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