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Simple Summary: This article herein presented explores the role of the epigenetic marker H3K27me3 in tumors of the Central Nervous System, highlighting its importance for diagnosis, prognosis, and treatment. H3K27me3 involves the trimethylation of lysine 27 on the histone H3 protein, which is essential for regulating gene activity and maintaining chromatin structure. A reduction in H3K27me3 levels is commonly seen in CNS tumors such as diffuse midline gliomas and meningiomas and is associated with more aggressive tumor behavior and a worse prognosis. This article emphasizes the utility of H3K27me3 loss in tumor diagnosis, prognosis, and the advancement of targeted therapies. Central nervous system (CNS) tumors represent a formidable clinical challenge due to their molecular complexity and varied prognostic outcomes. This review delves into the pivotal role of the epigenetic marker H3K27me3 in the development and treatment of CNS tumors. H3K27me3, specifically the trimethylation of lysine 27 on the histone H3 protein, plays a crucial role in regulating gene expression and maintaining chromatin architecture (e.g., in X-chromosome inactivation). Notably, a reduction in H3K27me3 levels, frequently tied to mutations in the H3 gene family such as H3F3A and HIST1H3B, is evident in diverse brain tumor variants, including the diffuse midline glioma characterized by the H3K27M mutation and certain pediatric high-grade gliomas. The loss of H3K27me3 has been linked to more aggressive behavior in meningiomas, with the trimethylation loss associated with significantly shorter recurrence-free survival (RFS) among grade 2 meningiomas, albeit not within grade 1 tumors. Pediatric posterior fossa ependymomas characterized by a lowered H3K27me3 and DNA hypomethylation exhibit poor prognosis, underscoring the prognostic significance of these epigenetic alterations in CNS tumors. Comprehending the role of H3K27me3 in CNS tumors is vital for advancing diagnostic tools and therapeutic interventions, with the goal of enhancing patient outcomes and quality of life. This review underscores the importance of ongoing investigations into H3K27me to refine and optimize management strategies for CNS tumors, paving the way for improved personalized medicine practices in oncology. [ABSTRACT FROM AUTHOR]

Simple Summary: Medroxyprogesterone acetate is a synthetic progesterone commonly used as a contraceptive in the United States, used by up to 25% of women aged 18–49 who have had intercourse. Progesterone is reported to be associated with the increased growth of meningiomas, a type of central nervous system tumor that can affect the meninges of the brain or spine, and recently an article utilizing a population of French women noted a significant association between medroxyprogesterone use and cerebral meningioma risk, particularly for patients using it for two years. The current study supported the findings of the prior published research, finding an increased chance of cerebral meningioma for those with use of medroxyprogesterone acetate; this association became stronger with longer duration of use. There were no associations observed for spinal meningiomas. Background/Objectives: Medroxyprogesterone acetate (MPA) is a synthetic progesterone that is most commonly used as a contraceptive. MPA acts by binding to the progesterone receptor of the hypothalamus, and this receptor has been found to be important in the pathophysiology of meningiomas. Recent research has reported an increased association between the use of MPA and intracranial meningioma, though the literature is mostly limited by low numbers of meningioma cases and low exposure to MPA. The objective of the current study is to build upon the previously published literature utilizing a large database from the United States. Methods: Utilizing a large commercial insurance database, the current matched case–control study identified meningioma cases using ICD-10 codes from hospital data and MPA exposure, as established from pharmaceutical claims data. Controls were matched 10:1 to cases based on age, year of enrollment, and duration of enrollment. A conditional logistic regression estimated odds ratios (ORs) for the association between MPA exposure and the odds of developing a meningioma. Results: Among 117,503 meningioma cases and 1,072,907 matched controls, oral MPA exposure was not associated with odds of meningioma; however, injection MPA exposure was associated with a 53% increased odds of being a case (OR 1.53, 95% CI 1.40–1.67). This association was specific to cerebral meningiomas (OR 1.68, 95% CI 1.50–1.87), an association that became stronger with a longer duration of use of injection MPA. Conclusions: The current results are consistent with the prior literature, which reports an association between injection exposures to MPA and a stronger association with increasing use of MPA. Women should be cautioned about the prolonged use of MPA, and future research should examine whether the extended use of MPA is associated with the meningioma grade. [ABSTRACT FROM AUTHOR]

Simple Summary: Cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) loss is a key factor in diagnosing meningiomas as Central Nervous System (CNS) WHO grade 3 tumors. Typically, detecting this gene loss involves costly and complex techniques like sequencing or FISH. However, the MTAP gene, which is located near CDKN2A/B on the same chromosome, may provide a more accessible way to detect these losses through a simpler, more affordable test called immunohistochemistry (IHC). This study explored different concentrations and antibodies for MTAP and p16 across two institutions to evaluate their potential as surrogate markers for CDKN2A/B loss. The results showed that p16 expression varied and did not align with either MTAP expression or CDKN2A FISH results. This study suggests that IHC for MTAP is a promising, cost-effective method for identifying high-grade meningiomas, offering a quicker and less expensive alternative to existing techniques. Background: Homozygous cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) loss is one of the parameters that support the designation of meningiomas as Central Nervous System (CNS) WHO grade 3 tumors. Evaluation of CDKN2A/B by sequencing or Fluorescence in situ hybridization (FISH) is costly and not always readily accessible. An immunohistochemistry (IHC)-based marker for the evaluation of CDKN2A/B loss would provide faster results at a lower cost. Methods: This retrospective study included patients diagnosed with meningioma at our institution between 2016 and 2019. Archival tumor tissue was used for analysis. MTAP immunohistochemistry (IHC) was performed at various dilutions (1:1200, 1:400, 1:200, 1:100) using two different antibodies, and p16 IHC was conducted simultaneously. These analyses were carried out at two different institutions. To determine the sensitivity and specificity of MTAP and p16 as surrogate markers for CDKN2A/B loss, CDKN2A FISH was utilized as the gold standard. Results: Overall, 46/49 tumors showed strong MTAP staining (94%) at institution 1, and 44/49 (90%) showed either faint positive or positive results at institution 2. One grade 3 meningioma that demonstrated homozygous CDKN2A loss by FISH also showed loss of MTAP expression by IHC. One grade 2 meningioma showed regional CDKN2A loss by FISH and variable MTAP expression under different IHC conditions. MTAP expression evaluation was superior at a dilution of 1:100 with the Abnova Anti-MTAP Monoclonal antibody. Conclusions: P16 expression was variable and did not correlate with either MTAP expression or CDKN2A FISH results. MTAP IHC is a promising surrogate marker for the evaluation of CDKN2A status in meningiomas. [ABSTRACT FROM AUTHOR]

Simple Summary: Many studies have analyzed the relationship between the different subtypes of canine meningiomas and prognostic immunohistochemical markers. However, the expression of tenascin-C (TN-C), an extracellular matrix glycoprotein, in canine meningiomas has not been performed. Twenty-one cases of canine meningioma were analyzed. The immunoreactivity of TN-C was mild in grade I, moderate in grade II, and moderate to severe in grade III neoplasms. 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. 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Simple, instantaneous, contactless, multiple-point metamaterial-inspired microwave sensors, composed of multi-band, low-profile metamaterial-inspired antennas, were developed to detect and identify meningioma tumors, the most common primary brain tumors. Based on a typical meningioma tumor size of 5–20 mm, a higher operating frequency, where the wavelength is similar or smaller than the tumor target, is crucial. The sensors, designed for the microwave Ku band range (12–18 GHz), where the electromagnetic property values of tumors are available, were implemented in this study. A seven-layered head phantom, including the meningioma tumors, was defined using actual electromagnetic parametric values in the frequency range of interest to mimic the actual human head. The reflection coefficients can be recorded and analyzed instantaneously, reducing high electromagnetic radiation consumption. It has been shown that a single-band detection point is not adequate to classify the nonlinear tumor and head model parameters. On the other hand, dual-band and tri-band metamaterial-inspired antennas, with additional detecting points, create a continuous function solution for the nonlinear problem by adding extra observation points using multiple-band excitation. The point mapping values can be used to enhance the tumor detection capability. Two-point mapping showed a consistent trend between the S11 value order and the tumor size, while three-point mapping can also be used to demonstrate the correlation between the S11 value order and the tumor size. This proposed multi-detection point technique can be applied to a sensor for other nonlinear property targets. Moreover, a set of antennas with different polarizations, orientations, and arrangements in a network could help to obtain the highest sensitivity and accuracy of the whole system. [ABSTRACT FROM AUTHOR]

Meningiomas are predominantly benign tumors, but there are also malignant forms that are associated with a poor prognosis. Like almost all tumors, meningiomas metabolize glucose as part of aerobic glycolysis (Warburg effect) for energy supply, so there are attempts to influence the prognosis of tumor diseases using a glucose-reduced diet. This altered metabolism leads to so called hallmarks of cancer, such as glycation and glycosylation. In this study, we investigated the influence of low (3 mM), normal (5.5 mM) and high glucose (15 mM) on a malignant meningioma cell line (IOMM-Lee, WHO grade 3). In addition, the influence of methylglyoxal, a by-product of glycolysis and a precursor for glycation, was investigated. Impedance-based methods (ECIS and RTCA) were used to study migration and invasion, and immunoblotting was used to analyze the expression of proteins relevant to these processes, such as focal adhesion kinase (FAK), merlin or integrin ß1. We were able to show that low glucose reduced the invasive potential of the cells, which was associated with a reduced amount of sialic acid. Under high glucose, barrier function was impaired and adhesion decreased, which correlated with a decreased expression of FAK. [ABSTRACT FROM AUTHOR]

