Intradural angiomatous meningioma arising from a thoracic nerve root

BACKGROUND: Spinal intradural meningiomas that arise purely from a nerve root without dural attachments are extremely rare. Spinal meningiomas arise from arachnoidal cap cells in the spinal canal, and growth of these tumors exerts pressure on the spinal cord and nerve roots. CASE DESCRIPTION: A patient presented with a lesion at the T3-T4 level that resembled a schwannoma on magnetic resonance imaging. During surgery, the tumor originated from a spinal nerve root. Pathologically, it was an angiomatous meningioma (AM). CONCLUSIONS: In a review of the literature, we discuss the pathogenesis and surgical strategy for diagnosing and treating these extremely rare AM lesions

The impact of epilepsy on the quality of life of patients with benign meningioma

Meningiomas account for 20% of all brain tumours. They are usually benign and around 35% will develop epilepsy. Despite surgery or anti-epileptic drug (AED) use, intermittent seizures can remain. This may be significant as AED use and continued seizures can lead to reduced quality of life. The aim of this study was to evaluate the impact of epilepsy on the quality of life of patients with benign WHO grade 1 meningiomas. Quality of life questionnaires were posted to meningioma patients with and without epilepsy, and the scores were compared between the two groups. An epilepsy control group (without meningioma) was also included so that the role of meningioma could be evaluated. This is the first study to directly compare quality of life between meningioma patients and meningioma patients with epilepsy. The study hypothesis is that the QoL of meningioma patients with epilepsy will be more impaired than the scores of meningioma patients without epilepsy. It is additionally hypothesised that meningioma patients with epilepsy will have QoL scores that are more impaired than the scores of epilepsy patients without meningioma. In total 229 patients participated in this study: 109 had a meningioma, 56 had meningioma and epilepsy, and 64 had epilepsy without a meningioma. Each group was sent three questionnaires: the Short Form 36 (SF-36), the Functional Assessment of Cancer Therapy with brain subscales (FACT-BR) and the Liverpool Adverse Events Profile (AEP). The demographics and comorbidities of all patients were reviewed, as were the tumour and epilepsy characteristics. Quality of life scores were impaired in the meningioma with epilepsy group but only the FACT-BR detected a significant difference. Quality of life was more impaired in the epilepsy without meningioma group when compared to the meningioma with epilepsy group, but this difference was not significant in any of the questionnaires. In a multiple regression analysis of the meningioma and meningioma with epilepsy groups, unemployment, depression, the number of meningioma symptoms, and the use of AEDs were repeatedly shown to predict impaired quality of life scores. In a regression model containing epilepsy patients and meningioma patients with epilepsy, meningioma symptoms did not significantly predict impaired quality of life. It was concluded that epilepsy does have a negative impact on the quality of life of meningioma patients. However, as epilepsy severity in meningioma patients is mild, so is the impact on quality of life. The effect of the meningioma in epilepsy patients was not as strong as the effect of epilepsy in meningioma patients

Advanced radiation therapies for meningioma

Radiotherapy has been used to treat meningiomas for decades, both in the primary setting when resection is not possible and as an adjunct to surgery in recurrent/ high grade disease. Newer radiotherapy planning and delivery techniques aim to optimise tumour control and minimise long-term toxicities. The purpose of this thesis was to explore the feasibility and potential for the use of advanced radiation planning and delivery techniques to treat meningiomas. In a prospective observational study of intensity modulated radiotherapy (IMRT) in fifty patients I demonstrated that IMRT is feasible and provided excellent dosimetric parameters. Medium term meningioma control rates were >90% in benign disease. Objective measures of toxicity were low. Visual symptoms improved in 38.5% of patients. In a pilot study of ten patients I showed that simultaneous 68Ga DOTATATE PET/MRI can be utilised in meningioma radiotherapy planning. Baseline levels of interobserver variability in target volume definition between three Observers using CT/MRI alone were very high (mean target volume conformity levels of 0.31-0.34). Levels of agreement improved only 4-5% with the addition of PET and there was negligible difference in contouring between standard PET(CT) and simultaneous PET(MRI). In a planning study of ten meningiomas I did not find a notable advantage for proton therapy (non-intensity modulated) over IMRT. The high quality of the IMRT plans left little room for improvement and range uncertainty restricted exploitation of proton dose deposition characteristics. In my review of the first six patients treated with the radionuclide 177Lutetium DOTATATE for advanced progressive meningioma, tumour growth rates were found to slow, but there was generally disease progression during treatment. In conclusion, advanced radiation techniques for meningioma treatment are feasible and can confer clinical benefit. However, advances in technology do not necessarily translate into therapeutic gains. Careful prospective evaluation is required to ensure their optimal use