This book provides a comprehensive overview of the multidisciplinary management of meningiomas, followed by evaluation and management considerations along a spectrum of benign to more malignant behavior. It outlines the management of presumed Grade 1 tumors and how to identify features of tumors radiographically and clinically that may support a benign course rather than aggressive and vice versa. Following a stepwise progression from simple to complex, chapters introduce and tackle more aggressive meningiomas and tumor recurrence (of all Grades), with paradigms for evaluation and treatment. Tumor biology and genomics are fundamental and largely focused in the book. More recent findings which have directed personalized medicine and clinical trials are also addressed.
Meningiomas: Comprehensive Strategies for Management addresses all aspects of the evaluation and care of patients with all WHO grades of meningiomas. It is highly informative and provides clarity for a wide audience of neurosurgeons, reconstructive surgeons, oncologists, neurologists, radiation oncologists, pathologists, radiologists, residents and students who treat these patients and those who are training for a career in managing patients with these potentially challenging tumors.
Author(s): Jennifer Moliterno, Antonio Omuro
Publisher: Springer
Year: 2021
Language: English
Pages: 243
City: Cham
Preface
Contents
Contributors
Part I: Meningioma Basics
1: An Overview of Meningiomas
A Brief Historical Perspective on Meningiomas
Demographics, Incidence, and Prevalence
Risk Factors
Neurofibromatosis Type 2
Other Genetic Risk Factors
Radiation
Hormonal Factors
Current Research Trends
References
2: Histopathology and Grading of Meningiomas
Meningioma Histogenesis
Grading of Meningioma
WHO Grade I (Benign) Meningiomas
WHO Grade II Meningiomas
WHO Grade III (Malignant) Meningiomas
Meningioma Immunophenotype
Differential Diagnoses of Meningioma
Non-meningothelial Mesenchymal Tumors
Metastatic Neoplasms
Other Differential Diagnoses
References
3: Radiographic Assessment of Meningiomas
Introduction
Standard Imaging Assessment of Meningioma
CT
MRI
Current Limitations of Standard Imaging
Volumetric Analysis of Meningiomas
Advanced Imaging Techniques
PET Imaging
MR Perfusion
Other Modalities
References
4: The Genomic Landscape of Meningiomas
Introduction
Genomic Profile of Meningiomas
Hereditary Meningioma Syndromes
Common Variants in Meningioma Susceptibility
Radiation-Induced Meningiomas
Sporadic Meningiomas
Somatic Mutations in Meningiomas
Somatic Copy Number Variations in Meningiomas
Somatic Noncoding Alterations in Meningiomas
Epigenetic Regulation/Deregulation in Meningiomas and Atypical Meningiomas
Clinical Correlates of Meningioma Genomics
Precision Medicine for Meningiomas
Conclusion and Future Directions
References
Part II: Initial Meningioma Management and Treatment Paradigms
5: The Initial Evaluation and Surveillance of Meningiomas
Epidemiology
Prognostic Factors
Pathogenesis
Grading
Clinical Evaluation
Imaging Studies
Differential Diagnosis
Histopathology
Surveillance and Treatment
Presumed
Grade I
Grade II
Grade III
Survival
Future Avenues
References
6: Surgical Considerations for Newly Diagnosed Meningiomas
Introduction
Indications for Surgery
Surgical Considerations for Multiple Meningiomas
Pre-operative Evaluation and Surgical Planning
Technical Nuances to Meningioma Surgery
CSF Diversion
Neurophysiology Monitoring
Microsurgical Techniques
Post-Operative Considerations
Conclusions
References
7: Endoscopic and Minimally Invasive Meningioma Surgery
Rationale and Background
Endoscopic Endonasal Approach to Skull Base Meningiomas
Indications, Contraindications, and Considerations
Surgical Technique
Instruments
The Approach
The Supraorbital Keyhole Craniotomy for Meningiomas
Indications, Contraindications, and Considerations
Approach
The Transorbital Endoscopic Eyelid Approach for Meningiomas