Background: Understanding complex neurosurgical procedures and diseases, such as skull-base meningiomas, is challenging for patients due to the intricate anatomy and the involvement of critical neurovascular structures. Enhanced patient comprehension is crucial for satisfaction and improved clinical outcomes. Patient-specific 3D models have demonstrated benefits in patient education, though they are costly and time-intensive to produce. This study investigates whether the use of 3D volumetric reconstructions with anatomical segmentation, widely available via neuronavigation software, can improve patients' understanding of skull-base meningiomas, surgical procedures, and potential complications. Materials and Methods: This study included twenty patients with skull-base meningiomas. Three-dimensional volume reconstructions and anatomical segmentations were created using preoperative MRI sequences with neuronavigation software. These reconstructions were used during patient consultations where a surgeon explained key aspects of the disease, the surgical intervention, and potential complications. A questionnaire assessed the patients' perceptions of the utility of these 3D reconstructions. Results: The majority of patients (75%) found the 3D volumetric reconstructions and anatomical segmentations to be more beneficial than MRI images for understanding their disease. Similarly, 75% reported improved comprehension of the surgical approach, and 85% felt that the reconstructions enhanced their understanding of potential surgical complications. Overall, 65% of patients considered the 3D reconstructions valuable in medical consultations. Conclusions: Our study indicates that using accessible, cost-effective, and non-time-consuming 3D volumetric reconstructions with anatomical segmentation enhances patient understanding of skull-base meningiomas. Further research is necessary to confirm these findings, compare these reconstructions with physical 3D models and virtual reality models, and evaluate their impact on patient anxiety regarding the surgical procedure. [ABSTRACT FROM AUTHOR]

Meningiomas are the most common primary intracranial tumors in adults and typically have a slow-growing and benign nature. However, there is also a substantial subset of meningiomas that shows aggressive clinical behavior and is refractory to standard treatment modalities, which are still limited to surgery and/or radiotherapy. Despite intensive research, no systemic treatment options are yet available in the clinic for these challenging tumors, resulting in poor patient outcome. Intensive research on the molecular pathogenesis of meningiomas has led to improved diagnostic tools, but so far there is no standardized implementation for the molecular profiling of these tumors for clinical practice. Recent research advances have also focused on the immunophenotyping of meningiomas, leading to several clinical trials examining the use of immune checkpoint blockade therapy in patients with clinically aggressive subtypes. In this review, we aim to summarize the current knowledge on the molecular and immunological landscape of meningiomas in detail and provide current and progressive ideas for future directions. [ABSTRACT FROM AUTHOR]

Radiation therapy continues to be the cornerstone treatment for malignant brain tumors, the majority of which express wild-type p53. Therefore, the identification of drugs that promote the ionizing radiation (IR)-induced activation of p53 is expected to increase the efficacy of radiation therapy for these tumors. The growth inhibitory effects of CEP-1347, a known inhibitor of MDM4 expression, on malignant brain tumor cell lines expressing wild-type p53 were examined, alone or in combination with IR, by dye exclusion and/or colony formation assays. The effects of CEP-1347 on the p53 pathway, alone or in combination with IR, were examined by RT-PCR and Western blot analyses. The combination of CEP-1347 and IR activated p53 in malignant brain tumor cells and inhibited their growth more effectively than either alone. Mechanistically, CEP-1347 and IR each reduced MDM4 expression, while their combination did not result in further decreases. CEP-1347 promoted IR-induced Chk2 phosphorylation and increased p53 expression in concert with IR in a Chk2-dependent manner. The present results show, for the first time, that CEP-1347 is capable of promoting Chk2-mediated p53 activation by IR in addition to inhibiting the expression of MDM4 and, thus, CEP-1347 has potential as a radiosensitizer for malignant brain tumors expressing wild-type p53. [ABSTRACT FROM AUTHOR]

Simple Summary: Seizures are one of the most common and severe symptoms of meningioma, leading to increased morbidity and mortality in the affected patients. Therefore, seizure prevention represents an important goal in the treatment of meningioma patients. For this purpose, our study aims to identify predictors for the occurrence of preoperative and postoperative seizures in meningioma. Neurosurgical tumor resection was demonstrated as an effective treatment of seizures in meningioma patients but is also associated with a moderate risk of new-onset seizures after surgery. The present study identified several independent predictors for seizures in meningioma that could contribute to improved seizure treatment and a deeper understanding of the occurrence of seizures in meningioma patients. Seizure is a common symptom of meningioma that has a major impact on patients' quality of life. The purpose of this study was to identify predictive factors for the occurrence of preoperative and postoperative seizures. The data of patients with resection of histologically confirmed meningioma at University Hospital Leipzig from 2009 to 2018 were retrospectively examined. Univariate and multivariate logistic regression analyses of different factors influencing seizure outcome were performed. The male gender was identified as an independent positive predictor for preoperative seizures (odds ratio [OR] 1.917 [95% confidence interval {CI} 1.044–3.521], p = 0.036), whereas headache (OR 0.230 [95% CI 0.091–0.582], p = 0.002) and neurological deficits (OR 0.223; [95% CI 0.121–0.410], p < 0.001) were demonstrated to be negative predictive factors. Sensorimotor deficit after surgery (OR 4.490 [95% CI 2.231–9.037], p < 0.001) was found to be a positive predictor for the occurrence of postoperative seizures. The identified predictors for the occurrence of seizures in meningioma can contribute to improving seizure treatment and patients' quality of life. [ABSTRACT FROM AUTHOR]

Meningiomas represent approximately 40% of all primary tumors of the central nervous system (CNS) and, based on the latest World Health Organization (WHO) guidelines, are classified into three grades and fifteen subtypes. The optimal treatment comprises gross total tumor resection. The WHO grade and the extent of tumor resection assessed by the Simpson grading system are the most important predictors of recurrence. Atypical meningiomas, a grade 2 meningioma, which represent almost a fifth of all meningiomas, have a recurrence rate of around 50%. Currently, different histopathologic, cytogenetic, and molecular genetic alterations have been associated with different meningioma phenotypes; however, the data are insufficient to enable the development of specific treatment plans. The optimal treatment, in terms of adjuvant radiotherapy and postoperative systemic therapy in atypical meningiomas, remains controversial, with inconclusive evidence in the literature and existing studies. We review the recent literature to identify studies investigating relevant atypical meningioma biomarkers and their clinical application and effects on treatment options. [ABSTRACT FROM AUTHOR]

Meningiomas are tumors originating from arachnoid meningothelial cells. Occasionally, meningiomas are identified outside the central nervous system, and are referred to as extracranial meningiomas (EMs). The vast majority of EMs are an extension from an intracranial or intraspinal tumor. However, primary EMs may arise from extracranial sites with the most common sites being the skin and scalp subcutis, which are further categorized as cutaneous meningiomas (CMs). CMs are rare cutaneous tumors with similar ultrastructural and cytologic findings compared to those of intracranial meningiomas, but with a wide range of histologic differences. Therefore, an assessment using a panel of investigative tools, including imaging, histopathology, and immunohistochemistry, is required to determine the diagnosis of CMs. Here, we report the case of a 64-year-old gentleman presenting with a posttraumatic well-circumscribed superficial mass overlying the right nasal bridge. We are unable to identify other cases arising in the nasal bridge. [ABSTRACT FROM AUTHOR]

Background: In routine medical practice, patients are increasingly using ASA for primary and secondary prevention. Although many of these patients discontinue ASA prior to elective intracranial surgery, there are limited data to support whether perioperative ASA use raises the risk of postoperative hemorrhage. This study aimed to investigate the implications of continuing or stopping ASA around the time of surgery in patients with intracranial meningiomas, focusing on postoperative hemorrhage and thromboembolic events. Methods: For this purpose, medical records and radiological images of 1862 patients who underwent cranial neurosurgical procedures for brain tumors over a decade at our neurosurgical institute were retrospectively analyzed. The risk of postoperative hemorrhage was evaluated by comparing meningioma patients who received ASA treatment with those who did not. Furthermore, we investigated other factors that influence postoperative hemorrhage and thromboembolic events, particularly in patients receiving ASA treatment. Results: A total of 422 patients diagnosed with meningiomas underwent surgical intervention. Among the patients who received ASA preoperatively, 4 out of 46 (8.69%) experienced postoperative hemorrhage requiring surgical intervention, whereas the same complication occurred in only 4 out of 376 patients (1.06%) in the non-ASA group (p = 0.007). There was no significant difference in the incidence of thromboembolic events between the two groups. Conclusions: Our analysis revealed an increased risk of postoperative hemorrhage in patients using ASA. [ABSTRACT FROM AUTHOR]

Simple Summary: Indocyanine green (ICG) is a dye that helps surgeons see the blood supply to tissues. In this study, (MIRRORS ICG) researchers wanted to see if this dye could help find cancer in women with advanced ovarian cancer undergoing robotic surgery after chemotherapy. After injecting ICG, a special camera was used to look at the whole abdomen and pelvic area. In this study, 102 tissue samples were taken to see if ICG helped identify cancerous tissue. The results showed that ICG correctly identified cancer in 91.1% of cases but had a low specificity of 13.0%, meaning it often falsely indicated cancer. This technique did not significantly help in detecting cancer in patients with widespread disease, but it showed some potential in those who had responded well to chemotherapy and had few remaining cancer spots. Molecular imaging with targeted dyes could enhance precision surgery in the future. Indocyanine green (ICG) is a fluorescent dye used for sentinel lymph node assessment and the assessment of perfusion in skin flaps and bowel anastomoses. ICG binds serum proteins and behaves as a macromolecule in the circulation. Tumour tissue has increased vascular permeability and reduced drainage, causing macromolecules to accumulate within it. MIRRORS ICG is designed to determine whether indocyanine green (ICG) helped identify metastatic deposits in women undergoing robotic interval cytoreductive surgery for advanced-stage (3c+) ovarian cancer. Peritoneal surfaces of the abdominal and pelvic cavity were inspected under white light and near-infrared light (da Vinci Si and Xi Firefly Fluorescence imaging, Intuitive Surgical Inc.) following intravenous injection of 20 mg ICG in sterile water. Visibly abnormal areas were excised and sent to histopathology, noting IGC positivity. In total, 102 biopsies were assessed using ICG. Intravenous ICG assessment following neoadjuvant chemotherapy had a sensitivity of 91.1% (95% CI [82.6–96.4%]), a specificity of 13.0% (95% CI [2.8–33.6%]), a positive predictive value of 78.3% (95% CI [68.4–86.2%]), and a negative predictive value of 30.0% (95% CI [6.7–65.2%]) False-positive samples were seen in 9/20 patients. Psammoma bodies were noted in the histopathology reports of seven of nine of these patients with false-positive results, indicating that a tumour had been present (chemotherapy-treated disease). This study demonstrates the appearance of metastatic peritoneal deposits during robotic cytoreductive surgery following the intravenous administration of ICG in women who have undergone neoadjuvant chemotherapy for stage 3c+ advanced ovarian cancer. A perfusion assessment using indocyanine green (ICG) peritoneal angiography during robotic interval cytoreductive surgery for advanced ovarian cancer did not clinically improve metastatic disease identification in patients with high-volume disease. The use of ICG in patients with excellent response to chemotherapy where few tumour deposits remained shows some promise. The potential of molecular imaging to enhance precision surgery and improve disease identification using the robotic platform is a novel avenue for future research. [ABSTRACT FROM AUTHOR]

