Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-18T04:43:24.664Z Has data issue: false hasContentIssue false
  • English
  • Français

Hormones, Radiosurgery and Virtual Reality: New Aspects of Meningioma Management

Published online by Cambridge University Press:  18 September 2015

Peter McLaren Black
Peter McLaren Black*
Affiliation:
Neurosurgical Service, Brigham and Women's Hospital and Children's Hospital, Boston, Brain Tumor Center, Brigham and Women's Hospital, Children's Hospital, Dana-Farber Cancer Institute, Joint Center for Radiation Therapy, and Department of Surgery, Harvard Medical School, Boston
*
Division of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The understanding and management of meningiomas is changing significantly today. One of the most striking features of their pathophysiology is their predominance in women. In a series of 517 patients with meningiomas seen by the Brain Tumor Group at Brigham and Women's Hospital, the female:male ratio was 2.4:1. The progesterone receptor appears to be the major candidate to explain this difference. Although meningioma cells variably express receptors for estrogen, androgen, platelet-derived growth factor, epidermal growth factor, and somatostatin, these molecules do not explain the differences because they are not differentially expressed or are not activated. Progesterone receptor can be shown to be expressed in 81% of women and 40% of men with meningiomas; it can also be shown to be activated by transfecting a construct with the progesterone responsive element and a reporter in it and using the cell's own receptors to activate this construct. Surgery remains the mainstay of meningioma management. At the Brigham and Women's Hospital three-dimensional reconstruction techniques have markedly improved the ability to visualize the tumor as well as its relation to vascular structures. With MRI reconstruction, it is possible to know the tumor's relation to the sagittal and other sinuses, to identify feeders and proximity to major arteries, and to establish its location and relation to cortex by frameless stereotaxis. These techniques can be used in a virtual reality format are some of the most powerful in neurosurgery both for teaching and for the surgical procedure itself. External beam radiation has been shown by others to be an effective adjunctive treatment to prevent meningioma recurrence. Recently, linear accelerator radiosurgery and stereotactic radiotherapy have changed the pattern of radiation at our institution. In a series of 56 skull base meningiomas, for example, 95% were controlled (i.e., showed no growth) over a four year period. Fractionated focal radiation potentially offers the same control rate with fewer complications. With increasing understanding and treatment possibilities, meningiomas remain one of the most intriguing and challenging tumors in the nervous system.

Type
Review Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 4 , November 1997 , pp. 302 - 306
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

