The Meningioma Research Group are conducting a range of clinical and laboratory studies related to the natural history, biological behaviour, imaging characteristics, and long-term outcomes of all grades of meningioma. Meningiomas are one of the most common primary tumours of the central nervous system and have the potential to cause both morbidity and mortality. Understanding the behaviour, associations, and clinical outcomes of these tumours will improve patient care, refine surgical techniques, and other related disciplines such as neuroradiology and neuropathology.

• Epileptogenesis in meningioma

We are collaborating with the University of Liverpool and other Neurosurgical Units around the UK in the multi-centre RCT ‘STOP ‘EM’, investigating placebo-controlled levetiracetam prophylaxis in seizure-naïve patients undergoing elective meningioma surgery. Primary clinical outcome measurements include seizure incidence within the first post-operative year and patient-reported quality of life. Part of the study will also involve taking blood samples from patients in the perioperative period and measuring blood plasma cytokines. As there is emerging evidence of the role of inflammation in seizures, including in epilepsy, TBI, and brain tumours, it is envisaged that this work could risk stratify patients who are likely to have seizures and may need closer clinical follow-up or seizure prophylaxis. There may also be therapeutic implications for confirming and understanding an inflammatory basis to seizures in meningioma.

• Novel imaging methods for pre-operative planning

Recent improvements in the understanding of meningioma biology, including the discovery and utilisation of the somatostatin receptor have enabled somatostatin-analogue PET ligands to be developed that may have additional benefit in identifying the extent of meningioma than conventional imaging alone. We are studying the utility of Ga-DOTATOC PET/MRI in identifying the extent of meningioma-associated dural tails and comparing this with pathological analysis of somatostatin receptor antibody immunohistochemistry. This work may improve our ability to safely resect maximal tumour-involved dura and minimise risk of recurrence.

• Outcome assessment following meningioma resection

Patients who have low-grade meningiomas resected may have normal lifespans. Most clinical follow-up ceases within a few years after surgery therefore we understand little about the long-term outcomes patients are experiencing, which may include disability due to motor deficit, seizures, or other post-operative problems. Health-related quality of life outcomes are an important metric in ensuring clinical care is responsive to patient needs and is managing post-operative problems appropriately.

 

Group Leaders:

Mr Thomas Santarius Consultant Neurosurgeon

Mr Adel Helmy University Associate Professor & Hon Consultant Neurosurgeon Email: aeh33@cam.ac.uk

Members:

Dr William H. Cook

Mr Mutwakil Abdulla

Collaborators

Dr Tomasz Matys, Academic Consultant Neuroradiologist

Dr Kieren Allison, Consultant Neuropathologist

Mr Ramez Kirollos, Senior Consultant Neurosurgeon, Clinical Associate Professor, National Neuroscience Institute, Singapore

Previous Members:

Clinical Trials:

Surgeons Trial Of Prophylaxis for Epilepsy in seizure naïve patients with Meningioma: a randomised controlled trial (STOP’EM)

Key Publications

1. Results of Transcranial Resection of Olfactory Groove Meningiomas in Relation to Imaging-Based Case Selection Criteria for the Endoscopic Approach.
   Patel K, Kolias AG, Santarius T, Mannion RJ, Kirollos RW. Oper Neurosurg (Hagerstown). 2019 May 1;16(5):539-548.
2. An integrated genomic analysis of anaplastic meningioma identifies prognostic molecular signatures.
   Collord G, Tarpey P, Kurbatova N, Martincorena I, Moran S, Castro M, Nagy T, Bignell G, Maura F, Young MD, Berna J, Tubio JMC, McMurran CE, Young AMH, Sanders M, Noorani I, Price SJ, Watts C, Leipnitz E, Kirsch M, Schackert G, Pearson D, Devadass A, Ram Z, Collins VP, Allinson K, Jenkinson MD, Zakaria R, Syed K, Hanemann CO, Dunn J, McDermott MW, Kirollos RW, Vassiliou GS, Esteller M, Behjati S, Brazma A, Santarius T, McDermott U.Sci Rep. 2018 Sep 10;8(1):13537. doi: 10.1038/s41598-018-31659-0.
3. Predictors of early progression of surgically treated atypical meningiomas.
   Budohoski KP, Clerkin J, Millward CP, O’Halloran PJ, Waqar M, Looby S, Young AMH, Guilfoyle MR, Fitzroll D, Devadass A, Allinson K, Farrell M, Javadpour M, Jenkinson MD, Santarius T, Kirollos RW.Acta Neurochir (Wien). 2018 Sep;160(9):1813-1822. doi: 10.1007/s00701-018-3593-x. Epub 2018 Jun 30.
4. Correlation of volumetric growth and histological grade in 50 meningiomas.
   Soon WC, Fountain DM, Koczyk K, Abdulla M, Giri S, Allinson K, Matys T, Guilfoyle MR, Kirollos RW,Santarius T.Acta Neurochir (Wien). 2017 Nov;159(11):2169-2177. doi: 10.1007/s00701-017-3277-y. Epub 2017 Aug 9.
5. Volumetric growth rates of meningioma and its correlation with histological diagnosis and clinical outcome: a systematic review.
   Fountain DM, Soon WC, Matys T, Guilfoyle MR, Kirollos R, Santarius T.Acta Neurochir (Wien). 2017 Mar;159(3):435-445. doi: 10.1007/s00701-016-3071-2. Epub 2017 Jan 18.
6. A quest towards personalised medicine for grade II meningiomas–will need to zoom in.
   Santarius T, Jenkinson MD, Kirollos RW.Acta Neurochir (Wien). 2016 May;158(5):931-2.
7. Image-guided resection of spheno-orbital skull-base meningiomas with predominant intraosseous component.
   Marcus H, Schwindack C, Santarius T, Mannion R, Kirollos R.Acta Neurochir (Wien). 2013 Jun;155(6):981-8. doi: 10.1007/s00701-013-1662-8. Epub 2013 Mar 10.
8. Secretory meningiomas are defined by combined KLF4 K409Q and TRAF7 mutations.
   Reuss DE, Piro RM, Jones DT, Simon M, Ketter R, Kool M, Becker A, Sahm F, Pusch S, Meyer J, Hagenlocher C, Schweizer L, Capper D, Kickingereder P, Mucha J, Koelsche C, Jäger N, Santarius T, Tarpey PS, Stephens PJ, Andrew Futreal P, Wellenreuther R, Kraus J, Lenartz D, Herold-Mende C, Hartmann C, Mawrin C, Giese N, Eils R, Collins VP, König R, Wiestler OD, Pfister SM, von Deimling A.Acta Neuropathol. 2013 Mar;125(3):351-8. doi: 10.1007/s00401-013-1093-x. Epub 2013 Feb 12.
9. Molecular analysis of alterations of the p18INK4c gene in human meningiomas.
   Santarius T, Kirsch M, Nikas DC, Imitola J, Black PM.Neuropathol Appl Neurobiol. 2000 Feb;26(1):67-75. doi: 10.1046/j.1365-2990.2000.00219.x.

Bibliography

1. Life After a Rare Brain Tumour and Supplementary Motor Area Syndrome: Awake Behind Closed Eyes. Alex Jelly, Adel Helmy, Barbara Wilson, Taylor and Routledge

2. Oxford Textbook of Neurological Surgery. Oxford University Press