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The medical management of painful endometriosis is essentially based on anti-gonadotropic molecules and analgesics in the absence of a desire for pregnancy on the part of the patients, and constitutes the first therapeutic step. Dienogest, a recent treatment, has found its place in the management algorithm for painful endometriosis in view of its proven efficacy. It is recommended as a second-line treatment. The ANSM has very recently (March 2023) issued recommendations aimed at controlling the risk of meningioma for various progestogens including dienogest. Relugolix Combination Therapy, which combines a GnRH antagonist and an estrogen-progestin addback therapy in a single tablet, appears to be a promising treatment for painful endometriosis and the initial data on the safety of the treatment (after 6 months of use) are reassuring. Today, anti-aromatases, SERMs or selective inhibitors cannot be considered as an alternative therapy in the medical treatment of painful endometriosis. [ABSTRACT FROM AUTHOR]

Chordoid meningioma is classified in the latest classification of brain tumours as a grade II meningioma, along with large cell meningiomas. It is a rare tumour often associated with systemic symptoms, as described by Castelman. He described a case of chordoid meningioma discovered incidentally in a 45-year-old female patient following road accident. Brain CT scan showed left isodense intradiploid pterional lesion with bone lysis, which was homogeneously enhanced after injection of contrast medium. Magnetic resonance imaging showed T1- hypointense and spontaneously T2 FLAIR hyperintense lesion, which was very strongly enhanced after injection of Gadolinium. Complete resection of the tumour was performed. Histological and immunohistochemical examination showed chordoid meningioma. [ABSTRACT FROM AUTHOR]

Introduction. Meningiomas are benign tumours of the arachnoid layer and although relatively frequent they have an intracranial development, implications of the visceral cranium or the neck are rare. Case presentation. We present the case of a 67-year-old male with an intracranial meningioma, with recurrences in the extra cranial area. We focused on clinical presentation, imaging studies and treatment options in this kind of tumour. Extra cranial meningiomas, primary or secondary, are rare and a sinonasal type should always be considered that it may be an extension of an intracranial tumour. The recurrence rate is moderate and outcome is good, but a missed follow-up may lead to unfavourable consequences. Treatment options may vary from „watch and wait“ to surgery – transcranial and endoscopic approaches, combined techniques – and even radiotherapy, depending on the site and extension. Conclusions. Endoscopic endonasal surgery may be a safe and effective way of treatment for skull base tumours, although it requires advanced techniques and a good knowledge of reconstruction of dura and skull base defects. There are also limitations, that can be surpassed with a combined approach.

In 2018 the French National Health Database study results were released showing the increased risk of prevalent and incident meningioma in current or past female users of cyproterone acetate. A dose, age and treatment duration effect was shown. Cyproterone acetate indications in the treatment of hirsutism have been limited to severe cases of hirsutism in premenopausal women. In 2020 the French Endocrine Society has updated recommendations for hirsutim care, including alternatives to cyproterone acetate in case of contra indication, and for women worried to use it. [ABSTRACT FROM AUTHOR]

Intraspinal tumors are uncommon. Positive diagnosis is based on medical imaging exams, in particular MRI. Anatomopathological examination allows for definitive diagnosis. Surgery is the treatment of choice for most of them. Prognosis is related to the histological type and patient´s initial clinical condition. We here report the histological profile and progression of intraspinal tumors in our department. We conducted a retrospective study over a period of 10 years. All operated patients with histology-confirmed intraspinal tumor (23 cases) were enrolled. Four unworkable records were excluded. The median time from symptom onset and first consultation was 79 days. Patients presented with spinal cord compression. In 11 cases this was characterized by slow onset. Seven CT scan and 14 MRI were performed, which showed 4 intramedullary tumors, 9 intradural, 1 extradural, and 5 of unknown site. Histological examination showed meningioma in 11 cases, neurinoma in 3 cases. In 7 cases, it confirmed the diagnosis based on Imaging tests (4 CT and 3 MRI). Macroscopically complete resection was performed in 14 cases; it was partial in 5 cases. After a 6-month follow-up period 6 patients had fully recovered, 9 partially. This study highlights diagnosis delays. MRI better defined the lesion, but its histological approach was limited. Meningiomas dominated. Complete resection was most often performed. The postoperative course was uneventful. [ABSTRACT FROM AUTHOR]

