for patients with large meningiomas, showing good tumor control and manageable complications. Further studies with larger cohorts are necessary to confirm these findings., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2024 The Korean Brain Tumor Society, The Korean Society for Neuro-Oncology, and The Korean Society for Pediatric Neuro-Oncology.)

In humans, tenascin-C (TN-C) expression has been detected in more aggressive neoplasms of the central nervous system, such as gliomas and meningiomas. No study has analyzed the immune expression of TN-C in canine meningioma. The current study aimed to investigate the immunohistochemical distribution of TN-C in different grades of canine meningiomas. Twenty-one cases of canine meningioma (12 grade I, 6 grade II, and 3 grade III) were analyzed. All samples were examined by immunohistochemistry with the following antibodies: TN-C, epithelial membrane antigen (EMA), Ki-67, pan-cytokeratin (Pan CK), and vimentin. The histopathological diagnosis of meningioma was reinforced with the positive labeling of vimentin (moderate to strong) and EMA (mild to moderate) in neoplastic cells in most cases, independently of its grade or subtype. The immunoreactivity of TN-C was irregular: mild in grade I, moderate in grade II, and moderate to severe in grade III neoplasms. Usually, immune positivity was observed in the stroma and perivascular space in all subtypes. In addition, the concentric whorls of neoplastic cells were labeled positive in some psammomatous and transitional meningiomas. The reaction to TN-C was more significant in grade II and III tumors. The immunohistochemical findings of the current study suggest that TN-C can act as a stromal marker, mainly in grade II or III meningiomas.

Purpose: To assess whether the Modified 5 (mFI-5) and 11 (mFI-11) Factor Frailty Indices associate with postoperative mortality, complications, and functional benefit in supratentorial meningioma patients aged over 80 years., Methods: Baseline characteristics were collected from eight centers. Based on the patients' preoperative status and comorbidities, frailty was assessed by the mFI-5 and mFI-11. The collected scores were categorized as "robust (mFI=0)", "pre-frail (mFI=1)", "frail (mFI=2)", and "significantly frail (mFI≥3)". Outcome was assessed by the Karnofsky Performance Scale (KPS); functional benefit was defined as improved KPS score. Additionally, we evaluated the patients' functional independence (KPS≥70) after surgery., Results: The study population consisted of 262 patients (median age 83 years) with a median preoperative KPS of 70 (range 20 to 100). The 90-day and 1-year mortality were 9.0% and 13.2%; we recorded surgery-associated complications in 111 (42.4%) patients. At last follow-up within the postoperative first year, 101 (38.5%) patients showed an improved KPS, and 183 (69.8%) either gained or maintained functional independence. "Severely frail" patients were at an increased risk of death at 90 days (OR 16.3 (CI95% 1.7-158.7)) and one year (OR 11.7 (CI95% 1.9-71.7)); nine (42.9%) of severely frail patients died within the first year after surgery. The "severely frail" cohort had increased odds of suffering from surgery-associated complications (OR 3.9 (CI 95%) 1.3-11.3)), but also had a high chance for postoperative functional improvements by KPS≥20 (OR 6.6 (CI95% 1.2-36.2))., Conclusion: The mFI-5 and mFI-11 associate with postoperative mortality, complications, and functional benefit. Even though "severely frail" patients had the highest risk morbidity and mortality, they had the highest chance for functional improvement., (© 2024. The Author(s).)

Purpose: Meningiomas classified as grade 2-3 according to the World Health Organisation (WHO) require combined surgery and in most cases radiotherapy (RT). Their initial management was evaluated using the Dutch Brain Tumour Registry., Methods: The study included 393 patients aged ≥ 18 years with newly diagnosed meningioma WHO grade 2-3 between 2016 and 2021. Factors associated with adjuvant RT < 6 months following surgery were identified using logistic regression analyses, thereby accounting for variation between CNS regional tumour boards through mixed-effect modelling. This variation was further assessed by funnel plots for case-mix adjusted ratios of RT across tumour boards. The association with patients' survival at 5 years was evaluated with inverse probability-weighted accelerated failure (Weibull) models. Analyses were performed on multiple imputed datasets (m = 10) to account for missing data., Results: Adjuvant RT was administered to 22.2% (59/266) of patients with WHO grade 2 meningioma following a total resection, to 61.1% (58/95) following a partial resection, and to 68.8% (22/32) of patients with WHO grade 3 meningioma (61.5% after partial and 73.7% after total resection). RT was associated with grade 3, partial resection, bone invasion, and absence of multiple lesions. Management varied across tumour boards for grade 2 meningioma following total resection. Adjuvant RT was associated with survival benefit in case of grade 3 disease (hazard ratio: 0.40, 95%-confidence interval: 0.16-0.95, p = 0.04)., Conclusion: This national review revealed variation across CNS regional tumour boards in the management of grade 2 meningioma following total resection, and demonstrated survival benefit of adjuvant RT in grade 3 meningioma., (© 2024. The Author(s).)