Indications, Contraindications, and Considerations
Approach
Conclusion
References
8: Comprehensive Treatment Strategies for Spinal Meningiomas
Introduction
Part I:Epidemiology, Pathology, and Diagnosis of Spinal Meningioma
Epidemiology
Histology and Pathophysiology
Imaging
Terminology for Spinal Meningioma
Natural History of Spinal Meningioma
Differential Diagnosis
Part II: Management of Spinal Meningioma
Observation
Surgical Indications
Surgical Goals
Surgical Approach and Considerations
Resection Techniques
Immediate Postoperative Management
Instrumentation
Surgical Adjuvants
Role of Radiation/Radiosurgery
Chemotherapy
Part III: Outcomes for Spinal Meningioma
Surgical Outcomes
Recurrence
Conclusion
References
9: Radiation Therapy for Low Grade Meningiomas
General Radiation Paradigm
Efficacy of Primary Radiotherapy for Benign Meningioma
Candidates for Definitive Radiation Therapy
Modalities of Radiation
Photon
Proton
Stereotactic Radiosurgery (SRS)
Gamma Knife SRS
LINAC-Based Radiosurgery
CyberKnife SRS
Fractionated External Beam Radiation Therapy
Radiation Effects
Radiation-Induced Meningioma
Radiation in the Setting of Genetic Diseases
Conclusion
References
Part III: Treatment Options for more aggressive meningiomas
10: Low Grade Tumor Recurrence and Management of More Aggressive Meningiomas
Introduction
Characteristics of the “Aggressive Meningioma”
Demographics
Imaging
Current Management of Aggressive Meningiomas
Principles
Surgery
Adjuvant Treatment
Future Directions
The Status Quo
Radiotherapy
Chemotherapy
Hormonal Therapy
Molecular Therapy
Other Modalities
Conclusions
References
11: Surgical Considerations for Recurrent Meningiomas
Introduction
Incidence of Meningioma Recurrence
Natural History and Pathogenesis
Surgical Planning and Strategizing
Major Venous Sinus Invasion and Sinus Reconstruction Techniques
Conservative Management
Aggressive Management
Adjuvant Therapies
Treatment Outcome
Recurrent Skull Base Meningiomas
Recurrent Non-skull Base Meningiomas
Conclusions
References
12: Radiotherapy for Aggressive Meningiomas and Recurrent Low Grade Tumors
Introduction
Histopathology
Management and Outcomes
General Principles of Surgical Resection
Radiotherapy for WHO Grade II Meningiomas
Stereotactic Radiosurgery
Radiotherapy for WHO Grade III Meningiomas
Stereotactic Radiosurgery
Recurrent Disease
Radiotherapy for Recurrent Disease
Radiotherapy Planning
Grade II: Intermediate Risk
Grade III
Recurrence
Advanced Imaging Techniques
Adverse Effects
External Beam Radiation Therapy
Stereotactic Radiosurgery
Conclusion
References
13: The Role of Medical Therapy for Menigniomas
Introduction and General Treatment Strategies
Cytotoxic Therapy
Hydroxyurea
Other Chemotherapy Agents (Dacarbazine, Doxorubicin, Ifosfamide, Mesna, Temozolomide, and Irinotecan)
Current Agents Under Investigation
Hormonal Therapy
Estrogen Receptor Inhibitors
Progesterone Receptor Inhibitors
Somatostatin Analogues
Immunologic Agents
Interferon-Alpha-2b
Molecularly Targeted Agents
PDGFR Inhibitors: Imatinib
EGFR Inhibitors: Erlotinib and Gefitinib
VEGF Inhibitors
Summary and Conclusions
References
14: Emerging Meningioma Therapies I: Precision Medicine, Targeted Therapies, and Mutation-Specific Approaches
Introduction
Molecularly Targeted Therapies Directed by Genetic Analyses
NF2 Mutations and Deletions
Non-NF2-Deleted Tumors
Mutations Affecting CDK
TERT Promoter Mutations
Germline Mutations
Epigenetic Changes
Conclusions
References
15: Emerging Meningioma Therapies II: Immunotherapies, Novel Radiotherapy Techniques, and Other Experimental Approaches
Immunotherapy
PD-L1 Expression
Tumor-Infiltrating Lymphocytes
T-Cell Receptor Engineering
Novel Radiotherapy Techniques
Carbon Ion Therapy
Brachytherapy
Peptide Receptor Radionuclide Therapy
Protein Phosphatase 2A Inhibitor
Mebendazole
Other Experimental Approaches
Tumor Treatment Fields
Conclusion
References
Index
