Cranial nerve function after cerebellopontine angle meningiomas removal

Objective. To analyze cranial nerves (CN) dysfunction incidence in cerebellopontine angle (CPA) meningiomas removal depending on topographic and anatomical tumor location type and define the ways to reduce CN dysfunction incidence and severity. Materials and methods. The study included 30 CPA meningioma patients operated on in the clinic over a 10-year period (from 2010 to 2020 inclusive). Tumor characteristics, the degree of extent (including matrix location, particularly in relation to the internal auditory canal (IAC), jugular foramen (JF), and Meckel’s cave), and supratentorial extension were assessed. The tumors were divided into 5 groups according to the classification of Nakamura et al. Particular attention was paid to the presence and severity of pre- and postoperative cranial nerves dysfunction. Results. Different groups of CPA meningiomas in terms of the presence of a new CN neurological deficit were compared in the study. CN VII dysfunction was more frequently detected in group 2 — meningiomas extending to IAC, which was 54.5% of all observed tumors in this group vs. premeatal tumors, where new CN VII deficit was 20%, in group 1. At the same time in groups 3, 4, and 5 there was no new CN VII deficit. Conclusions. The most frequent symptoms in patients of all groups were dizziness, headache and unsteady gait. Of all the symptoms, only unsteady gait and hearing impairment were more common in patients in group 2, however the differences were statistically insignificant (p = 0.135 and p = 0.268, respectively). Trigeminal nerve and auditory nerve were most commonly affected. Auditory nerve lesions were more often detected in patients of group 2 than in patients of other groups, however, the differences were statistically insignificant (p = 0.268). In general, there were no statistically significant differences between the groups in terms of the incidence of various symptoms and the incidence of CPA cranial nerve damage

Surgical treatment of glossopharyngeal nerve schwannomas: Results of two-center study (14 patients included) and literature review

Objective: This study is aimed to analyze the outcomes of surgical treatment of glossopharyngeal schwannomas based on pre- and postoperative neurological status assessment. Materials and methods: This paper is a retrospective analysis of examination and surgical treatment of 14 patients who were operated on in two large clinics from 2018 to 2021 inclusive. When analyzing the collected data, gender, age, disease symptoms, tumor size and location, surgical approach, tumor to cranial nerves (CN) ratio, jugular foramen (JF) condition, and tumor removal volume were taken into account. All tumors were divided into groups depending on tumor location relative to the JF. Particular attention was paid to assessing cranial nerves functions. Facial nerve function was assessed as per House-Brackmann Scale (HBS), hearing function as per Gardner-Robertson Scale (GRS). Results: 3 (21.4%) patients had total tumor removal: 2 patients had type A tumors and one had type B tumor. Subtotal resection took place in 7 (50%) cases. In 4 cases, a tumor was partially removed: 3 patients had type D tumors and one had type B tumor. 3 (21.4%) patients had preoperative FN deficit (HBS Grade II) and mild dysfunction. 5 (35.7%) patients had postoperative facial nerve deficit: HBS ІІ, 2; ІІІ, 1; V, 2. Preoperative sensorineural type hearing impairment on the affected side was diagnosed in 13 (92.6%) patients. Before surgery, 6 patients had non-serviceable hearing, which remained at the same level after surgery. None of the patients with grade I or II hearing before surgery had any hearing impairment postoperatively. In 2 (14.3%) cases, hearing improved from grade V to grade III after surgery. 6 (42.9%) patients developed new neurological deficit in the caudal group CN. Postoperative deficit of the caudal group CN occurred in type D tumors in 3 patients, type A tumors 2 patients, and type B tumors one patient. Conclusions: Applying a retrosigmoid approach only makes it possible to achieve total tumor removal in case of type A tumors. To remove other tumor types, it is necessary to select approaches that enable access to the jugular foramen and infratemporal fossa. Intraoperative neurophysiological monitoring is an extremely important tool in glossopharyngeal schwannoma surgery. The most common postoperative complication is a developed or increased deficit of the caudal CN group, which can lead to persistent impairments in the patients’ quality of life. Preservation of the CN VII and VIII function in most cases is a feasible task and shall be ensured as a standard for this pathology

