Abstract
Objective : Meningioma is the most common brain tumor. Surgery is the treatment of choice when the tumor is symptomatic and larger than 3cm ; however, it is sometimes challenging, especially when important perforators or cranial nerves are either related to or affected by the tumor. Herein, we summarize our surgical strategy for meningiomas at our institution and review the current research focusing on the intracellular mechanism of development of the tumor.
Methods : Review of recently published studies on meningioma and case presentations at our institution.
Results : In our surgical strategy, the identification of feeding arteries to meningioma with virtual-reality three-dimensional fusion images constructed from multimodality images is crucial to minimize intraoperative bleeding and to ease the following procedures. Recent progress in intracellular mechanisms, such as epigenetics and transcription factors, is enormous. Genetic mutations in NF2, TRAF7, KLF4, AKT1, and SMO have been reported, some of which are reported to be specific locations or pathological types. A new classification of meningioma, besides the WHO classification, based on epigenetics or transcription factors, has been reported with promising results. Based on these studies on the intracellular mechanism of meningiomas, a chemotherapy regimen has also been reported.
Conclusions : Understanding the vascular construction of meningiomas on a case-by-case basis is important for surgical strategy. Research on intracellular mechanisms is marking an epoch whose findings can lead to a new classification of the tumor as well as treatment.