This study reports the case of a 45-year-old female patient who underwent brain CT scan which fortuitously revealed de novo lesion. She was diagnosed with left isodense intradiploid lesion in the pterional region with bone lysis uniformly enhancing after injection of contrast medium. Magnetic resonance imaging showed T1-weighted hypointense lesion, spontaneously hyperintense signal on T2-weighted images and FLAIR images, strongly enhancing after gadolinium injection. Total tumor excision was performed. Histological examination showed chordoid meningioma. [ABSTRACT FROM AUTHOR]

We describe an unusual case of delayed onset acute cerebral venous infarct that developed after an uneventful parasagittal meningioma excision. While the acute and chronic venous infarct are well known entities, there is dearth of literature regarding delayed onset acute form, which may prove to be fatal.

INTRODUCTION: We aimed to discuss surgical approaches and results that we applied foramen magnum meningiomas. METHODS: we retrospectively investigated 11 foramen magnum meningioma cases, who had been operated between the dates of February 2012 and March 2017. RESULTS: eight of the patients were females and 3 of the patients were males, the age range was 32-75 and the age average was 60.8. 5 of the tumors were anatomically localized as posterolateral, 2 of them were localized as anterolateral, 2 of them were localized as lateral and 2 of them were localized as anterior according to the brain stem or spinal cord. Posterior far lateral (4 patients) approach including C1 laminoplasty (7 patients) and 1/3 condyle resection was surgically applied to the patients with median suboccipital craniotomy. Gross total excision was applied to 82% of the patients (9 patients) and subtotal mass excision was applied to 18% (2 patients) of the patients. The most frequent post-operative complications were temporary lower cranial nerve (CN IX and X ) palsy in our 2 anterior localized cases (18%) and also cerebrospinal fluid (CSF) fistula in our 1 anterior localized case with difficulty in swallowing (dysphagia). Karnofsky scores of the patients, who were followed for 18 months in post-operative 12 and 48 months of average, in the last follow-up were 80 and no post-operative mortality occurred. CONCLUSION: posterior midline suboccipital and far lateral approaches that we apply in our own series were appropriate approaches for foramen magnum meningiomas.

Non-Hodgkin's lymphomas (NHL) with intracranial origin are very rare and constitutes about 1-2% of primary central nervous system lymphomas (PCNSL). Diffuse large B cell lymphoma (DLBCL) is the most common subtype of NHL and mostly seen in immunocompromised patients. Therefore, the occurrence of giant solitary DLBCL in an immunocompetent patient is puzzling. We present a case of 68-year-old man who was admitted at our facility with a history of "hypomnesia of two (2) months" duration. Magnetic resonance imaging (MRI) revealed a space occupying lesion in the bilateral frontal lobe and corpus callosum measuring about 5.4cm * 4.6cm * 3.8cm with mixed signal intensities and vasogenic edema around the mass. Radiological, this mass was mistaken for meningioma until histopathological studies revealed DLBCL. Giant solitary primary intracranial lymphomas are very rare and can be mistake for meningioma even with very experience radiologist or neurosurgeon since the radiological features of PCNSL can be very unspecific. We achieved to total resection because of the giant and solitary nature of our case. The prognosis of PCNSL is general very poor when the patient is immunocompromised. In immunocompetent patients, who are well managed with surgery and chemotherapy, the overall survival and quality of life can very encouraging.

