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Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins

OBJECTIVE: Hyperostosis in meningiomas can be present in 4.5% to 44% of cases. Radical resection should include aggressive removal of invaded bone. It is not clear however to what extent bone removal should be carried to achieve pathologically free margins, especially that in many cases, there is a...

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Autores principales: Fathalla, Hussein, Tawab, Mohamed Gaber Abdel, El-Fiki, Ahmed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Neurosurgical Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671773/
https://www.ncbi.nlm.nih.gov/pubmed/32750757
http://dx.doi.org/10.3340/jkns.2020.0020
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author Fathalla, Hussein
Tawab, Mohamed Gaber Abdel
El-Fiki, Ahmed
author_facet Fathalla, Hussein
Tawab, Mohamed Gaber Abdel
El-Fiki, Ahmed
author_sort Fathalla, Hussein
collection PubMed
description OBJECTIVE: Hyperostosis in meningiomas can be present in 4.5% to 44% of cases. Radical resection should include aggressive removal of invaded bone. It is not clear however to what extent bone removal should be carried to achieve pathologically free margins, especially that in many cases, there is a T2 hyperintense signal that extends beyond the hyperostotic bone. In this study we try to investigate the perimeter of tumour cells outside the visible nidus of hyperostotic bone and to what extent they are present outside this nidus. This would serve as an initial step for setting guidelines on dealing with hyperostosis in meningioma surgery. METHODS: This is a prospective case series that included 14 patients with convexity meningiomas and hyperostosis during the period from March 2017 to August 2018 in two university hospitals. Patients demographics, clinical, imaging characteristics, intraoperative and postoperative data were collected and analysed. In all cases, all visible abnormal bone was excised bearing in mind to also include the hyperintense diploe in magnetic resonance imaging (MRI) T2 weighted images after careful preoperative assessment. To examine bony tumour invasion, five marked bone biopsies were taken from the craniotomy flap for histopathological examinations. These include one from the centre of hyperostotic nidus and the other four from the corners at a 2-cm distance from the margin of the nidus. RESULTS: Our study included five males (35.7%) and nine females (64.3%) with a mean age of 43.75 years (33-55). Tumor site was parietal in seven cases (50%), fronto-parietal in three cases (21.4%), parieto-occipital in two cases (14.2%), frontal region in one case and bicoronal (midline) in one case. Tumour pathology revealed a World Health Organization (WHO) grade I in seven cases (50%), atypical meningioma (WHO II) in five cases (35.7%) and anaplastic meningioma (WHO III) in two cases (14.2%). In all grade I and II meningiomas, bone biopsies harvested from the nidus revealed infiltration with tumour cells while all other bone biopsies from the four corners (2 cm from nidus) were free. In cases of anaplastic meningiomas, all five biopsies were positive for tumour cells. CONCLUSION: Removal of the gross epicentre of hyperostotic bone with the surrounding 2 cm is adequate to ensure radical excision and free bone margins in grade I and II meningiomas. Hyperintense signal change in MRI T2 weighted images, even beyond visible hypersototic areas, doesn’t necessarily represent tumour invasion.
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spelling pubmed-76717732020-11-19 Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins Fathalla, Hussein Tawab, Mohamed Gaber Abdel El-Fiki, Ahmed J Korean Neurosurg Soc Clinical Article OBJECTIVE: Hyperostosis in meningiomas can be present in 4.5% to 44% of cases. Radical resection should include aggressive removal of invaded bone. It is not clear however to what extent bone removal should be carried to achieve pathologically free margins, especially that in many cases, there is a T2 hyperintense signal that extends beyond the hyperostotic bone. In this study we try to investigate the perimeter of tumour cells outside the visible nidus of hyperostotic bone and to what extent they are present outside this nidus. This would serve as an initial step for setting guidelines on dealing with hyperostosis in meningioma surgery. METHODS: This is a prospective case series that included 14 patients with convexity meningiomas and hyperostosis during the period from March 2017 to August 2018 in two university hospitals. Patients demographics, clinical, imaging characteristics, intraoperative and postoperative data were collected and analysed. In all cases, all visible abnormal bone was excised bearing in mind to also include the hyperintense diploe in magnetic resonance imaging (MRI) T2 weighted images after careful preoperative assessment. To examine bony tumour invasion, five marked bone biopsies were taken from the craniotomy flap for histopathological examinations. These include one from the centre of hyperostotic nidus and the other four from the corners at a 2-cm distance from the margin of the nidus. RESULTS: Our study included five males (35.7%) and nine females (64.3%) with a mean age of 43.75 years (33-55). Tumor site was parietal in seven cases (50%), fronto-parietal in three cases (21.4%), parieto-occipital in two cases (14.2%), frontal region in one case and bicoronal (midline) in one case. Tumour pathology revealed a World Health Organization (WHO) grade I in seven cases (50%), atypical meningioma (WHO II) in five cases (35.7%) and anaplastic meningioma (WHO III) in two cases (14.2%). In all grade I and II meningiomas, bone biopsies harvested from the nidus revealed infiltration with tumour cells while all other bone biopsies from the four corners (2 cm from nidus) were free. In cases of anaplastic meningiomas, all five biopsies were positive for tumour cells. CONCLUSION: Removal of the gross epicentre of hyperostotic bone with the surrounding 2 cm is adequate to ensure radical excision and free bone margins in grade I and II meningiomas. Hyperintense signal change in MRI T2 weighted images, even beyond visible hypersototic areas, doesn’t necessarily represent tumour invasion. Korean Neurosurgical Society 2020-11 2020-08-05 /pmc/articles/PMC7671773/ /pubmed/32750757 http://dx.doi.org/10.3340/jkns.2020.0020 Text en Copyright © 2020 The Korean Neurosurgical Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Article
Fathalla, Hussein
Tawab, Mohamed Gaber Abdel
El-Fiki, Ahmed
Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins
title Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins
title_full Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins
title_fullStr Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins
title_full_unstemmed Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins
title_short Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins
title_sort extent of hyperostotic bone resection in convexity meningioma to achieve pathologically free margins
topic Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671773/
https://www.ncbi.nlm.nih.gov/pubmed/32750757
http://dx.doi.org/10.3340/jkns.2020.0020
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