Review of Intracranial Meningioma in North Sumatera

Ridha Dharmajaya

Department of Neurosurgery, Universitas Sumatera Utara, Medan, Indonesia

Keyword: Intracranial Meningioma, North Sumatera.

Abstract: Meningioma, also known as meningeal tumor, is typically a slow-growing tumor that forms from the

meninges, the membranous layers surrounding the brain and spinal cord. Risk factors include exposure to

ionizing radiation such as during radiation therapy, a family history of the condition, and neurofibromatosis

type 2. The goal of management strategy in meningiomas is to keep the patient fully functional and provide

long-term relief or prevent intracranial tumor growth associated problems.

1 INTRODUCTION

Meningiomas has attracted the attention of surgeons,

anatomists, pathologists, and physicians for many

centuries. Given the tendency of these neoplasms to

cause thickening of the overlying calvarium,

meningiomas have left an unmistakable mark on

human skulls dated as far back as prehistoric times.

Harvey Cushing coined the term meningioma in 1922

to describe a benign neoplasm of the meninges of the

brain.

However, many other surgeons and

pathologists described and named this neoplasm as

well. In fact, naming of the tumor likely represents

one of the most frequently changed nomenclatures in

the history of medicine. Antoine Louis, born in Metz,

France, in 1723 into a family of surgeons, developed

an interest in surgery of dural tumors, which he

named tumeurs fongueuses de la duremere or fungoid

tumors of the dura mater. He included their

description in Memoire de l’Académie Royale de

Chirurgie in 1774. In 1854, Sir James Paget named

the neoplasm myeloid tumor (marrow like), based on

its gross appearance and less malignant behavior.

In 1863, Virchow was the first to describe the

granules in these tumors and named it psammoma

(sand-like). As Virchow was uncertain of the origin

of these bodies, he gave the neoplasm a descriptive

name. Subsequently, he changed the nomenclature

from psammoma to Sarkoma der dura mater to

describe these tumors.

Meningioma, also/ known as meninge j liglllsoal

tumor, is typically a slow-growing tumor that forms

from the meninges, the membranous layers

surrounding the brain and spinal cord. Risk factors

include exposure to ionizing radiation such as during

radiation therapy, a family history of the condition,

and neurofibromatosis type 2.

2 PATIENTS AND METHODS

This was a retrospective study carried out at the Haji

Adam Malik General Hospital serve as teaching

hospitals of the University of the Sumatera Utara, The

study was over a period of 6 years ( January 2013 –

December 2017). Haji Adam Malik General Hospital

is located within the city centre in Medan, North

Sumatera as one of the referral hospitals for

Provincial Hospitals in Indonesia.

Consecutive patients seen at the this hospital

with histologically proven intracranial meningioma

during the study period were recruited for the study.

We obtained data from the medical record. Diagnosis

was made after detailed history and careful physical

examination, neuroimaging including CT scan and or

MRI, and histological confirmation. All patients who

underwent neurosurgical operative intervention had

specimens removed at operative intervention and

subjected to histology for a final tissue diagnosis.

Patients who had non-operative intervention were

taken off the study due to the absence of a final

histological diagnosis data.

Dharmajaya, R.

Review of Intracranial Meningioma in North Sumatera.

DOI: 10.5220/0010084706990702

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

699-702

ISBN: 978-989-758-449-7

699

3 RESULTS

During the 6 years study period, 171 consecutive

patients (out of 370 patients with primary brain

tumours) seen at Haji Adam Malik General Hospital

had histologically confirmed intracranial

meningioma with a hospital distribution of Frequency

of distribution of intracranial meningiomas among

primary brain tumours.