Résumé La méningite bactérienne nosocomiale est une complication redoutable pouvant survenir après une neurochirurgie ou des soins contaminant les méninges. C’est une infection de diagnostic et de prise en charge thérapeutique difficile. Les auteurs rapportent le cas d’une méningite nosocomiale à Acinetobacter baumannii multirésistant aux antibiotiques survenant dans les suites post-opératoires d’un méningiome et qui s’est compliqué au cours de son évolution par un empyème à Citrobacter freundii également multirésistant aux antibiotiques. Le diagnostic a été retenu sur un faisceau d’arguments cliniques, biochimiques et bactériologiques. L’évolution a été favorable sous traitement par voie intrathécale et parentérale. Nosocomial bacterial meningitis is a dangerous complication after neurosurgery or meningeal contaminating care. It is a difficult infection to diagnose and to treat. The authors report the case of nosocomial meningitis with a multiresistant Acinetobacter baumannii strain occurring in the post-operative course of a meningioma and which has been follow up during the evolution by empyema to a Citrobacter freundii multi resistant to antibiotics. The diagnosis was based on a range of clinical, biochemical and bacteriological arguments. Evolution was favorable under intrathecal and parenteral treatment. [ABSTRACT FROM AUTHOR]

Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (80%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.

Last month, the media seized the cyproterone acetate and meningioma dossier after the publication of data from a pharmaco-epidemiology study conducted by the CNAM (Caisse Nationale de l'Assurance Maladie). The term health scandal was then used by many of them. But this case is also an illustration of the difficulties of pharmacovigilance in the face of a serious but very rare undesirable effect and the ramp-up, late but welcome, of the French pharmaco-epidemiology using the databases of the Health Insurance. [ABSTRACT FROM AUTHOR]

The authors report a case of metastatic microcystic meningioma in breast adeno-carcinoma. They point out the impor-tance of histopathologic and immunohis-tochemistry diagnose. [ABSTRACT FROM AUTHOR]

Cystic meningioma of the falx is a rare extra-axial tumor, representing 4 to 7% of all intracranial meningioma. We report the case of a 23 years old patient with relative personal health history who has presented for nearly two years generalized headache associated with left hemiparesis. The head CT scan and MRI showed a right posterior parietal tumor with a cystic and fleshy component which was interpreted as glioma. The patient was operated and the intraoperative aspect was an extra axial lesion inserted to the middle tier of the falx cerebri with a clear cleavage plan with the cerebrum. A total ablation of the lesion was down and the histological study confirm the diagnosis. The cystic meningioma is a rare variant of intracerebral meningioma of which only histology makes it possible give the diagnosis of certainty. [ABSTRACT FROM AUTHOR]

A 37-year-old woman, previously healthy with no history of trauma, presented with a scalp swelling of the left frontal region. The swelling was present for the last one year and had gradually increased in size with recent localized headache. The patient had no neurologic deficit. Local examination showed a painful local swelling of about 25 mm in diameter in the left frontal area and appeared to arise from the bone. Hematological and biochemical investigation results were within the normal range. Computed tomography scan revealed a left frontal intradiploic mass with bone defect (figure A). Magnetic resonance imaging showed that the lesion was soft with homogeneous enhancement following gadolinium injection. There was erosion of both inner and outer table of the cranial vault with extracranial and intracranial extradural extension (figures B and C). The tumor was excised completely and the surrounding bone was removed (figure D), followed by cranial reconstruction. There was no intradural extension of the lesion. Histologically, the tumor was diagnosed as meningothelial meningioma. The patient has been well for 1 year following the operation with no evidence of recurrence. Meninigiomas are primary tumors of arachnoid cell layers and the lesions are in purely settled intradural locations. Meningiomas in extradural locations are very rare and should be considered in the differential diagnosis of osteolytic skull vault lesions.

Abstract: Stereotactic radiotherapy can be delivered in one fraction or in multiple fractions schedule. It is used in benign tumours such as meningiomas, mainly localized in the base of the skull, for acoustic schwannoma and pituitary tumours. Whatever the tumour, results with the Gamma Knife® are the most numerous, but those obtained by linear accelerators, adapted or dedicated, are comparable. The peripheral dose is preferred to the dose delivered to the isocentre. One fraction stereotactic irradiation should be proposed in small lesions and fractionated treatment for tumours larger. Whatever the tumour, the results are satisfactory with a control rate of 90%. However, this value reflects a disparity assessment, radiological stability for meningiomas, radiological stability and preservation of useful hearing in schwannoma and radiological stability and a decrease in hormonal secretions for pituitary adenomas. Overall complication rates are low. In total, the treatment of benign lesions with stereotactic irradiation gives satisfactory results with few complications. [Copyright &y& Elsevier]