Brain tumour disease develops due to abnormal cell proliferation. The early identification of brain tumours is vital for their effective treatment. Most currently available examination methods are laborious, require extensive manual instructions, and produce subpar findings. The EfficientNet-B0 architecture was used to diagnose brain tumours using magnetic resonance imaging (MRI). The fine-tuned EffeceintNet B0 model was proposed for the Internet of Medical Things (IoMT) environment. The fine-tuned EfficientNet-B0 architecture was employed to classify four different stages of brain tumours from the MRI images. The fine-tuned model showed 99% accuracy in the detection of four different classes of brain tumour detection (glioma, no tumour, meningioma, and pituitary). The proposed model performed very well in the detection of the pituitary class with a precision of 0.95, recall of 0.98, and F1 score of 0.96. The proposed model also performed very well in the detection of the no-tumour class with values of 0.99, 0.90, and 0.94 for precision, recall, and the F1 score, respectively. The precision, recall, and F1 scores for Glioma and Meningioma classes were also high. The proposed solution has several implications for enhancing clinical investigations of brain tumours. [ABSTRACT FROM AUTHOR]

Simple Summary: Peptide receptor radionuclide therapy (PRRT) is a potential new treatment option for patients with meningiomas, the most common form of adult intracranial brain tumors. During PRRT, targeted radiation is delivered to the tumor through a radiolabeled peptide binding a receptor commonly overexpressed in meningioma cells. Unfortunately, preclinical research into therapy effects is limited due to the lack of appropriate in vitro models. Here, we aimed to develop an easy-to-use, scaffold-free patient-derived 3D culture model to support this research. Peptide receptor radionuclide therapy (PRRT) using 177Lu-DOTA-TATE has recently been evaluated for the treatment of meningioma patients. However, current knowledge of the underlying radiation biology is limited, in part due to the lack of appropriate in vitro models. Here, we demonstrate proof-of-concept of a meningioma patient-derived 3D culture model to assess the short-term response to radiation therapies such as PRRT and external beam radiotherapy (EBRT). We established short-term cultures (1 week) for 16 meningiomas with high efficiency and yield. In general, meningioma spheroids retained characteristics of the parental tumor during the initial days of culturing. For a subset of tumors, clear changes towards a more aggressive phenotype were visible over time, indicating that the culture method induced dedifferentiation of meningioma cells. To assess PRRT efficacy, we demonstrated specific uptake of 177Lu-DOTA-TATE via somatostatin receptor subtype 2 (SSTR2), which was highly overexpressed in the majority of tumor samples. PRRT induced DNA damage which was detectable for an extended timeframe as compared to EBRT. Interestingly, levels of DNA damage in spheroids after PRRT correlated with SSTR2-expression levels of parental tumors. Our patient-derived meningioma culture model can be used to assess the short-term response to PRRT and EBRT in radiobiological studies. Further improvement of this model should pave the way towards the development of a relevant culture model for assessment of the long-term response to radiation and, potentially, individual patient responses to PRRT and EBRT. [ABSTRACT FROM AUTHOR]

Brain tumor classification is essential for clinical diagnosis and treatment planning. Deep learning models have shown great promise in this task, but they are often challenged by the complex and diverse nature of brain tumors. To address this challenge, we propose a novel deep residual and region-based convolutional neural network (CNN) architecture, called Res-BRNet, for brain tumor classification using magnetic resonance imaging (MRI) scans. Res-BRNet employs a systematic combination of regional and boundary-based operations within modified spatial and residual blocks. The spatial blocks extract homogeneity, heterogeneity, and boundary-related features of brain tumors, while the residual blocks significantly capture local and global texture variations. We evaluated the performance of Res-BRNet on a challenging dataset collected from Kaggle repositories, Br35H, and figshare, containing various tumor categories, including meningioma, glioma, pituitary, and healthy images. Res-BRNet outperformed standard CNN models, achieving excellent accuracy (98.22%), sensitivity (0.9811), F1-score (0.9841), and precision (0.9822). Our results suggest that Res-BRNet is a promising tool for brain tumor classification, with the potential to improve the accuracy and efficiency of clinical diagnosis and treatment planning. [ABSTRACT FROM AUTHOR]

Simple Summary: Meningiomas are the most common primary benign tumor of the central nervous system, and, despite their prevalent benign nature, they exhibit variable tendency to recur during the lifetime, even after multiple reoperations, adjuvant radiation treatment and several years, posing a significant challenge of management. While well-defined risk factors of recurrence have been identified, the topographic pattern after surgery has scarcely been investigated. Nevertheless, the possibility of theoretically predicting the site of recurrence provides a significant advantage for a multidisciplinary team during the decision-making process regarding the strategy of treatment at the first surgery. The authors performed a comprehensive and detailed systematic literature review on the topographic pattern of recurrence after surgical treatment for intracranial meningiomas. Background: While several risk factors for recurrences have been defined, the topographic pattern of meningioma recurrences after surgical resection has been scarcely investigated. The possibility of theoretically predicting the site of recurrence not only allows us to better understand the pathogenetic bases of the disease and consequently to drive the development of new targeted therapies, but also guides the decision-making process for treatment strategies and tailored follow-ups to decrease/prevent recurrence. Methods: The authors performed a comprehensive and detailed systematic literature review of the EMBASE and MEDLINE electronic online databases regarding the topographic pattern of recurrence after surgical treatment for intracranial meningiomas. Demographics and histopathological, neuroradiological and treatment data, pertinent to the topography of recurrences, as well as time to recurrences, were extracted and analyzed. Results: Four studies, including 164 cases of recurrences according to the inclusion criteria, were identified. All studies consider the possibility of recurrence at the previous dural site; three out of four, which are the most recent, consider 1 cm outside the previous dural margin to be the main limit to distinguish recurrences closer to the previous site from those more distant. Recurrences mainly occur within or close to the surgical bed; higher values of proliferation index are associated with recurrences close to the original site rather than within it. Conclusions: Further studies, including genomic characterization of different patterns of recurrence, will better clarify the main features affecting the topography of recurrences. A comparison between topographic classifications of intracranial meningioma recurrences after surgery and after radiation treatment could provide further interesting information. [ABSTRACT FROM AUTHOR]

Simple Summary: Parasellar meningiomas are rare tumours of the skull base that may invade the cavernous sinus, making complete removal of the tumour impossible. The remaining tumour remnant is observed or treated with radiotherapy. This study aimed to assess which prognostic factors influence progression-free survival (PFS) in cases of incomplete removal of parasellar meningioma invading the cavernous sinus. The study included 32 patients who underwent surgery owing to parasellar meningioma invading the cavernous sinus. In some cases, the tumour was almost completely removed (near-total resection, NTR), with the tumour remnant left in the cavernous sinus, while in the remaining patients, the tumour was subtotally removed, leaving a small extracavernous portion (subtotal resection, STR). We found that radiotherapy only influenced PFS in the group that underwent STR, and tumour size was an independent factor affecting PFS after surgery. In conclusion, we found that a tumour remnant left in the cavernous sinus can be safely observed, but leaving an extracavernous tumour fragment in place requires adjuvant radiotherapy or radiosurgery to achieve meningioma control. Background: Parasellar meningiomas, which may invade the cavernous sinus, pose a significant challenge to neurosurgeons due to the high risk of postoperative neurological deficits associated with aggressive resection of the intracavernous part of the tumour. Therefore, subtotal tumour removal followed by observation or radiotherapy for the residual meningioma in the cavernous sinus is recommended. This retrospective study aimed to identify prognostic factors influencing recurrence and progression-free survival (PFS) in parasellar meningiomas invading the cavernous sinus after incomplete surgical treatment. Methods: This study included adult patients diagnosed with benign parasellar meningioma (WHO Grade I) invading the cavernous sinus, treated at our institution between 2006 and 2020, and with a postsurgical follow-up of at least 3 years. Surgical treatment involved near-total resection (NTR) with an intracavernous residual tumour or subtotal resection (STR) with additional extracavernous tumour left in place. Kaplan–Meier analysis estimated PFS rates, and Cox regression tested survival time differences between groups. Results: Among the 32 patients, the estimated median PFS was 11 years. Radiotherapy improved 5-year PFS only in patients with STR (p = 0.003). The univariate analysis identified preoperative tumour size, low preoperative Karnofsky Performance Score (KPS), and marked brain oedema as significant factors affecting meningioma progression after surgery. The multivariate analysis confirmed tumour size as an independent factor for progression (p = 0.012). Conclusions: For patients with parasellar meningioma invading the cavernous sinus, extracavernous tumour removal followed by close radiological surveillance of the residual intracavernous meningioma is a safe and appropriate strategy. When an extracavernous tumour component is left, adjuvant stereotactic radiotherapy or radiosurgery is recommended to control tumour growth. [ABSTRACT FROM AUTHOR]