Objective: The aim was to conduct a comprehensive bibliometric analysis of meningioma research, focusing on publication trends, top authors, universities, countries, and thematic analysis of keywords., Methods: From Scopus databases, first we analyzed 23,180 papers (or 19,824 articles and 3356 reviews) published between 2001 and 2023. Second, we selected the top 100 most cited papers and descriptively analyzed on Vosviewer and R Studio (bibliometrix/biblioshiny)., Results: For both sets, we highlighted the annual publication trends and the impact of top-cited papers. We identified leading authors, universities, and countries contributing significantly to the field. Keyword analysis categorized research themes across all papers. Specific focus was given to the top 100 most cited documents in meningioma. Details about the annual number of papers, mean citations per year, and the citable years are provided. The top authors are presented by number of publications, citations, h-index, g-index, and m-index. Co-word analysis was performed, and the main focus of the 100 most cited papers are presented in more than 20 categories., Conclusions: Our findings may provide insights into the evolution of meningioma research and its scholarly impact. The analysis underscores the pivotal contributions of top authors and institutions, outlines thematic research trends, and highlights areas of significant interest and growth in the field. Our study may contribute to understanding the landscape of meningioma research, guiding future research directions and collaborations., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To provide practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor (SSTR) ligands., Methods: This joint practice guideline/procedure standard was collaboratively developed by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neurooncology (EANO), and the PET task force of the Response Assessment in Neurooncology Working Group (PET/RANO)., Results: Positron emission tomography (PET) using somatostatin receptor (SSTR) ligands can detect meningioma tissue with high sensitivity and specificity and may provide clinically relevant information beyond that obtained from structural magnetic resonance imaging (MRI) or computed tomography (CT) imaging alone. SSTR-directed PET imaging can be particularly useful for differential diagnosis, delineation of meningioma extent, detection of osseous involvement, and the differentiation between posttherapeutic scar tissue and tumour recurrence. Moreover, SSTR-peptide receptor radionuclide therapy (PRRT) is an emerging investigational treatment approach for meningioma., Conclusion: These practice guidelines will define procedure standards for the application of PET imaging in patients with meningiomas and related SSTR-targeted PRRTs in routine practice and clinical trials and will help to harmonize data acquisition and interpretation across centers, facilitate comparability of studies, and to collect larger databases. The current document provides additional information to the evidence-based recommendations from the PET/RANO Working Group regarding the utilization of PET imaging in meningiomas Galldiks (Neuro Oncol. 2017;19(12):1576-87). The information provided should be considered in the context of local conditions and regulations., (© 2024. The Author(s).)