Abstract: We describe the case of a patient with an untreated Parkinson''s disease who underwent surgery for a temporal meningioma. Extrapyramidal syndrome, initially attributed to the meningioma, had improved over the 48hours following the procedure and then reappeared. This observation raises the question about the impact of drugs used during perioperative days in patients with Parkinson''s disease not treated with levodopa. [Copyright &y& Elsevier]

Abstract: Purpose: To compare several techniques in order to determine the best treatment for benign brain tumours. Methods and patients: A retrospective study was performed for five patients who received 3D-conformal radiotherapy, intensity modulated radiotherapy or CyberKnife®. These patients had a meningioma, a pituitary tumour, a craniopharyngioma or a neurinoma. In each case, these treatment plans were optimised and compared with the three other dosimetries. Radiobiological or positioning parameters were evaluated, as well as dosimetric parameters, in order to compare treatments with different characteristics. Results: The dosimetric parameters showed that the choice of treatment seemed to be determined mostly by tumour size, shape and proximity with organs at risk (not tumour localisation). Whereas the results showed no significant deviations with regards to the radiobiological parameters. Therefore, with these parameters, it was difficult to give priority to a treatment. Conclusions: With regards to benign brain tumours of medium or large size, intensity modulated radiotherapy seemed the recommended treatment. It enabled to obtain a good ratio between efficacy and toxicity for tumours that are really close to organs at risk. Concerning small benign brain tumours, the CyberKnife® was probably the best treatment. [Copyright &y& Elsevier]

Objective: To compare the clinical and paraclinical picture and the postoperative results of meningiomas of the posterior petrous bone and to compare them with those of vestibular schwannomas (VSs) operated on by the same surgical team. Material and Method: A retrospective study of 27 patients (23 females) operated on for meningioma of the posterior petrous bone between 1994 and 2004. These were compared with 424 patients with VS operated on between October 1994 and January 2001. All patients had a full audiovestibular workup before and after surgery. Tumours were classified according to the Desgeorges classification for meningiomas and Koss for the VS. Results-Discussion: For smaller tumours, facial function is better for the VS, whereas other cranial nerves are more frequently affected in the meningiomas. For larger turnouts, facial function results are better for meningiomas, but other cranial nerve complications are more frequent, with a 33.3% cranial nerve V complication rate and a mortality rate of 6.6%. Conclusion: Meningiomas of the posterior temporal bone may present clinically and radiologically like a VS, especially for intracanalar tumour and stage IV tumours. For smaller meningiomas, hearing preservation is similar to VS and could be proposed even for stage III meningiomas. On the other hand, trigeminal nerve, facial nerve, and other cranial nerve complications are more common after excision of stage I and II meningiomas. [ABSTRACT FROM AUTHOR]

Abstract: We report the case of a 57-year-old man who presented with two local recurrences and metastatic dissemination of a papillary meningioma of the sphenoid 3 years after surgery. Treatment consisted in a combination of surgery for the local recurrence in the initial site, radiotherapy and chemotherapy for bone metastases. Evolution of the disease spread over 7.5 years. The literature relating metastatic meningiomas is reviewed; prognostic factors and main therapeutic protocols are discussed. [Copyright &y& Elsevier]

Abstract: We report a new case of aggressive meningioma without dural attachment occurring in a three-year-old girl. We emphasize the rarity of meningiomas in children and the absence of the female predominance associated whit meningioma in adults and we describe their pathological and radiological features. [Copyright &y& Elsevier]

Stereotactic radiosurgery is used for treating several brain diseases. Radiosurgery is a non-invasive alternative to surgery for brain metastases, and randomized trials are on going to assess the role of radiosurgery. Radiosurgery has been advocated for patients with small benign meningioma or with vestibular schwannoma, but there is no proof of efficacy and safety of radiosurgery in comparison with other treatments. Radiosurgery can obliterate 80-90% of small arteriovenous malformations, but no information exists on the survival of treated compared with untreated patients. The limited information available suggests that radiosurgery should be fully evaluated in well-designed prospective studies. [Copyright &y& Elsevier]

