Abstract
Both intraparenchymal papillary meningioma and papillary meningioma with cyst formation of brainstem have never been reported. The authors present an extremely rare case of patient with intraparenchymal papillary meningioma of brainstem. A 23-year-old Chinese male presented with a 4-month history of progressive left upper limb and facial nerve palsy. Magnetic resonance imaging revealed a cystic-solid, heterogeneously enhancing mass in pons and right cerebral peduncle with no dural attachment. The tumor was totally removed via subtemporal approach. During surgery, the lesion was found to be completely intraparenchymal. Histological and immunohistochemical examinations were compatible with the diagnosis of papillary meningioma. The lesion recurred nine months after primary surgery, a second surgery followed by radiotherapy was performed. Till to now (nearly 2 years after the treatment), the patient is tumor free survival. Intraparenchymal meningioma of brainstem with cystic formation is very rare, however, it should be considered as a differential diagnosis of a brainstem neoplasm. The present case strongly recommended that postoperative radiotherapy was essential for the patients with papillary meningiomas.
Highlights
Meningiomas account for nearly 35% of all primary intracranial neoplasms, deriving from the arachnoid cap or meningothelial cells [1]
In previous literatures [6,13,14], infratentorial meningiomas without dural attachment were classified into 5 types: meningioma arising from the choroid of the fourth ventricle and lying wholly within it, meningioma arising from the inferior tela and lying partially in the fourth ventricle and partially in the cerebellar hemisphere, meningioma lying in the cisterna magna, meningioma arising from the choroid plexus and lying in the lateral cerebellomedullary cistern, and intraparenchymal meningioma
Intraparenchymal meningioma is considered as a same type of subcortical meningioma, which locates in brain parenchyma without dural attachment, they can reach the surface of the brain [6,15]
Summary
Meningiomas account for nearly 35% of all primary intracranial neoplasms, deriving from the arachnoid cap or meningothelial cells [1] They usually display a dural attachment [2]. The patient was recommended for radiotherapy, but he refused to further treatment Nine months later, he was re-admitted with facial palsy and left upper limb weakness again, and brain MRI showed local tumor recurrence (Figure 3A). He was re-admitted with facial palsy and left upper limb weakness again, and brain MRI showed local tumor recurrence (Figure 3A) He was re-operated on through the previous approach, with a total tumor resection. During the more than 2 years follow-up, brain MRI revealed no residual or recurred tumor (Figure 3B) His left upper limb weakness remained grade IV despite rehabilitation therapy
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