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Malignant Meningioma: rarity to creativity

Malignant Meningioma: rarity to creativity. MGH Neurosurgery Grand Rounds August 23, 2012 Leonardo Aliaga University of Chicago. JD, 53y/o RHM. Complex history of multiple recurrent meningiomas. 2008. 2008 – initial resection at Umass Path – atypical meningioma (II)

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Malignant Meningioma: rarity to creativity

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  1. Malignant Meningioma: rarity to creativity MGH Neurosurgery Grand Rounds August 23, 2012 Leonardo Aliaga University of Chicago

  2. JD, 53y/o RHM Complex history of multiple recurrent meningiomas 2008

  3. 2008 – initial resection at Umass Path – atypical meningioma (II) 2010 April – Proton beam therapy 2011 March – 2nd resection 4 meningiomas removed Radioactive iodine seeds placed Path – rhabdoid malignant meningioma (III) 2011 March, preop

  4. Asdasd 2011 July 2011 October

  5. Asdasd 2011 July 2011 October

  6. 2011 October 2012 February 2012 June 3rd resection

  7. 2012 June

  8. August 2012, 4th resection Worsening left sided weakness Worsening eye pain, proptosis

  9. August 2012, 4th resection Right frontal craniotomy - resection of 2 frontal parasagittal meningiomas Right orbitozygomatic osteotomy - resection of orbital sphenoid wing recurrence Planned subtotal resection, sparing of eye Exploration of infratemporal fossa

  10. August 2012, 4th resection Right frontal craniotomy - resection of 2 frontal parasagittal meningiomas Right orbitozygomatic osteotomy - resection of orbital sphenoid wing recurrence Planned subtotal resection, sparing of eye Exploration of infratemporal fossa Plastic surgery – cranioplasty and scalp flap reconstruction

  11. Post-op course

  12. Post-op course Complicated by low hematocrit, tachycardia, confusion and delerium, downtrending Na Transfused, PE protocol CT negative, Na normalized Discharged on POD 8, LUE 3/5, LLE wiggled toes

  13. What does the future hold Mr. JD?

  14. Malignant Meningioma • Meningiomas – 30% of CNS neoplasm • Grade III – malignant meningioma, 1-3% • 2007 WHO Criteria • Papillary, rhabdoid and anaplastic histological subtypes • 20 or more mitoses per HPF and/or malignant characteristics resembling carcinoma, sarcoma, or melanoma

  15. Recurrence, Resection, Radiation

  16. Recurrence, Resection, Radiation

  17. Recurrence, Resection, Radiation

  18. Recurrence, Resection, Radiation Marked survival benefit for 37 pts undergoing second resection for recurrence

  19. Recurrence, Resection, Radiation 34 pts,undergoing primary operation 37 pts, undergoing second operation Minor survival benefit with subtotal resection vs. gross-total resection

  20. Recurrence, Resection, Radiation

  21. Recurrence, Resection, Radiation • Radiation for recurrence • 45 pts undergoing resection for recurrence • 26 underwent at least 1 treatment of focal radiotherapy • SRS • Iodine-125 brachytherapy • No difference in survival with focal radiotherapy after resection

  22. Creativity and the future

  23. Thank you • MGH Department of Neurosurgery • Harvard Medical School • University of Chicago

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