Rationale and Objectives: To explore the feasibility of delta histogram parameters (including absolute delta histogram parameters (AdHP) and relative delta histogram parameters (RdHP)) in predicting the grade of meningioma and to further investigate whether delta histogram parameters correlate with the Ki-67 proliferation index., Methods: 92 patients with meningioma who underwent MRI examination (including T1-weighted (T1) and contrast-enhanced T1-weighted images (T1C)) were enrolled in this retrospective study. A total of 46 low-grade cases formed the low-grade group (grade 1, LGM), and a total of 46 high-grade cases formed the high-grade group (38 grade 2, 8 grade 3, HGM). Histogram parameters (HP) of T1 and T1C were extracted. Subsequently, morphological MRI features, AdHP (AdHP=T1CHP-T1HP), and RdHP (RdHP=(T1CHP-T1HP)/T1HP) were recorded and compared, respectively. Binary logistic regression analysis was used to obtain combined performance of the significant parameters. Diagnostic performance was identified by ROC. Spearman's correlation coefficients were taken to assess the relationship between delta histogram parameters and the Ki-67 proliferation index., Results: In morphological MRI features, HGM is more prone to lobulation and necrosis/cystic changes (all p < 0.05). In delta histogram parameters, HGM exhibits higher mean, Perc.01, Perc.25, Perc.50, Perc.75, Perc.99, SD, and variance of AdHP, maximum, mean, Perc.25, Perc.50, Perc.75, and Perc.99 of RdHP, compared to LGM (all p < 0.00357). The optimal predictive performance was obtained by combining morphological MRI features and delta histogram parameters with an AUC of 0.945. Significant correlations were observed between significant delta histogram parameters and the Ki-67 proliferation index (all p < 0.05)., Conclusion: Delta histogram parameter is a promising potential biomarker, which may be helpful in noninvasive predicting the grade and proliferative activity of meningioma., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Although various aspects of cisplatin resistance have been studied, the impact of genetic variations still needs to be explored., Aim: This study aimed to investigate the impact of cisplatin on meningiomas using a two-sample Mendelian randomization (MR) approach, employing genetic variants associated with cisplatin use as instrumental variables., Method: We conducted a two-sample MR analysis using genome-wide association study (GWAS) data. Instrumental variables were derived from single-nucleotide polymorphisms (SNPs) associated with meningioma to estimate the causal relationship with cisplatin resistance. Sensitivity analyses were performed to confirm the findings., Results: Genetic predisposition to meningioma significantly increased the risk of cisplatin resistance (odds ratio (OR): 1.63; 95% confidence interval (CI) 1.44-1.85, P < 0.05). Sensitivity analyses supported the causal link., Conclusion: This MR study suggests that genetic predisposition to meningioma increases susceptibility to cisplatin resistance. Further research is needed to uncover the mechanisms behind these causal effects., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background/objective: Visual impairment affects 55%-80% of medial sphenoid wing meningiomas (mSWMs) patients, making optic nerve decompression a critical surgical goal. Complete resection often leads to better visual outcomes. However, involvement of critical neurovascular structures increases postoperative morbidity and mortality, with vascular injury reported in 18%-20% of cases. This study aims to evaluate the relationship between the extent of resection (EOR), visual outcomes, and the incidence of vascular injury, seeking to identify the optimal surgical approach for mSWMs., Methods: We retrospectively analyzed data from patients undergoing surgery for mSWM at our tertiary care center from January 2001 to December 2021. Inclusion criteria included histopathologically confirmed globoid mSWMs (N = 89). Patients with recurrent tumors (n = 14) or lost to follow-up (n = 9) were excluded. We classified patients into 2 groups based on EOR using Simpson's grade: Group 1 (good-resection,Simpson Grade-I/II,n = 51) and Group 2 (poor-resection,Simpson Grade III/IV, n = 15)., Results: Among 66 (=N) patients, visual impairment was the most common symptom (81.8%), followed by headaches (77.3%) and seizures (27%). T2-hyperintensity on magnetic resonance imaging [(OR:5.4, 95%CI:1.5-18.6) (P-value<0.01)] and cavernous sinus-extension [(OR:3.9, 95%CI:1.1-13.1) (p-value-0.02)] were independent significant predictors of poor resection. Visual status was preserved in 90.3% of Group-1 and 86.6% of Group-2, with no significant difference based on EOR. Vascular involvement was noted in 87.9%, higher than the vessel encasement (>180 0 ) (57.6%, P = 0.04). Vessel injury occurred in 7.8% of Group-1 and 6.6% of Group-2, with no significant impact on EOR., Conclusions: Cavernous sinus-extension and T2-hyperintensity predict poor resection rates in mSWMs. While visual outcomes are not directly affected by EOR, long-term visual status may decline due to tumor recurrence and radiotherapy. Vascular injury incidence is not associated with EOR. Thus, the "maximal safe resection" of mSWMs involves a surgical strategy balancing targeted aggressive and conservative resection for maximal cytoreduction and functional preservation., (Copyright © 2024 Elsevier Inc. All rights reserved.)