Parasagittal meningiomas: surgical treatment outcomes

Purpose: to improve the outcomes of surgical treatment of parasagittal meningioma patients by implementing a differentiated approach to the choice of surgical intervention, given the preoperative assessment of patency of the superior sagittal sinus (SSS) and collateral venous circulation. Materials and methods. Analysis of short-term and long-term outcomes of surgical treatment of 199 patients in the Department of Neurosurgery № 2, Mechnikov Dnipropetrovsk Regional Clinical Hospital was carried out. In the first follow-up period (2000 to 2012), the data were obtained retrospectively (95 cases). In the second follow-up period (2013 to 2021), the data were obtained prospectively (104 cases). The patients were assigned to the groups according to a differentiated approach (implemented in 2013) to the choice of surgical treatment tactics based on preoperative angiographic data (selective cerebral angiography and CT angiography). Results. In the first follow-up period, the completeness of surgical resection according to Simpson Grading Scale was: type I, 23 (24.2%) cases; type II, 37 (38.9%) cases; type III, 13 (13.7%) cases; type IV, 22 23.2%) cases. 53.7% of patients had intraoperative or postoperative complications. Among patients with tumors of the middle third of the SSS, 21 (41.2%) had their neurological status improved postoperatively. Mortality rate was 4.2%. 14 (14.7%) patients had further parasagittal meningioma growth after its removal grade II–IV according to Simpson Scale. In the second follow-up period, the completeness of surgical intervention according to Simpson Scale was: type I, 74 (71.2%) cases; type II, 26 (25%) cases; type III, 2 (1.9%) cases; type IV, 2 (1.9%) cases. 19.2% of patients had intraoperative or postoperative complications. Among the patients with tumors of the middle third of the SSS, 46 (79.3%) patients had postoperative improvement of neurological status. No lethal outcome was reported. 3 (2.9%) patients had further parasagittal meningioma growth after radical surgical removal according to Simpson grade II. Conclusions. Adequate analysis of instrumental methods of brain study using cerebral vasculature study, application of neuronavigation station (with brain MRI and/or CT angiography data available) and new microsurgical techniques contributed to the completeness of surgery and minimally invasive removal of parasagittal meningioma with reduced intraoperative and postoperative complications, which affected the immediate and long-term treatment outcomes

The prognostic role of Ki67, p53, Her2, and CyD1 immunohistochemical markers in recurrent parasagittal meningiomas