Meningiomas are the most frequent among intracranial tumors, and represent more than 30% of primitive central nervous system neoplasms. Arising from the meninges, they are generally benign lesions and can be treated by either radio-clinical follow-up or surgical resection with excellent outcome. However, more than 20% of meningiomas harbor atypical or malignant features and represent challenges for both prognostic evaluation and therapeutic strategy. The discovery of the genetic and epigenetic landscapes of meningiomas enabled the identification of new prognostic markers and potential therapeutic targets for refractory meningiomas. This review summarizes current epidemiology, histological and molecular characteristics, diagnosis and treatments for meningiomas, and highlights the close relationship between the development of meningiomas and hormonal intake, as illustrated by recent recommendations of the "Agence Nationale de Securité du Medicament", the French national drug safety agency., (Copyright © 2021 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Considering intracranial tumours, only few indications of protontherapy, such as chordoma, chondrosarcoma or uveal melanoma, are uniformly approved in the world. Other indications, excluding paediatric pathologies, are still debated. The aim of this article is to describe the rationale for the use of protonbeam irradiation for meningioma, pituitary adenoma, craniopharyngioma, paraganglioma, glioma, and schwannoma, and to inform the radiation oncologists if prospective studies or randomized studies are opened for inclusions. This article deals only with indications for adults., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

We report the case of a 74-year-old woman who, as part of the follow-up for two breast cancers, presented a 2cm long lung nodule. A microscopic examination of the biopsy under a scanner showed a proliferation of epithelial appearance but whose immunophenotypic profile did not permit a precise diagnosis (negativity of CK7, GATA3, TTF1, negative estrogen receptors but positive progesterone receptors). Wedge resection surgery was performed. Extemporaneous and definitive microscopic examination showed a well-defined lesion made up of lobules of cohesive-looking cells, frequently forming coils. The tumor cells showed some intranuclear inclusions and a few psammomas while the immunohistochemical study showed diffuse expression of EMA, SSTR2A and progesterone receptor markers and a low proliferation index. A diagnosis of a pulmonary localization of a meningioma was proposed. The radiological assessment of the entire neuraxis did not show any other lesion leading to the final diagnosis of primary intra-pulmonary meningioma. This is an exceptional tumor with a difficult histopathological diagnosis of biopsy material, which must familiar to the pathologists. It is associated with an excellent prognosis. Our observation aims to illustrate the macroscopic and microscopic aspects and to present the data from the recent literature review., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Intracerebral hemorrhage remote from the site of surgery is an infrequent complication after neurosurgical procedures. Cerebellar hemorrhage after supratentorial craniotomy is the most commonly described pattern of remote hemorrhage unknown by the anesthesiologist. It is linked with a frequent morbidity and mortality. We report a case of this complication after meningioma surgery with a favorable outcome. [Copyright &y& Elsevier]

Intraspinal tumors are uncommon. Positive diagnosis is based on medical imaging exams, in particular MRI. Anatomopathological examination allows for definitive diagnosis. Surgery is the treatment of choice for most of them. Prognosis is related to the histological type and patient´s initial clinical condition. We here report the histological profile and progression of intraspinal tumors in our department. We conducted a retrospective study over a period of 10 years. All operated patients with histology-confirmed intraspinal tumor (23 cases) were enrolled. Four unworkable records were excluded. The median time from symptom onset and first consultation was 79 days. Patients presented with spinal cord compression. In 11 cases this was characterized by slow onset. Seven CT scan and 14 MRI were performed, which showed 4 intramedullary tumors, 9 intradural, 1 extradural, and 5 of unknown site. Histological examination showed meningioma in 11 cases, neurinoma in 3 cases. In 7 cases, it confirmed the diagnosis based on Imaging tests (4 CT and 3 MRI). Macroscopically complete resection was performed in 14 cases; it was partial in 5 cases. After a 6-month follow-up period 6 patients had fully recovered, 9 partially. This study highlights diagnosis delays. MRI better defined the lesion, but its histological approach was limited. Meningiomas dominated. Complete resection was most often performed. The postoperative course was uneventful., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (Copyright: Sylvain Denléwendé Zabsonre et al.)