Simple Summary: Spinal cord tumors represent a significant surgical challenge. Neurophysiological evaluation using motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) is used to assess the function of motor and somatosensory pathways before and during surgery. However, its role with respect to the detection of neurological damage is not fully known. This study assesses the prognostic value of alterations of pre- and per-operative MEPs and SSEPs in a cohort of 67 patients undergoing spinal cord tumor surgery. We show that pre- and intraoperative alterations to MEPs and SSEPs are strongly associated with a risk of neurological deterioration 3 months after surgery that is independent of initial clinical severity, tumor size, or histological subtype. Leveraging a classical machine learning approach, it is possible to predict neurological outcomes with an accuracy of 84%. Thus, this study demonstrates the pivotal role of pre- and intraoperative neurophysiological explorations in detecting and preventing neurological suffering during spinal tumor surgery. Surgery for spinal cord tumors poses a significant challenge due to the inherent risk of neurological deterioration. Despite being performed at numerous centers, there is an ongoing debate regarding the efficacy of pre- and intraoperative neurophysiological investigations in detecting and preventing neurological lesions. This study begins by providing a comprehensive review of the neurophysiological techniques commonly employed in this context. Subsequently, we present findings from a cohort of 67 patients who underwent surgery for intradural tumors. These patients underwent preoperative and intraoperative multimodal somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), with clinical evaluation conducted three months postoperatively. The study aimed to evaluate the neurophysiological, clinical, and radiological factors associated with neurological outcomes. In univariate analysis, preoperative and intraoperative potential alterations, tumor size, and ependymoma-type histology were linked to the risk of worsening neurological condition. In multivariate analysis, only preoperative and intraoperative neurophysiological abnormalities remained significantly associated with such neurological deterioration. Interestingly, transient alterations in intraoperative MEPs and SSEPs did not pose a risk of neurological deterioration. The machine learning model we utilized demonstrated the possibility of predicting clinical outcome, achieving 84% accuracy. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to evaluate the impact of radiation dose on the outcomes of stereotactic radiosurgery (SRS) for benign meningiomas and determine an optimal dosing strategy for balancing tumor control and treatment-related toxicity. Clinical data of 147 patients with 164 lesions treated between 2014 and 2022 were reviewed. Primary outcomes included progression-free survival (PFS), local control rate (LCR), and radiation-induced toxicity, with secondary outcomes focusing on LCR and radiation-induced peritumoral edema (PTE) in two dose groups (≥14 Gy and <14 Gy). The results revealed a median follow-up duration of 47 months, with 1-year, 2-year, and 5-year PFS rates of 99.3%, 96.7%, and 93.8%, respectively, and an overall LCR of 95.1%. Radiation-induced toxicity was observed in 24.5% of patients, primarily presenting mild symptoms. Notably, no significant difference in LCR was found between the two dose groups (p = 0.628), while Group 2 (<14 Gy) exhibited significantly lower PTE (p = 0.039). This study concludes that SRS with a radiation dose < 14 Gy demonstrates comparable tumor control with reduced toxicity, advocating consideration of such dosing to achieve a balance between therapeutic efficacy and safety. [ABSTRACT FROM AUTHOR]

Simple Summary: "Surgery-first" is the main paradigm of treatment for intracranial meningiomas, with the aim of maximal safe tumor resection while preserving the neurological function. This purpose is not always achievable for meningiomas involving the spheno-orbital region, due to their close anatomical relationship with highly functional neurovascular structures, which limits the extent of resection. Therefore, surgery aims to achieve an onco-functional balance, mainly addressed to symptoms and signs of resolution. For this purpose, several surgical approaches, each with related pros and cons, can be considered. Surgery stands as the primary treatment for spheno-orbital meningiomas, following a symptoms-oriented approach. We discussed the decision-making process behind surgical strategies through a review of medical records from 80 patients who underwent surgical resection at the University of Naples Federico II. Different surgical approaches were employed based on the tumor's location relative to the optic nerve's long axis, categorized into lateral (type I), medial (type II), and diffuse (type III). We examined clinical, neuroradiological, surgical, pathological, and outcome factors. Proptosis emerged as the most frequent symptom (97%), followed by visual impairment (59%) and ocular motility issues (35%). Type I represented 20%, type II 43%, and type III 17%. Growth primarily affected the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%). The resection outcomes varied, with Simpson grades I and II achieved in all type I cases, 67.5% of type II, and 18% of type III. Recurrence rates were highest in type II (41.8%) and type III (59%). Improvement was notable in proptosis (68%) and visual function (51%, predominantly type I). Surgery for spheno-orbital meningiomas should be tailored to each patient, considering individual characteristics and tumor features to improve quality of life by addressing primary symptoms like proptosis and visual deficits. [ABSTRACT FROM AUTHOR]

Simple Summary: Laser interstitial thermal therapy (LITT) is a minimally invasive, MRI-guided procedure that causes localized tissue hyperthermia. This results in the ablation of targeted cells and disruption of the blood–brain barrier. LITT offers an alternative treatment option to standard-of-care resection for glioma in addition to potentially enhancing drug delivery of adjuvant therapy. Here, we present the first meta-analysis since the fifth edition of the WHO Classification of Tumors of the Central Nervous System (WHO CNS5) to assess the current literature on the safety and efficacy of LITT in the upfront treatment of primary brain tumors. This study summarizes the current relevant literature on LITT and supports its viability as a treatment option for glioblastoma and IDH-mutant astrocytoma. Although primary studies have reported the safety and efficacy of LITT as a primary treatment in glioma, they are limited by sample sizes and institutional variation in stereotactic parameters such as temperature and laser power. The current literature has yet to provide pooled statistics on outcomes solely for primary brain tumors according to the 2021 WHO Classification of Tumors of the Central Nervous System (WHO CNS5). In the present study, we identify recent articles on primary CNS neoplasms treated with LITT without prior intervention, focusing on relationships with molecular profile, PFS, and OS. This meta-analysis includes the extraction of data from primary sources across four databases using the Covidence systematic review manager. The pooled data suggest LITT may be a safe primary management option with tumor ablation rates of 94.8% and 84.6% in IDH-wildtype glioblastoma multiforme (GBM) and IDH-mutant astrocytoma, respectively. For IDH-wildtype GBM, the pooled PFS and OS were 5.0 and 9.0 months, respectively. Similar to rates reported in the prior literature, the neurologic and non-neurologic complication rates for IDH-wildtype GBM were 10.3% and 4.8%, respectively. The neurologic and non-neurologic complication rates were somewhat higher in the IDH-mutant astrocytoma cohort at 33% and 8.3%, likely due to a smaller cohort size. [ABSTRACT FROM AUTHOR]

Simple Summary: Meningiomas are classified pathologically by the World Health Organization (WHO) grading system, with WHO grade 2 and 3 tumors considered "high-grade". These tumors are characterized microscopically by high mitotic rates and macroscopically by a brain invasion. The goal of the surgical treatment of these tumors is maximal safe resection to minimize surgical morbidity and extend patient survival. Surgical resection is made difficult by frequently indistinct boundaries between normal brain layers and the encasement of blood vessels and cranial nerves. Surgeons and scientists must continue to collaborate to offer patients the highest quality operative and post-operative medical care. Maximal resection with the preservation of neurological function are the mainstays of the surgical management of high-grade meningiomas. Surgical morbidity is strongly associated with tumor size, location, and invasiveness, whereas patient survival is strongly associated with the extent of resection, tumor biology, and patient health. A versatile microsurgical skill set combined with a cogent multimodality treatment plan is critical in order to achieve optimal patient outcomes. Continued refinement in surgical techniques in conjunction with directed radiotherapeutic and medical therapies will define future treatment. [ABSTRACT FROM AUTHOR]

Background/Objective: No guidelines indicate surgical risk factors for the elderly because of the lack of data from general neurosurgeons. To better understand the management of surgical risk in elderly patients with meningiomas based on a national database in Japan. Methods: Results of surgically treated meningiomas were explored in 8138 patients registered in the Diagnosis Procedure Combination database in Japan during 2010–2015. Age (<65, 65–74, and ≥75 years), sex, Barthel index (BI), medical history, tumor location, oral medication prescriptions on admission, and stroke complications were evaluated. Multivariate logistic regression analysis identified risk factors for stroke complications, BI deterioration between admission and discharge, and in-hospital mortality. Results: Advanced age was the prominent risk factor for BI deterioration (odds ratio: 3.26; 95% confidence interval: 2.69–3.95) but not for in-hospital mortality. Lower BI (60–80) on admission increased the risk of BI deterioration in all age groups; however, BI < 60 demonstrated a significant inverse risk (0.47; 0.32–0.69) in the elderly (≥75 years). Location (falx, parasagittal, and deep) and anticoagulants were not significant risk factors for BI deterioration in patients aged ≥ 75 years, despite being significant risk factors in patients aged <65 and/or 65–74 years. Conclusions: Although advanced age could lead to postoperative functional decline at discharge, it was not sufficiently significant enough to be associated with in-hospital mortality. Because of the possibility of recovery even in elderly patients with severe disabilities, appropriate surgical selection and optimal management may lead to favorable functional outcomes in elderly patients with meningiomas. [ABSTRACT FROM AUTHOR]

