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Cranial and Spinal Meninges

Cranial and Spinal Meninges

The cranial and spinal meninges are complex protective structures surrounding the central nervous system (CNS), consisting of the brain and spinal cord. These meninges consist of the dura mater, the arachnoid mater, and the pia mater. They protect the CNS, provide structural support, and aid in circulating cerebrospinal fluid (CSF).
Cranial Meninges
These meningeal layers cover the cranium. The dura mater is the outermost layer of cranial meninges. It is a thick and durable membrane of dense...

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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

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Meningiomas with CNS invasion.

Konstantinos Gousias^1,2,3, Leonidas Trakolis¹, Matthias Simon⁴

¹Department of Neurosurgery, St. Marien Academic Hospital Lünen, KLW St. Paulus Corporation, Luenen, Germany.

Frontiers in Neuroscience

|July 17, 2023

Summary

The prognostic significance of brain invasion in high-grade meningiomas remains uncertain. Further research is needed to clarify its role and develop specific diagnostic markers for this challenging brain tumor diagnosis.

Keywords:

CNS invasion Simpson grade of resection functional outcome invasive meningioma surgery

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Area of Science:

Neurosurgery
Neuropathology
Oncology

Background:

Central nervous system (CNS) invasion is a diagnostic criterion for high-grade meningiomas (WHO grade 2 and 3) since 2016.
The prognostic value of brain invasion as an independent factor is currently debated.
Surgical management of brain-invasive meningiomas presents unique challenges.

Purpose of the Study:

To systematically review the literature on the prognostic relevance and surgical management of brain-invasive meningiomas.
To identify current gaps in knowledge regarding histological definitions and molecular markers.
To explore the role of advanced neuroimaging and surgical adjuncts.

Main Methods:

Systematic literature review of studies published between 2016 and 2022.
Databases searched include Pubmed, Scopus, Web of Science, and the Cochrane Library.
Analysis focused on prognostic relevance, diagnostic criteria, and surgical considerations.

Main Results:

The prognostic significance of brain invasion as a standalone criterion is still unclear.
Robust definitions and larger studies are needed to address sampling errors.
Molecular markers for brain invasion are currently lacking, but advanced neuroimaging may aid preoperative prediction.
Extent of resection is crucial for recurrence, even in benign tumors.
Surgical adjuncts used for gliomas may improve outcomes for brain-invasive meningiomas.

Conclusions:

The prognostic role of brain invasion in meningiomas requires further investigation with standardized definitions.
Maximal safe resection is paramount in surgical management.
Advanced neuroimaging and specialized surgical techniques may enhance outcomes for these challenging cases.