Presentation and surgical management of a WHO grade II meningioma of the cerebellopontine angle: A case report and review of the literature

Abstract

Meningiomas are relatively slow-growing, typically benign tumors that arise from the arachnoid cells which form the meninges. They are the most common primary brain tumor and account for nearly one-third of all primary brain and spine tumors. Meningiomas can arise from any dural site, however they are infrequently found at the cerebellopontine angle (CPA). While WHO grade I meningiomas are benign and the slowest growing, WHO grade II meningiomas grow significantly faster, display cellular atypia, and frequently recur. Compared with WHO grade I meningiomas, these often present a therapeutic challenge. An 87-year-old woman presented to the emergency department with a two-month history of dizziness and dysequilibrium. MRI revealed a large left-sided CPA lesion which was not present on MRI just two years prior. She underwent surgical resection and post-operative imaging confirmed gross-total resection. Surgical histology identified the tumor as an atypical WHO grade II meningioma. WHO grade II meningiomas of the CPA are exceedingly rare entities, but should be considered in patients who present with a rapidly growing CPA mass. The literature supports the notion that complete resection, when possible, is likely the strongest determinant of overall control. Stereotactic radiosurgery (SRS) has established itself as a suitable adjunct for higher grade lesions of the CPA, particularly those that were resected subtotally. These tumors can be successfully managed, even in the elderly population.