Simple Summary: Multiple tumor types feature frequent overexpression of somatostatin receptor type 2 (SSTR2). In addition to its well-established role in determining the primary diagnosis, a PET/CT can be helpful in the radiation treatment of these tumors. It has the potential to improve recognition of the tumor burden compared to CT or MRI alone. In a blinded comparative interobserver study, we anonymized 47 patients with various tumors with SSTR2 expression and instructed four radiation oncologists to independently contour the macroscopic tumor volume using MRI alone and subsequently with the addition of DOTA-conjugated PET/CT. This study showed that for meningioma and skull base paraganglioma (SBPGL), there was a better consensus and certainty between the observers, with the opposite trend for pituitary neuroendocrine tumors (PitNET). For PitNET and meningioma, the addition of PET/CT led to higher sensitivity between the observers compared to CT and MRI alone, suggesting the benefits of integrating DOTA-conjugated PET/CT for target definition. The overexpression of somatostatin receptor type 2 (SSTR2) is a property of various tumor types. Hybrid imaging utilizing [68Ga]1,4,7,10-tetraazacyclododecane-1,4,7,10-tetra-acetic acid (DOTA) may improve the differentiation between tumor and healthy tissue. We conducted an experimental study on 47 anonymized patient cases including 30 meningiomas, 12 PitNET and 5 SBPGL. Four independent observers were instructed to contour the macroscopic tumor volume on planning MRI and then reassess their volumes with the additional information from DOTA-PET/CT. The conformity between observers and reference volumes was assessed. In total, 46 cases (97.9%) were DOTA-avid and included in the final analysis. In eight cases, PET/CT additional tumor volume was identified that was not detected by MRI; these PET/CT findings were potentially critical for the treatment plan in four cases. For meningiomas, the interobserver and observer to reference volume conformity indices were higher with PET/CT. For PitNET, the volumes had higher conformity between observers with MRI. With regard to SBGDL, no significant trend towards conformity with the addition of PET/CT information was observed. DOTA PET/CT supports accurate tumor recognition in meningioma and PitNET and is recommended in SSTR2-expressing tumors planned for treatment with highly conformal radiation. [ABSTRACT FROM AUTHOR]

Simple Summary: Spinal intradural tumors can grow along multiple segments. Extensive approaches such as long-segment laminoplasties may be necessary to achieve the gold standard of gross total resection. Here, we present a comprehensive cohort study describing the satisfying clinical outcome of patients undergoing four or more segment approaches without requiring dorsal fixation for intradural tumor resection. The clinical outcomes are comparable to patients undergoing surgical treatment of short-segment approaches, and no patient underwent a secondary fixation for symptoms of mechanical instability. Introduction: Spinal intradural tumors account for 15% of all CNS tumors. Typical tumor entities include ependymomas, astrocytomas, meningiomas, and neurinomas. In cases of multiple affected segments, extensive approaches may be necessary to achieve the gold standard of complete tumor resection. Methods: We performed a bicentric, retrospective cohort study of all patients equal to or older than 14 years who underwent multi-segment surgical treatment for spinal intradural tumors between 2007 and 2023 with approaches longer than four segments without instrumentation. We assessed the surgical technique and the clinical outcome regarding signs of symptomatic spinal instability. Children were excluded from our cohort. Results: In total, we analyzed 33 patients with a median age of 44 years and interquartile range IQR of 30–56 years, including the following tumors: 21 ependymomas, one subependymoma–ependymoma mixed tumor, two meningiomas, two astrocytomas, and seven patients with other entities. The median length of the approach was five spinal segments with a range of 4–14 and with the foremost localization in the cervical or thoracic spine. Laminoplasty was the most chosen approach (72.2%). The median time to follow-up was 13 months IQR (4–56 months). Comparing pre- and post-surgery outcomes, 72.2% of the patients (n = 24) reported pain improvement after surgery. The median modified McCormick scores pre- and post surgery were equal to II IQR (I–II) and II IQR (I–III), respectively. Discussion: We achieved satisfying results with long-segment approaches. In general, patients reported pain improvement after surgery and received similar low modified McCormick scores pre- and post surgery and did not undergo secondary dorsal fixation. Thus, we conclude that intradural tumor resection via extensive approaches does not seem to impair long-term spinal stability in our cohort. [ABSTRACT FROM AUTHOR]

Simple Summary: Meningiomas are the most common intracranial tumors, and significant advances have been made in our understanding of the biology that leads to meningioma growth and aggressiveness. This review summarizes molecular advances and the historical contexts that led to them. Meningioma classification and treatment have evolved over the past eight decades. Since Bailey, Cushing, and Eisenhart's description of meningiomas in the 1920s and 1930s, there have been continual advances in clinical stratification by histopathology, radiography and, most recently, molecular profiling, to improve prognostication and predict response to therapy. Precise and accurate classification is essential to optimizing management for patients with meningioma, which involves surveillance imaging, surgery, primary or adjuvant radiotherapy, and consideration for clinical trials. Currently, the World Health Organization (WHO) grade, extent of resection (EOR), and patient characteristics are used to guide management. While these have demonstrated reliability, a substantial number of seemingly benign lesions recur, suggesting opportunities for improvement of risk stratification. Furthermore, the role of adjuvant radiotherapy for grade 1 and 2 meningioma remains controversial. Over the last decade, numerous studies investigating the molecular drivers of clinical aggressiveness have been reported, with the identification of molecular markers that carry clinical implications as well as biomarkers of radiotherapy response. Here, we review the historical context of current practices, highlight recent molecular discoveries, and discuss the challenges of translating these findings into clinical practice. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigates the relationship between genomic alterations and preoperative olfactory function in patients with olfactory groove meningioma (OGM), often associated with olfactory impairment. Utilizing next-generation sequencing on 22 individuals with OGM, the research identified mutations with SMO/SUFU, with AKT1, and as wild type. The presence of planum sphenoidale hyperostosis (PSH) correlated with significant variations in tumour morphology and negatively impacted olfactory function, affecting odour threshold, discrimination, identification, and overall olfactory performance. Additionally, perifocal oedema was linked to decreased olfactory performance. The study also found that age over 65 and female gender were associated with reduced olfactory capabilities. Despite these findings, no direct link between olfactory impairment and tumour mutations was established, possibly due to the limited sample size. The research suggests further investigation with a larger participant group in order to better understand the impact of OGM driver mutations on olfactory function. Purpose: The study aims to examine the possible correlation between genomic alterations and preoperative olfactory function in patients with olfactory groove meningioma (OGM), due to the frequent presence of olfactory impairment. Methods: We utilised next-generation sequencing to analyse samples from 22 individuals with OGM in order to detect driver mutations. Tumour morphology was assessed using preoperative imaging, whereas olfactory function was examined using Sniffin' Sticks. Results: In a study of 22 OGM patients, mutations were as follows: 10 with SMO/SUFU, 7 with AKT1, and 5 as wild type. Planum sphenoidale hyperostosis (PSH) was present in 75% of patients, showing significant variation by mutation (p = 0.048). Tumour volumes, averaging 25 cm3, significantly differed among groups. PSH negatively impacted olfaction, notably affecting odour threshold, discrimination, identification, and global olfactory performance score (TDI) (p values ranging from <0.001 to 0.003). Perifocal oedema was associated with lower TDI (p = 0.009) and altered threshold scores (p = 0.038). Age over 65 and female gender were linked to lower thresholds and discrimination scores (p = 0.037 and p = 0.019). Conclusion: The study highlights PSH and perifocal oedema's significant effect on olfactory function in OGM patients but finds no link between olfactory impairment and tumour mutations, possibly due to the small sample size. This suggests that age and gender affect olfactory impairment. Additional research with a larger group of participants is needed to explore the impact of OGM driver mutations on olfactory performance. [ABSTRACT FROM AUTHOR]

Meningiomas are tumors of the central nervous system that vary in their presentation, ranging from benign and slow-growing to highly aggressive. The standard method for diagnosing and classifying meningiomas involves invasive surgery and can fail to provide accurate prognostic information. Liquid biopsy methods, which exploit circulating tumor biomarkers such as DNA, extracellular vesicles, micro-RNA, proteins, and more, offer a non-invasive and dynamic approach for tumor classification, prognostication, and evaluating treatment response. Currently, a clinically approved liquid biopsy test for meningiomas does not exist. This review provides a discussion of current research and the challenges of implementing liquid biopsy techniques for advancing meningioma patient care. [ABSTRACT FROM AUTHOR]