Objective. Determine the role of Ki67, p53, Her2, and CyD1 immunohistochemical markers in predicting the recurrence of parasagittal meningiomas Materials and Methods. The immunohistochemical (IHC) study was conducted in 26 parasagittal meningioma (PM) patients aged 36 to 72, who were treated in the Mechnikov Dnipropetrovsk Regional Clinical Hospital from 2000 to 2021 inclusive. 26 patients were divided into 2 equal groups with the most similar characteristics (patient’s gender, age, and meningioma malignancy as of the time of primary surgery) using the balancing method (pairwise selection). The study group consisted of 13 (50%) patients with detected postoperative PM recurrence/prolonged growth, while the control group included the remaining 13 (50%) patients with no PM recurrence. To evaluate prospects of further studies, the expression of the following markers by the tumor was analyzed: cell proliferation (Ki67), genome stability (p53 protein), dysfunction of epidermal growth factor signaling pathways (ERBB2 or Her-2/neu (Her2)), and cell cycle regulators (cyclin D1 (CyD1)). Results. An association between the PM’s high proliferative activity and its recurrence was moderate (rs=0.44, р=0.025). Median Ki-67 in the study PM group (with recurrence) was three times higher than that in the control group (no recurrence) — 6.0% (4.0%; 9.0%) vs. 2.0% (0.5%; 4.5%) (p=0.029). In the case of Ki67 expression > 4.5%, the risk of PM recurrence/prolonged growth increased by 7.5 times (OR=7.5; 95% CI (1.3–43.0)) (area under the ROC curve, AUC=0.751 (95% CI, 0.544–0.898), p=0.011). The comparative and correlation analysis found no significant association between the p53 protein mutation and the PM recurrence (rs=0.23, р=0.254). Neither we found a significant association between the PM recurrence and the CyD1 expression (rs=0.29, р=0.147) or severity (rs=-0.08, р=0.696). The correlation between the Her2 expression in the PM cells and the PM recurrence was insignificant (rs=0.23, р=0.251). The primary PM malignancy (Grade II–III) increases the risk of unfavorable prognosis by 5.3 times (95% CI, 1.0–29.4) (AUC= 0.722) (95% CI, 0.513–0.878); p=0.016, sensitivity= 61.5%, specificity= 76.9%. Conclusions. The following can be considered probable predictors of the PM recurrence after the primary surgery (within 20 years of follow-up): Ki67 proliferation index > 4.5% and grade II–III tumor malignancy. The comparative and correlation analysis found no statistically significant association between the tumor recurrence and the p53, Her2, and CyD1 immunohistochemical markers. However, the detected significant correlation between the p53, Her2, and CyD1 markers expression and the Ki67 proliferative index and tumor malignancy requires further research with a larger number of clinical observations

Intracranial aneurysms treatment using new generation FRED X flow diverters with antithrombotic coating and preoperative PreSize Neurovascular software simulation: literature review and own clinical observations analysis

Objective: Evaluate the possibilities of treating giant intracranial aneurysms and complex anatomy aneurysms by implanting new generation of FRED X flow diverters (MicroVention, USA) with antithrombogenic surface subject to preoperative virtual modeling and sizing with PreSize Neurovascular software (Oxford Heartbeat Ltd, Great Britain). Materials and Methods. FRED X flow diverters with antithrombogenic surface were implanted in 7 patients with giant cerebral aneurysms and complex anatomy aneurysms in the Endovascular Center at Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, within two months (May 2, 2023 to June 27, 2023). Our study group consisted of 4 (57.1%) female patients and 3 (42.9%) male patients (p=1.0). The average age was 50.4±13.7. 4 patients had single intracranial aneurysms and 3 patients had multiple aneurysms. 2 patients had 2 aneurysms and 1 patient had 4 aneurysms. 3 patients had a hemorrhagic clinical course of the disease (spontaneous subarachnoid hemorrhage in the history), 3 patients had asymptomatic aneurysms, and 1 patient had a pseudotumorous aneurysm. Results. All 7 patients underwent the ICA aneurysm(s) surgery. 3 patients had a flow diverter implanted at the level of multiple aneurysms (in 2 patients, 2 aneurysms; in 1 patient, 3 aneurysms). 2 patients, in addition to flow diverter implantation, underwent coil aneurysms embolization (using jailing technique). In all patients, the flow diverter was implanted under dual (ticagrelor and acetylsalicylic acid) antiplatelet therapy. 3 patients with a history of subarachnoid aneurysmal hemorrhage received a loading dose of dual antiplatelet therapy immediately before the flow diverter implantation. In one patient with a complex closed siphon shape, balloon angioplasty was required to optimize flow diverter opening to the arterial wall. In all other 6 patients, the flow diverters were opened in a controlled manner with a Push & Pull technique variant: Load/Tension Unsheath technique. Conclusions: In the endovascular treatment of giant and complex aneurysms, the use of new generation FRED X flow diverters (MicroVention, USA) with antithrombogenic coating subject to proper diverters sizing with PreSize Neurovascular software does not cause technical difficulties and is controlled