couldwell_edited.qxp 6/8/08 9:13 am Page 78
Surgery
patients requiring immediate decompression for symptomatic relief.
However, preliminary (10-year) results of radiosurgical treatment of small
meningioma remnants or small inoperable tumors have influenced the
Editor’s Recommendation
management of these tumors. Radiation therapy has gained wide
Natural History of Meningioma Development
acceptance in the treatment of incompletely resected meningiomas, as
in Mice Reveals: A Synergy of Nf2 and
well as a primary treatment option for inoperable tumors. Furthermore,
p16
Ink4a
Mutations
SRS is a convenient single-day alternative to surgery for meningiomas
Kalamarides M, et al., Brain Pathol, 2008:18(1):62–70.
located along the skull base, particularly those along the petroclival
Reported in a previous paper, the authors inactivated Nf2 in
region or within the cavernous sinus, where attempted resection may
homozygous conditional knockout mice by adenoviral Cre delivery
place critical neurovascular structures at risk.
and demonstrated that Nf2 loss in arachnoid cells is rate-limiting for
meningioma formation. In this paper, it is reported that additional
Although there are reports of long-term progression-free survival,
nullizygosity for p16
Ink4a
increases the frequency of meningioma and
radiation treatment of meningiomas fails in some cases. With the
meningothelial proliferation in these mice without modifying the
increasing number of patients undergoing SRS for benign tumors, careful
tumor grade. Also, through screening of a large cohort of mutant
attention is warranted, as some lesions will progress despite ‘adequate’
mice through magnetic resonance imaging, the authors were able to
treatment. Therefore, extended (exceeding 10 years) follow-up deserves
detect meningothelial proliferation and meningioma development. It
consideration in all patients after radiosurgery. ■
is hoped that these findings will provoke future studies in which
therapeutic interventions can be tested as pre-clinical assessment of
Acknowledgments
their potential clinical application.
We thank Kristin Kraus, MSc, for editorial assistance in preparing
■
this paper.
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78 US NEUROLOGY
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