Simple Summary: This study offers a comprehensive review of the current basic science and clinical literature concerning the diagnosis and treatment of spinal meningiomas in conjunction with illustrative case studies to emphasize up-to-date knowledge on molecular genetics, surgical resection, and alternative therapies. Spinal meningiomas are the most common intradural, extramedullary tumor in adults, yet the least common entity when accounting for all meningiomas spanning the neuraxis. While traditionally considered a benign recapitulation of their intracranial counterpart, a paucity of knowledge exists regarding the differences between meningiomas arising from these two anatomic compartments in terms of histopathologic subtypes, molecular tumor biology, surgical principles, long-term functional outcomes, and recurrence rates. To date, advancements at the bench have largely been made for intracranial meningiomas, including the discovery of novel gene targets, DNA methylation profiles, integrated diagnoses, and alternative systemic therapies, with few exceptions reserved for spinal pathology. Likewise, evolving clinical research offers significant updates to our understanding of guiding surgical principles, intraoperative technology, and perioperative patient management for intracranial meningiomas. Nonetheless, spinal meningiomas are predominantly relegated to studies considering non-specific intradural extramedullary spinal tumors of all histopathologic types. The aim of this review is to comprehensively report updates in both basic science and clinical research regarding intraspinal meningiomas and to provide illustrative case examples thereof, thereby lending a better understanding of this heterogenous class of central nervous system tumors. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, the authors compare the outcomes of skull base meningioma resection using an endoscopic-assisted microsurgical keyhole approach. Between 2013 and 2019, 71 out of 89 patients underwent this procedure. The analysis included 42 anterior skull base and 29 posterior fossa meningiomas. While both cohorts achieved similar gross total resection rates (80% anterior, 82% posterior), complication rates were higher in the posterior fossa (31%) compared with the anterior skull base (16%). Endoscopic assistance was utilized in 79% of cases, with higher rates of tumor detection in the posterior fossa (58.6%) versus the anterior skull base (33%). Statistical analysis showed significantly greater benefits from endoscopy in the posterior fossa. Overall, endoscopic assistance enhances radicality and provides better anatomical visualization, particularly in the posterior fossa, improving outcomes in skull base meningioma surgery. Background: Keyhole-based approaches are being explored for skull base tumor surgery; aiming for reduced complications while maintaining resection success rates. This study evaluates skull base meningiomas resected using an endoscopic-assisted microsurgical keyhole approach, comparing outcomes with standard procedures. Methods: Between 2013 and 2019; 71 out of 89 patients were treated using an endoscopic-assisted microsurgical procedure. A total of 42 meningiomas were localized at the anterior skull base and 29 in the posterior fossa. The surgical techniques and use of an endoscope were analyzed and compared in terms of complications, surgical radicality, outcome, and recurrences in the patients' follow-up. Results: The two different cohorts yielded similar rates of GTR (anterior skull base: 80% versus posterior fossa: 82%). The complication rate was 31% for the posterior fossa and 16% for the anterior skull base. An endoscope was used in 79% of all cases. Tumor remnants were detected by means of endoscopic visualization in 58.6% of posterior fossa and 33% of anterior skull base meningiomas. The statistical analysis revealed significantly higher benefits from endoscope use in the posterior fossa cohort (p < 0.05). Conclusions: The results revealed that endoscopy was beneficial in both locations. The identification of remnant tumor tissue and the benefit of endoscopy were clearly higher in the posterior fossa. Endoscopic assistance is a very helpful tool for increasing radicality, providing a better anatomical overview during surgery, and better identifying remnant tumor tissue in skull base meningioma surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: Magnetic resonance imaging is an invaluable tool for the diagnosis of brain diseases in veterinary medicine. In this review, we provide a comprehensive summary of the magnetic resonance imaging appearances of and diagnostic approach to brain tumors affecting dogs and cats. Characteristic imaging features often allow for accurate prediction of commonly encountered types of brain tumors in clinical practice, such as meningiomas, gliomas, and pituitary tumors. However, a limitation of magnetic resonance imaging remains that some types of brain tumors, as well as other causes of brain disease, display similar imaging features, which can lead to diagnostic uncertainty and errors. There are also several uncommon to rare variants of brain tumors for which published magnetic resonance imaging descriptions are extremely limited or non-existent, especially in cats. The recent development and clinical usage of quantitative imaging and artificial intelligence techniques show promise for improving the ability of magnetic resonance imaging to correctly diagnose brain tumors and discriminate different tumor types. Magnetic resonance imaging (MRI) is used pervasively in veterinary practice for the antemortem diagnosis of intracranial tumors. Here, we provide an illustrated summary of the published MRI features of primary and secondary intracranial tumors of dogs and cats, following PRISMA scoping review guidelines. The PubMed and Web of Science databases were searched for relevant records, and input from stakeholders was solicited to select data for extraction. Sixty-seven studies of moderate to low-level evidence quality describing the MRI features of pathologically confirmed canine and feline brain tumors met inclusion criteria. Considerable variability in data inclusion and reporting, as well as low case numbers, prohibited comparative data analyses. Available data support a holistic MRI approach incorporating lesion number, location within the brain, shape, intrinsic signal appearances on multiparametric sequences, patterns of contrast enhancement, and associated secondary changes in the brain to prioritize differential imaging diagnoses, and often allows for accurate presumptive diagnosis of common intracranial tumors. Quantitative MRI techniques show promise for improving discrimination of neoplastic from non-neoplastic brain lesions, as well as differentiating brain tumor types and grades, but sample size limitations will likely remain a significant practical obstacle to the design of robustly powered radiomic studies. For many brain tumor variants, particularly in cats, there remains a need for standardized studies that correlate clinicopathologic and neuroimaging data. [ABSTRACT FROM AUTHOR]

S100 protein expression levels and neurofibromatosis type 2 (NF-2) mutations result in different disease courses in meningiomas. This study aimed to investigate non-invasive biomarkers of NF-2 copy number loss and S100 protein expression in meningiomas using morphological, radiomics, and deep learning-based features of susceptibility-weighted MRI (SWI). This retrospective study included 99 patients with S100 protein expression data and 92 patients with NF-2 copy number loss information. Preoperative cranial MRI was conducted using a 3T clinical MR scanner. Tumor volumes were segmented on fluid-attenuated inversion recovery (FLAIR) and subsequent registration of FLAIR to high-resolution SWI was performed. First-order textural features of SWI were extracted and assessed using Pyradiomics. Morphological features, including the tumor growth pattern, peritumoral edema, sinus invasion, hyperostosis, bone destruction, and intratumoral calcification, were semi-quantitatively assessed. Mann–Whitney U tests were utilized to assess the differences in the SWI features of meningiomas with and without S100 protein expression or NF-2 copy number loss. A logistic regression analysis was used to examine the relationship between these features and the respective subgroups. Additionally, a convolutional neural network (CNN) was used to extract hierarchical features of SWI, which were subsequently employed in a light gradient boosting machine classifier to predict the NF-2 copy number loss and S100 protein expression. NF-2 copy number loss was associated with a higher risk of developing high-grade tumors. Additionally, elevated signal intensity and a decrease in entropy within the tumoral region on SWI were observed in meningiomas with S100 protein expression. On the other hand, NF-2 copy number loss was associated with lower SWI signal intensity, a growth pattern described as "en plaque", and the presence of calcification within the tumor. The logistic regression model achieved an accuracy of 0.59 for predicting NF-2 copy number loss and an accuracy of 0.70 for identifying S100 protein expression. Deep learning features demonstrated a strong predictive capability for S100 protein expression (AUC = 0.85 ± 0.06) and had reasonable success in identifying NF-2 copy number loss (AUC = 0.74 ± 0.05). In conclusion, SWI showed promise in identifying NF-2 copy number loss and S100 protein expression by revealing neovascularization and microcalcification characteristics in meningiomas. [ABSTRACT FROM AUTHOR]

In our study, we document the case of a 48-year-old patient who presented at our clinic with various neurological disturbances. Magnetic Resonance Imaging revealed the presence of an intraventricular meningioma located in the body of the left lateral ventricle measuring 60 mm in diameter. This tumor was classified as a giant meningioma, accompanied by a significant amount of digitiform-type edema. A surgical procedure was conducted, resulting in a gross total resection of the tumor. Histopathological analysis identified the tumor as a fibrous meningioma. Postoperative assessments, as well as follow-ups conducted at 3 months and 1 year post-surgery, indicated considerable neurological improvement. The patient exhibited a remission of hemiparesis and gait disturbances along with a marginal improvement in the status of expressive aphasia. This case report underscores the significance of achieving total and safe resection of the tumor and includes an analysis of various cases from the literature, particularly focusing on those that describe minimally invasive surgical approaches and highlight the benefits of radiosurgery in the treatment of giant intraventricular meningiomas. [ABSTRACT FROM AUTHOR]

Matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) play critical roles in regulating processes associated with malignant behavior. These endopeptidases selectively degrade components of the extracellular matrix (ECM), growth factors, and their receptors, contributing to cancer cell invasiveness and migratory characteristics by disrupting the basal membrane. However, the expression profile and role of various matrix metalloproteinases remain unclear, and only a few studies have focused on differences between diagnoses of brain tumors. Using quantitative real-time PCR analysis, we identified the expression pattern of ECM modulators (n = 10) in biopsies from glioblastoma (GBM; n = 20), astrocytoma (AST; n = 9), and meningioma (MNG; n = 19) patients. We found eight deregulated genes in the glioblastoma group compared to the benign meningioma group, with only MMP9 (FC = 2.55; p = 0.09) and TIMP4 (7.28; p < 0.0001) upregulated in an aggressive form. The most substantial positive change in fold regulation for all tumors was detected in matrix metalloproteinase 2 (MNG = 30.9, AST = 4.28, and GBM = 4.12). Notably, we observed an influence of TIMP1, demonstrating a positive correlation with MMP8, MMP9, and MMP10 in tumor samples. Subsequently, we examined the protein levels of the investigated MMPs (n = 7) and TIMPs (n = 3) via immunodetection. We confirmed elevated levels of MMPs and TIMPs in GBM patients compared to meningiomas and astrocytomas. Even when correlating glioblastomas versus astrocytomas, we showed a significantly increased level of MMP1, MMP3, MMP13, and TIMP1. The identified metalloproteases may play a key role in the process of gliomagenesis and may represent potential targets for personalized therapy. However, as we have not confirmed the relationship between mRNA expression and protein levels in individual samples, it is therefore natural that the regulation of metalloproteases will be subject to several factors. [ABSTRACT FROM AUTHOR]

Brain tumor diagnosis traditionally relies on the manual examination of magnetic resonance images (MRIs), a process that is prone to human error and is also time consuming. Recent advancements leverage machine learning models to categorize tumors, such as distinguishing between "malignant" and "benign" classes. This study focuses on the supervised machine learning task of classifying "firm" and "soft" meningiomas, critical for determining optimal brain tumor treatment. The research aims to enhance meningioma firmness detection using state-of-the-art deep learning architectures. The study employs a YOLO architecture adapted for meningioma classification (Firm vs. Soft). This YOLO-based model serves as a machine learning component within a proposed CAD system. To improve model generalization and combat overfitting, transfer learning and data augmentation techniques are explored. Intra-model analysis is conducted for each of the five YOLO versions, optimizing parameters such as the optimizer, batch size, and learning rate based on sensitivity and training time. YOLOv3, YOLOv4, and YOLOv7 demonstrate exceptional sensitivity, reaching 100%. Comparative analysis against state-of-the-art models highlights their superiority. YOLOv7, utilizing the SGD optimizer, a batch size of 64, and a learning rate of 0.01, achieves outstanding overall performance with metrics including mean average precision (99.96%), precision (98.50%), specificity (97.95%), balanced accuracy (98.97%), and F1-score (99.24%). This research showcases the effectiveness of YOLO architectures in meningioma firmness detection, with YOLOv7 emerging as the optimal model. The study's findings underscore the significance of model selection and parameter optimization for achieving high sensitivity and robust overall performance in brain tumor classification. [ABSTRACT FROM AUTHOR]

