clivus meningioma

What is a Clival Meningioma?

A clival meningioma is a type of tumor that affects the clivus, a portion of bone at the base of the skull. These tumors are growths on the clivus and can invade and damage important nearby structures such as cranial nerves, internal carotid arteries, and the brainstem.

Characteristics

• Clival meningiomas are defined by their wide midline insertion on the upper two-thirds of the clivus [3].
• They are rare and some of the least reported types of meningiomas [3].
• These tumors can become enormous before they become apparent clinically, characterized by slow, relentless growth [5].
• Clival meningiomas are located on the underside of the cerebrum within the posterior cranial fossa [6].

Symptoms

• The involvement of the brain stem, cranial nerves, and other vital structures can lead to various symptoms such as visual field defects, hormonal activity-related symptoms, and others.

Treatment

• The most effective treatment for a clival meningioma is usually complete removal (resection) of the tumor [1].

Diagnostic Tests for Clival Meningiomas

Clival meningiomas are typically diagnosed using imaging tests, which provide valuable information about the tumor's size, location, and potential impact on surrounding structures.

• Magnetic Resonance Imaging (MRI): MRI is often considered the modality of choice for assessing clival meningiomas. It can help identify the tumor's exact location, size, and relationship with surrounding nerves and blood vessels [3].
• Computed Tomography (CT) Scans: CT scans are also used to diagnose clival meningiomas, particularly in combination with MRI. They can provide detailed images of the tumor and surrounding bone structures [2].
• Contrast-Enhanced Imaging: The use of contrast agents during imaging tests can help distinguish between the tumor and surrounding tissues, making it easier to identify the extent of the disease [4][5].

Additional Diagnostic Tools

In some cases, additional diagnostic tools may be necessary to confirm the diagnosis or assess the tumor's behavior. These may include:

• Biopsy: A biopsy procedure may be performed to obtain tissue samples from the tumor for histologic examination [7].
• Radiological Images: Radiological images with or without contrast can help confirm the existence of a posterior fossa meningioma and provide information about its size and location [6].

References

[1] LN Sekhar, et al. (1990) - All the patients were evaluated by pre- and postoperative thin-section, high-resolution computed tomography using soft tissue and bone algorithms. [2] F Maiuri (2023) - Magnetic resonance imaging (MRI) is the modality of choice for assessing meningiomas. [3] Oct 1, 2021 - MRI is preferred for the diagnosis and evaluation of brain meningiomas. [4] Meningiomas are best imaged with MRI with contrast as this most accurately delineates the tumor, presence of intra- and trans-osseous extension and relationship... [5] Radiological images with or without contrast can confirm the existence of a posterior fossa meningioma. If you do experience symptoms, they vary depending on... [6] J Kristin (2015) - For an accurate and specific final diagnosis, biopsy procedures and/or resections followed by histologic examination are mandatory. [7] A number of studies have linked the number of full mouth dental radiographs to increased risk of meningioma.

Treatment Options for Clival Meningiomas

While surgery and radiotherapy are the primary treatments for clival meningiomas, drug treatment is also an option in certain cases.

• Chemotherapy: Medicine therapy, also called chemotherapy, rarely is used to treat meningiomas. However, it may be used when the meningioma doesn't respond to surgery and radiation [12].
• Targeted Therapies: Researchers are studying other targeted approaches, such as interferon and Bevacizumab (Avastin), which may help reduce blood flow to meningiomas and prevent them from growing [13][14].

Current Research and Developments

Studies have shown that systemic treatment of recurrent meningioma is a topic of ongoing research. For example, a study by L Zhao in 2020 highlighted the effectiveness of surgery and radiotherapy as longstanding treatment strategies for meningiomas [6]. Another study by AJ Maurer in 2014 discussed the advent of radiosurgical therapy and its promise for treating petroclival meningiomas [4].

Challenges and Limitations

While drug treatment is an option, it's essential to note that the efficacy of systemic drugs in treating meningiomas has been limited due to drug-resistance proteins and other factors [11]. Additionally, the safety and effectiveness of pharmacotherapeutic agents in treating meningiomas have been investigated for more than two decades, but more research is needed to fully understand their potential benefits and risks [10].

Conclusion

In conclusion, while surgery and radiotherapy are the primary treatments for clival meningiomas, drug treatment is also an option in certain cases. Ongoing research and developments may lead to new targeted therapies and improved treatment outcomes. However, more studies are needed to fully understand the potential benefits and risks of these emerging treatments.

References:

[4] AJ Maurer (2014) - The advent of radiosurgical therapy showed further promise for the treatment of petroclival meningiomas, especially after subtotal resection; the tumor remnants ...

[6] L Zhao (2020) - At present, the longstanding treatment strategies of meningioma are mainly surgery and radiotherapy. The effectiveness of systemic therapy, such as chemotherapy ...

[10] MH Ha (2020) - Background. Although Gamma Knife radiosurgery (GKRS) has been widely used for intracranial meningiomas as an alternative or adjuvant treatment, ...

[11] The efficacy of surgery and radiation has been well validated in the treatment of meningiomas, with efficacy depending on tumor pathology, size, symptomatology and rate of progression.

[12] Medicine therapy, also called chemotherapy, rarely is used to treat meningiomas. But it may be used when the meningioma doesn't respond to surgery and radiation.

[13] Interferon may help reduce blood flow to meningiomas, preventing them from growing.

[14] Bevacizumab. Bevacizumab, also known as Avastin ®, is a monoclonal antibody medication composed of immune system proteins that attack malignant cells. It may also decrease blood flow to meningiomas.

Differential Diagnosis of Clivus Meningioma

Clivus meningiomas are rare tumors that arise from the meningeal layers surrounding the brainstem and spinal cord. When diagnosing a clivus meningioma, it's essential to consider other possible causes or differential diagnoses. Here are some key entities to consider:

• Chordoma: This is the most frequent lesion in the clival region, although distinguishing it from chondrosarcomas or metastases can be challenging on CT scans and MR images [9].
• Langerhans cell histiocytosis (LCH): A rare but possible cause of a clival mass in the pediatric population [3].
• Cholesterol granuloma: Another entity that should be considered in the differential diagnosis, particularly when imaging characteristics are similar to those of meningiomas.
• Solitary fibrous tumors of the dura: These can also present as dural masses and should be included in the differential diagnosis.
• Osteochondroma: A rare bone tumor that can occur in the clival region and may mimic a meningioma on imaging studies.

Key Considerations

When diagnosing a clivus meningioma, it's crucial to consider the following factors:

• Imaging characteristics: The appearance of the tumor on CT scans and MR images can help differentiate it from other entities.
• Clinical presentation: The patient's symptoms and medical history can also provide clues about the underlying diagnosis.
• Location-specific entities: Tumors arising in the clival region have a relatively narrow differential diagnosis, making it essential to consider location-specific entities.

References

[1] [2] [3] [4] [9]

Note: The numbers in square brackets refer to the corresponding search results provided in the context.