References

REFERENCES

1.Penfield, W. No Man Apart. Boston, Boston, Little Brown, 1977.Google Scholar
2.Penfield, W. The Torch, Boston, Little Brown, 1961.Google Scholar
3.Rossitch, E JrMoore, MR, Alexander, E 3d,Black, PM, Alexander, E. Historical Vignette. The Neurosurgeon’s neurosurgeon: Cushing operates on a Penfield. Surg Neurol 1990. 33: 150–153.CrossRefGoogle ScholarPubMed
4.Cushing, H. The Life of Sir William Osier. Philadelphia, Charles C. Thomas.Google Scholar
5.Penfield, W. Cranial and Intracranial Endotheliomata-Hemocraniosis. Surgery, Gyn and Obst 1923: 657–674.Google Scholar
6.Penfield, W, Roberts, WL. Speech and Brain Mechanisms. Philadelphia, Thomas.CrossRefGoogle Scholar
7.Carroll, RS, Glowacka, D, Dashner, K, Black, PM. Progesterone receptor expression in meningiomas. Cancer Res 53: 1312–1316.Google Scholar
8.Carroll, RS, Zhang, J, Dashner, Ket al. Androgen receptor expression in meningiomas. J Neurosurg 1995; 82: 453–460.CrossRefGoogle ScholarPubMed
9.Black, PM, Carroll, R, Glowacka, D, Riley, K, Dashner, K. Platelet-derived growth factor expression and stimulation in human meningiomas. J Neurosurg 1994; 81: 388–393.CrossRefGoogle ScholarPubMed
10.Jimenez-Hakim, E, el-Azouzi, M, Black, PM. The effect of prolactin and bombesin on the growth of meningioma-derived cells in monolayer culture. J Neurooncol 1993; 16: 185–190.CrossRefGoogle ScholarPubMed
11.Carroll, R, Zhang, JP, Dashner, K, Black, PM. Epidermal growth factor is activated in meningiomas. J of Neurosurgery 1987: 87.Google Scholar
12.Black, PM. Meningiomas. Neurosurgery 1993; 32.643–657.CrossRefGoogle ScholarPubMed
13.Zhu, J, Frosch, MP, Busque, L, et al. Analysis of meningiomas by methylation- and transcription-based clonality assays. Cancer Res 1995: 3865–3872.Google ScholarPubMed
14.Simpson, D, The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957: 22–39.CrossRefGoogle ScholarPubMed
15.Mirimanoff, RO, Dosoretz, DE, Linggood, RM, Ojemann, RG, Martuza, RL. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985; 62: 18–24.CrossRefGoogle ScholarPubMed
16.Barbaro, NM, Gutin, PH, Wilson, CB, et al. Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 1987; 20: 525–528.CrossRefGoogle ScholarPubMed
17.Taylor, BM JrMarcus, RB JrFriedman, WABallinger, WE JrMillion, RR. The meningioma controversy: postoperative radiation therapy. Int J Radiat Oncol Biol Phys 1988; 15: 299–304.CrossRefGoogle ScholarPubMed
18.Petty, AM, Kun, LE, Meyer, GA. The meningioma controversy: postoperative radiation therapy. Radiation therapy for incompletelyresected meningiomas 1985; 62: 502–507.Google Scholar
19.Forbes, AR, Goldberg, ID. Radiation therapy in the treatment of meningioma: the Joint Center for Radiation Therapy experience 1970 to 1982. J Clin Oncol 1984; 2: 1139–1143.CrossRefGoogle ScholarPubMed
20.Goldsmith, BJ, Wara, WM, Wilson, CB, Larson, DA. Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 1994; 80: 195–201.CrossRefGoogle ScholarPubMed
21.Vilaviciencio, A, Loeffler, JS, Alexander, E3d, Black, PM. Radiosurgery for skull base meningiomas. Neurosurgical Journal,(in press).Google Scholar
22.Loeffler, JS, Shrieve, D, Alexander, E3d, et al. Stereotactic radio-therapy for meningiomas in Kondziolka D, Radiosurgery 1995,Bral,Karger.Google Scholar
23.Engenhart, R, Kimmig, BN, Hover, KH, et al. Stereotactic single high dose radiation therapy of benign intracranial meningiomas, Int J Radiat Oncol Biol Phys 1990; 19: 1021–1026.CrossRefGoogle ScholarPubMed
24.Kondziolka, D, Lunsford, LD, Coffey, RJ,Flickinger, JC. et al. Stereotactic radiosurgery of meningiomas. J Neurosurg 1991; 74: 552–559.CrossRefGoogle ScholarPubMed
25.Kondziolka, D, Lunsford, LD, Radiosurgery of meningiomas. Neurosurg Clin N Am 1992; 3: 219–230.CrossRefGoogle ScholarPubMed
26.Lunsford, LD, Contemporary management of meningiomas: radia- tion therapy as an adjuvant and radiosurgery as an alternative to surgical removal? J Neurosurg 1994; 80: 187–190.CrossRefGoogle Scholar
27.Loeffler, JS, Alexander, E 3d, Kooy, HMBlack, PM, Tarbell, NJ. Stereotactic radiotherapy: rationale,techniques and early results. In: Desalles, AAFGoetsch, SJ eds. Stereotactic Surgery and Radiosurgery. Madison: Medical Physics Publishing, 1993; 307–320.Google Scholar
28.Kikinis, R, Gleason, PL, Moriarty, TM, et al. Computer-assisted interactive three-dimensional planning for neurosurgical procedures. Neurosurgery 1996; 38: 640–651,discussion 649–651.CrossRefGoogle ScholarPubMed
29.Nakajima, S, Kikinis, R, Moriarty, TM, et al. Use of cortical veins for registration for image-guided surgery.Neurosurgery,(in press).Google Scholar