Simple Summary: Malignant meningiomas have high aggressiveness and recurrence rates and a poor prognosis, with no clear pharmacological treatment available. The study aims to investigate the progression mechanism of malignant meningiomas and the targets of intervention. RACK1 and CSNK2B have been shown to promote tumor progression but their roles in meningiomas are not clear. In this study, we will investigate the roles of RACK1-CSNK2B in meningiomas and search for targets to inhibit the progression of meningiomas. Higher-grade meningiomas (WHO grade II and III) are characterized by aggressive invasiveness and high postoperative recurrence rates. The prognosis remains inadequate even with adjuvant radiotherapy and currently there is no definitive pharmacological treatment strategy and target for malignant meningiomas. This study aims to unveil the mechanisms driving the malignant progression of meningiomas and to identify potential inhibitory targets, with significant clinical implications. Implementing techniques such as protein immunoprecipitation, mass spectrometry, RNA interference, and transcriptome sequencing, we investigated the malignancy mechanisms in meningioma cell lines IOMM-LEE and CH157-MN. Additionally, in vivo experiments were carried out on nude mice. We discovered a positive correlation between meningioma malignancy and the levels of the receptor for activated C kinase 1 (RACK1), which interacts with CSNK2B, the β subunit of casein kinase 2 (CK2), inhibiting its ubiquitination and subsequent degradation. This inhibition allows CK2 to activate the NF-κb pathway, which increases the transcription of CDK4 and cyclin D3, resulting in the transition of the cell cycle into the G2/M phase. The RACK1 inhibitor, harringtonolide (HA), significantly suppressed the malignant tendencies of meningioma cells. Our study suggests that RACK1 may play a role in the malignant progression of meningiomas, and therefore, targeting RACK1 could emerge as an effective strategy for reducing the malignancy of these tumors. [ABSTRACT FROM AUTHOR]

Simple Summary: Neurotropic oncolytic viruses have shown promise for the treatment of brain tumors, as they are naturally capable of entering the brain and selectively killing cancer cells. In this study, the safety, immunologic responses, and anti-tumor effects of intravenous administration of a genetically modified strain of neurotropic oncolytic Newcastle disease virus (NDV) to 20 dogs with spontaneously occurring brain cancers are characterized. Viral treatment was safe, with common side effects limited to transient low-grade fever, chills, and diarrhea. Anti-tumor responses, defined by a post-treatment reduction in tumor size as measured with brain MRI scans, were observed in two dogs. NDV genetic material was detectable in canine tumor tissue after treatment, confirming the ability of NDV to infect tumors. All dogs rapidly developed antibodies to NDV, suggesting that the viral dosing schedule may require modification to improve anti-tumor effects. Neurotropic oncolytic viruses are appealing agents to treat brain tumors as they penetrate the blood–brain barrier and induce preferential cytolysis of neoplastic cells. The pathobiological similarities between human and canine brain tumors make immunocompetent dogs with naturally occurring tumors attractive models for the study of oncolytic virotherapies. In this dose-escalation/expansion study, an engineered Lasota NDV strain targeting the urokinase plasminogen activator system (rLAS-uPA) was administered by repetitive intravenous infusions to 20 dogs with intracranial tumors with the objectives of characterizing toxicities, immunologic responses, and neuroradiological anti-tumor effects of the virus for up to 6 months following treatment. Dose-limiting toxicities manifested as fever, hematologic, and neurological adverse events, and the maximum tolerated dose (MTD) of rLAS-uPA was 2 × 107 pfu/mL. Mild adverse events, including transient infusion reactions, diarrhea, and fever were observed in 16/18 of dogs treated at or below MTD. No infectious virus was recoverable from body fluids. Neutralizing antibodies to rLAS-uPA were present in all dogs by 2 weeks post-treatment, and viral genetic material was detected in post-treatment tumors from six dogs. Tumor volumetric reductions occurred in 2/11 dogs receiving the MTD. Systemically administered rLAS-uPA NDV was safe and induced anti-tumor effects in canine brain tumors, although modifications to evade host anti-viral immunity are needed to optimize this novel therapy. [ABSTRACT FROM AUTHOR]

To identify the characteristics of feeding arteries in skull base meningioma including location and prevalence, we evaluated the distributions and types of feeding arteries in skull base meningioma by cerebral angiography and assessed relationships to tumor attachment. We enrolled patients with skull base meningioma who underwent MRI and cerebral digital subtraction angiography (DSA), from September 2015 to October 2022. Subjects comprised 115 patients (32 males, 83 females; mean age, 52.7) with 117 meningiomas, showing tumor attachments around the "cavernous sinus to the upper part of the clivus" (Area 1), "lower part of the clivus to foramen magnum" (Area 2), and "tentorium around the petrous bone" (Area 3). Frequent arteries, such as the dorsal meningeal artery (DMA), the ascending pharyngeal artery (APA), the tentorial artery (TA), and the petrosal branch (PB) of the middle meningeal artery (MMA) were analyzed in terms of their associations with tumor attachment to Areas 1–3. Meningiomas with the DMA as a feeding artery correlated with tumor attachment to Area 1 (p < 0.001). Meningiomas with the APA correlated with tumor attachment to Area 2 (p < 0.001). Meningiomas with the TA correlated with tumor attachment to Area 3 (p < 0.001). The PB correlated with Area 3 (p < 0.05). Our study founded that visualization of these arteries correlated well with specific areas. These arteries were also the main feeders in each type of skull base meningioma. [ABSTRACT FROM AUTHOR]

This review explores the evolving landscape of antibody-based therapies in neuro-oncology, in particular, immune checkpoint inhibitors and immunomodulatory antibodies. We discuss their mechanisms of action, blood-brain barrier (BBB) penetration, and experience in neuro-oncological conditions. Evidence from recent trials indicates that while these therapies can modulate the tumor immune microenvironment, their clinical benefits remain uncertain, largely due to challenges with BBB penetration and tumor-derived immunosuppression. This review also examines emerging targets such as TIGIT and LAG3, the potential of antibodies in modulating the myeloid compartment, and tumor-specific targets for monoclonal antibody therapy. We further delve into advanced strategies such as antibody–drug conjugates and bispecific T cell engagers. Lastly, we explore innovative techniques being investigated to enhance antibody delivery, including CAR T cell therapy. Despite current limitations, these therapies hold significant therapeutic potential for neuro-oncology. Future research should focus on optimizing antibody delivery to the CNS, identifying novel biological targets, and discovering combination therapies to address the hostile tumor microenvironment. [ABSTRACT FROM AUTHOR]

Brain tumors account for 1% of all cancers diagnosed de novo. Due to the specificity of the anatomical area in which they grow, they can cause significant neurological disorders and lead to poor functional status and disability. Regardless of the results of biochemical markers of intracranial neoplasms, they are currently of no diagnostic significance. The aim of the study was to use LC-ESI-MS/MS in conjunction with multivariate statistical analyses to examine changes in amino acid metabolic profiles between patients with glioblastoma, meningioma, and a group of patients treated for osteoarthritis of the spine as a control group. Comparative analysis of amino acids between patients with glioblastoma, meningioma, and the control group allowed for the identification of statistically significant differences in the amino acid profile, including both exogenous and endogenous amino acids. The amino acids that showed statistically significant differences (lysine, histidine, α-aminoadipic acid, phenylalanine) were evaluated for diagnostic usefulness based on the ROC curve. The best results were obtained for phenylalanine. Classification trees were used to build a model allowing for the correct classification of patients into the study group (patients with glioblastoma multiforme) and the control group, in which cysteine turned out to be the most important amino acid in the decision-making algorithm. Our results indicate amino acids that may prove valuable, used alone or in combination, toward improving the diagnosis of patients with glioma and meningioma. To better assess the potential utility of these markers, their performance requires further validation in a larger cohort of samples. [ABSTRACT FROM AUTHOR]

Simple Summary: Tuberculum sellae meningioma is a condition that typically results in visual impairment as well as other symptoms, such as hemianopsia and parasellar extension. This study aimed to show the epidemiology and clinical profile of tuberculum sella meningioma at Indonesia's National Referral Hospital. This study also used the TSM scoring system to describe tumor severity and predict outcomes. Canal invasion is associated with visual impairment symptoms, and both canal and vascular invasion can impact the resectability of the tumor. Other factors that may influence the patient's visual outcome include the onset of visual symptoms, peritumoral edema, and grade of excision. Hence, this study can be utilized to develop a scoring system to predict the severity and outcomes of patients after surgery. Tuberculum sellae meningioma (TSM) is a challenging tumor that grows close to several crucial structures, such as the optic nerve, arteries, and pituitary. Surgical treatment is currently evolving from a transcranial microsurgical resection to a transsphenoidal approach. This study examined the clinical profile of patients with tuberculum sellae meningioma and explored its relationship with scoring systems. This retrospective observational study included patients with TSM who underwent surgery at the Department of Neurosurgery at our hospital between 2017 and 2022. The patients were excluded if their data required completion. The clinical profiles of the patients were counted and transformed into a scoring system using several variables such as size, vascular, and canal invasion. We then analyzed the relationship between the clinical signs and symptoms to determine the efficacy of this scoring system. Thirty-six patients were included in the study. Most of our patients had a high score for tumor diameter, bilateral canal invasion, and vascular invasion (2-2-2). Moreover, when related to clinical signs, there was no relationship between the canal and vascular invasion and decreased visual acuity. Tuberculum sellae meningioma mostly causes visual impairment and several other symptoms, such as hemianopsia and parasellar extension. Several factors in the scoring system should also be considered to predict outcomes, such as the onset of visual symptoms, peritumoral edema, and grade of excision. [ABSTRACT FROM AUTHOR]