A total 171 patients records were reviewed,

which were diagnosed by histophatological reports in

the preiod between January 2013 – December 2017

seen in table.1. There were 52 (30.4%) in male

patients and (69.5%) in female patients. The age of

patients range from 1 to 68 years. The highest number

of patients was seen in the age-group of 40-59 years

in males and 20-39 years in females in table 2. The

histopathologic report intracranial meningiomas

based on WHO claasifications showed

Meningothelial meningioma is the most common

histopathology type in 70 patients (40.9%) in table.3.

WHO Grade 1 is the most histological subtypes based

on WHO classifications seen in 131 patients (76.6%).

Table 1. Frequency of distribution of intracranial

meningiomas among primary brain tumours

Tumor Types

N %

Meningiomas

171 45.9

Metastatic Brain

tumo

76 78,1

Gliomas

59 15.9

Pituitary

21 5.6

Tumor of Nerves

and/ or Nerve

Sheath

17 4.5

PNET

13 3.5

Cysta

6 1.6

Other, more

bening pituitary

tumo

5 1.3

Pineal tumor

1 0.2

Other primary

tumors, including

skull

ase

1 0.2

Total

370 100.0

Table 2. Age of patients at presentation intracranial

meningiomas

Age Group

Gender

Males Females

0-19 years 4 (7.69%) 18 (15.1%)

20-39 years 12 (23.07%) 40 (33.6%)

40-59 years 21 (40.3%) 32 (26.8%)

> 60 years 15 (28.8%) 29 (24.3%)

Total 52 (30.4%) 119 (69.5%)

Table 3. Histopathology presentation intracranial

meningiomas based on World Health Organization

(WHO) Classification.

Histopathology N %

Meningothelial 70 40.9

Transitional 19 11.1

Fibroblastic 21 12.2

Clear Cell 9 5.2

Anaplastic 12 7.01

Atypical 9 5.2

Malignant 10 5.8

Metaplastic 11 6.4

Psammomatous 10 5.8

Total 171 100.0

Table 4. Distribution of intracranial meningiomas

based on World Health Organization (WHO Grading)

Histopathology N %

WHO Grade 1

131 76.6

WHO Grade 2

18 10.5

WHO Grade 3

22 12.86

Total

171 100.0

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4 CONCLUSION

The goal of management strategy in meningiomas is

to keep the patient fully functional and provide long-

term relief or prevent intracranial tumor growth

associated problems. The clinical picture at

presentation is very variable, and very little is known

regarding the natural history of these tumors;

therefore the management strategy is not universal.

The initial dilemma that the surgeon faces starts with

the decision to treat or not to treat. Only then is this

followed by the decision of how to treat. Both

decisions are taken together with the patient and the

surgeon plays the role of an advisor, rather than

directly deciding for the patient.

Treatment choice in patients who present to

medical attention for the first time with a

symptomatic meningioma or in those with neural

compression is mostly straightforward. The goal is

well defined and the possible gains most commonly

far outweigh the risks. However; decision making is

not so easy in non- or marginally symptomatic

patients, for whom the risks of treatment should be

weighed against the risk of iatrogenic injury. The

mortality and morbidity of surgical treatment

decreased significantly and continuously in the last

century, mainly as a result of the application of

microsurgery, bipolar coagulation, and other new

technologies. A better appreciation of microsurgical

anatomy and increasing use of skull-base surgery

have further improved results. The advent and

popularization of alternative treatment modalities

such as radiation treatment and radiosurgery have

also made significant contributions. Finally, with

accumulating experience and scientific data much

more is known today about the biology of

meningiomas.

Even with all these advances, today’s

neurosurgeon still has very little clinical evidence on

which to base his or her clinical decisions. This

chapter aims to summarize the controversies,

discussing different management paradigms and thus

providing a general guideline for treatment (or

nontreatment) of meningiomas. Five factors influence

the treatment decision in meningiomas: operative

gains, operative risks, tumor biology, mass

effect/symptomatology, and the preference of the

patient. In short, the balance between the risks and

benefits of surgery is evaluated in light of the tumor’s

biology, mass effect/symptomatology, and preference

of the patient.

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