Meningiomas are the most common tumours of the central nervous system. According to the World Health Organization (WHO), this disease is classified into three different grades: 80% of meningioma patients present with benign grade I tumours, while less than 2% present with malignant grade III meningiomas. Despite affecting thousands of people worldwide, much remains unknown about this disease, and the development of systemic treatments is still far behind in comparison to other types of tumours. Therefore, forming 3D structures (spheroids and organoids) could facilitate research on the mechanisms of formation, proliferation, migration, and invasion of these, for the most part, benign tumours, while also helping in the process of drug development. To date, there are three published methods for the formation of meningioma organoids primarily derived from patient tissue samples. Organoids offer many advantages in the development of treatments because they recapitulate the cellular complexity within tumours. These new methodological advances could open a substantial number of possibilities for the further characterisation and treatment of meningiomas. This review includes an overview of the disease and a description and comparison of established protocols for meningioma organoid formation. [ABSTRACT FROM AUTHOR]

Meningiomas are common primary brain tumors, and their accurate preoperative grading is crucial for treatment planning. This study aimed to evaluate the value of radiomics and clinical imaging features in predicting the histologic grade of meningiomas from preoperative MRI. We retrospectively reviewed patients with intracranial meningiomas from two hospitals. Preoperative MRIs were analyzed for tumor and edema volumes, enhancement patterns, margins, and tumor–brain interfaces. Radiomics features were extracted, and machine learning models were employed to predict meningioma grades. A total of 212 patients were included. In the training group (Hospital 1), significant differences were observed between low-grade and high-grade meningiomas in terms of tumor volume (p = 0.012), edema volume (p = 0.004), enhancement (p = 0.001), margin (p < 0.001), and tumor–brain interface (p < 0.001). Five radiomics features were selected for model development. The prediction model for radiomics features demonstrated an average validation accuracy of 0.74, while the model for clinical imaging features showed an average validation accuracy of 0.69. When applied to external test data (Hospital 2), the radiomics model achieved an area under the receiver operating characteristics curve (AUC) of 0.72 and accuracy of 0.69, while the clinical imaging model achieved an AUC of 0.82 and accuracy of 0.81. An improved performance was obtained from the model constructed by combining radiomics and clinical imaging features. In the combined model, the AUC and accuracy for meningioma grading were 0.86 and 0.73, respectively. In conclusion, this study demonstrates the potential value of radiomics and clinical imaging features in predicting the histologic grade of meningiomas. The combination of both radiomics and clinical imaging features achieved the highest AUC among the models. Therefore, the combined model of radiomics and clinical imaging features may offer a more effective tool for predicting clinical outcomes in meningioma patients. [ABSTRACT FROM AUTHOR]

A 61-year-old patient was diagnosed with a left-sided falx meningioma. Histopathological analysis following extirpation showed a meningothelial meningioma ZNS WHO grade 1 with sparse mitoses. Over the course of 12 years, the patient received irradiation (54.0 Gy), peptide radio-receptor therapy (177Lu-DOMITATE) and targeted therapy (mTOR inhibitor). Follow-up imaging revealed an increased size of the residual tumor. Due to increased liver function parameters, imaging of the liver was performed, showing widespread space-occupying lesions with atypical appearance. Biopsy revealed metastasis of the meningioma, now with 2.7 mitoses/mm2, necrosis and homozygous CDKN2A/B deletion, corresponding to an anaplastic CNS meningioma WHO grade 3. A second small meningioma on the left petroclival side has been consistent in size over 12 years. Metastatic meningiomas pose a pertinent clinical challenge due to poor prognosis. The lung, bone, liver and cervical lymph nodes are the most common sites of extracranial metastasis. According to the World Health Organization criteria, the most important predictive factor for recurrence and metastasis is the tumor grade. [ABSTRACT FROM AUTHOR]

Simple Summary: Prediction of high-grade meningioma on preoperative Magnetic Resonance Imaging (MRI) is essential in therapeutic planning and evaluation of prognosis. In this study, we propose a dual-level augmentation strategy incorporating image-level augmentation (IA) and feature-level augmentation (FA) to tackle class imbalance and improve the predictive performance of radiomics for meningioma grading on multisequence MRI. The radiomics model yields robust performance in 100 repetitions in 3-, 5-, and 10-fold cross-validation. In addition, our method significantly outperformed single-level augmentation (IA or FA) or no augmentation in each cross-validation. As an effective meningioma grading tool, our radiomics model may support clinical decision making and individualized treatment. Background: Preoperative, noninvasive prediction of meningioma grade is important for therapeutic planning and decision making. In this study, we propose a dual-level augmentation strategy incorporating image-level augmentation (IA) and feature-level augmentation (FA) to tackle class imbalance and improve the predictive performance of radiomics for meningioma grading on Magnetic Resonance Imaging (MRI). Methods: This study recruited 160 consecutive patients with pathologically proven meningioma (129 low-grade (WHO grade I) tumors; 31 high-grade (WHO grade II and III) tumors) with preoperative multisequence MRI imaging. A dual-level augmentation strategy combining IA and FA was applied and evaluated in 100 repetitions in 3-, 5-, and 10-fold cross-validation. Results: The best area under the receiver operating characteristics curve of our method in 100 repetitions was ≥0.78 in all cross-validations. The corresponding cross-validation sensitivities (cross-validation specificity) were 0.72 (0.69), 0.76 (0.71), and 0.63 (0.82) in 3-, 5-, and 10-fold cross-validation, respectively. The proposed method achieved significantly better performance and distribution of results, outperforming single-level augmentation (IA or FA) or no augmentation in each cross-validation. Conclusions: The dual-level augmentation strategy using IA and FA significantly improves the performance of the radiomics model for meningioma grading on MRI, allowing better radiomics-based preoperative stratification and individualized treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite the benign nature of these tumors, spinal meningiomas can cause significant neurological damage via compression of the spinal cord. In this study, we found that neurological function improves in a significant proportion of patients after surgery. Preoperative Frankel grade was a significant predictor of postoperative neurological worsening. Cross-section area measurements on MRI scans are not associated with early postoperative outcomes. Background: Due to the slow-growing nature of spinal meningiomas, they are mostly asymptomatic for a long time, and become symptomatic after the compression of the spinal cord or nerve roots. The aim of this study was to identify predictors for a poor clinical outcome after the surgical resection of spinal meningiomas and thereby to allow a preoperative identification of high-risk spinal meningiomas. Methods: Data acquisition was conducted as a single-center retrospective analysis. From 1 January 2004 to 31 December 2019, 121 patients who underwent surgical resection of a spinal meningioma were reviewed. Clinical and radiological data (such as tumor size, location, occupation ratio of the spinal canal, and the degree of spinal cord compression) were assessed. The functional clinical findings of the patients were recorded using the Karnofsky Performance Score, modified McCormick scale, and Frankel scale preoperatively, at discharge, and 3–6 months after surgery. Results: The mean patient age was 66 ± 13 years. A total of 104 (86%) patients were female and 17 (14%) were male. The thoracic spine (68%) was the most common location, followed by the cervical (29%) and lumbar (3%) spine. Preoperatively, 11.7% of patients were categorized as McCormick 1, 35.8% as 2, 39.2% as 3, 11.7% as 4, and 1.7% as 5. The neurological function of the patients with a functional deficit prior to surgery improved in 46% of the patients, remained unchanged in 52%, and worsened in 2% at discharge. At early follow-up, the proportions were 54%, 28%, and 5%, respectively. Preoperative Frankel scale was a significant predictor of a postoperative deterioration. Patients with Frankel score A to C preoperatively had a 9.2 times higher chance of clinical deterioration postoperatively (OR = 9.16). We found that the Frankel scale weakly correlated with the degree of spinal cord compression. In this study, other radiological parameters, such as the degree of cord compression and spinal canal occupation ratio, did not show a significant effect on the outcome. Conclusions: Surgery of intraspinal meningiomas can be considered safe. Neurological function improves in a large proportion of patients after surgery. However, a relevant preoperative deficit according to the Frankel scale (grade A–C) was a significant predictor of a postoperative neurological deterioration. [ABSTRACT FROM AUTHOR]

Simple Summary: MRI and histological assessment remain the gold standard for meningioma diagnosis. Currently, WHO grading of meningiomas mainly depends on histologic and morphological markers and two molecular markers. WHO grading can reliably diagnose meningiomas in most cases. However, it was not as dependable in predicting prognosis, especially time to recurrence of Grade 1 and 2 meningiomas. This warrants the integration of new biomarkers into the current WHO grading system of meningiomas. Future meningioma biomarkers need to utilize an array of molecular technologies for biomarkers discovery, including genomic, epigenetic, proteomis, metabolomic, and RNA biomarkers, as well as a panel format to complement the existing WHO grading. The majority of candidate meningioma molecular biomarkers are still experimental and need to undergo testing in clinical trials, but their application in meningioma diagnosis will be necessary to guide future targeted therapies of meningiomas. Meningiomas are the most prevalent primary intracranial tumors. The majority are benign but can undergo dedifferentiation into advanced grades classified by World Health Organization (WHO) into Grades 1 to 3. Meningiomas' tremendous variability in tumor behavior and slow growth rates complicate their diagnosis and treatment. A deeper comprehension of the molecular pathways and cellular microenvironment factors implicated in meningioma survival and pathology is needed. This review summarizes the known genetic and epigenetic aberrations involved in meningiomas, with a focus on neurofibromatosis type 2 (NF2) and non-NF2 mutations. Novel potential biomarkers for meningioma diagnosis and prognosis are also discussed, including epigenetic-, RNA-, metabolomics-, and protein-based markers. Finally, the landscape of available meningioma-specific animal models is overviewed. Use of these animal models can enable planning of adjuvant treatment, potentially assisting in pre-operative and post-operative decision making. Discovery of novel biomarkers will allow, in combination with WHO grading, more precise meningioma grading, including meningioma identification, subtype determination, and prediction of metastasis, recurrence, and response to therapy. Moreover, these biomarkers may be exploited in the development of personalized targeted therapies that can distinguish between the 15 diverse meningioma subtypes. [ABSTRACT FROM AUTHOR]