Case Of Intracranial Meningioma Research Articles

Prolonged use of chlormadinone acetate and risk of intracranial meningioma: A population-based cohort study.

Chlormadinone acetate (CMA) is a synthetic progestin for which cases of intracranial meningioma have been reported following prolonged exposure. An observational cohort study was conducted based on the French national health data system. Women aged 10-70 years and who started CMA between 2007 and 2017 were included. Participants were considered to be exposed if they had received a cumulative dose >360 mg of CMA during the first 6 months and very slightly exposed (control group) when they had received a cumulative dose ≤360 mg. The outcome was surgery or radiotherapy for one or more intracranial meningioma(s). Poisson models assessed the relative risk (RR) of meningioma. In total, 828,499 women were included: 469,976 in the exposed group (mean age 39.1 years, SD 10.1) and 358,523 in the control group (38.3 years, SD 11.0). Surgery or radiotherapy for intracranial meningioma between 2007 and 2017 was recorded for 164 and 104 women in the exposed and control groups, respectively. The incidence of meningioma was 18.5 and 6.8 per 100,000 person-years for the exposed and control groups respectively (crude RR = 2.7, 95% confidence interval [CI] 2.1-3.5; age-adjusted RR = 3.1, 95% CI 2.4-4.0). Meningioma incidence reached almost 47 cases/100,000 person-years in the most exposed group (>8.64 g), giving an age-adjusted RR of 6.9, 95% CI 5.1-9.2, relative to the control group. A strong dose-effect relationship was observed between prolonged use of CMA and risk of meningiomas. As with other progestogens, meningiomas associated with CMA are more likely to be found at the base of the skull.

Meningiomas in Elderly Subjects: Retrospective Studies of 8 Cases and a Literature Review

Aim. Intracranial meningiomas in adults are mainly benign tumors that develop from the meninges. They are common, accounting for about 18 to 20% of primary intracranial tumors, and they are slow-growing, with a predominance in women. They can occur at any age but are most common after the age of 56. Symptoms vary depending on the location of the tumor, its size, and the anatomical structures it comes into contact with. Surgery is the main treatment modality for meningiomas. The objective of this study is to evaluate the cases of meningiomas in our series and to compare their different aspects, such as epidemiological, clinical, radiological, therapeutic, histological, evolutionary, and prognostic characteristics, with those reported in other series of the literature. We seek to highlight the similarities and differences between our series and previous studies, considering recent advances in this field. Materials and measures. In our series, the retrospective study of 8 cases of intracranial meningioma in elderly subjects diagnosed and operated on at the Neurosurgery Department of a hospital over a period of 4 years. Brain CT and MRI were the primary preoperative diagnostic means. The use of these imaging techniques was essential to establish the diagnosis and plan the surgical procedure. The histopathological study was performed to confirm the post-operative diagnosis and determine the histological type, as well as the grade of the meningiomas, referring to the WHO classification to plan an appropriate follow-up of the management. Results. Meningiomas accounted for 2.33% of intracranial meningiomas in elderly subjects, and 22.22% were in subjects under 65 years of age out of 342 tumors operated on in the Department during the same period. The female predominance was clear, at 62%, compared to 38% for men. The average age of our patients was 69.9 years, with extremes of 65 and 74 years. The main clinical symptoms observed in our patients were headache, motor deficit (hemiparesis, hemiplegia), sensory deficit, convulsions, and cranial pair involvement (optic nerve and facial nerve).On CT, the tumor mass was spontaneously hyperdense in 100% of cases. After the injection of iodine product, there was a homogeneous intense contrast intake in all cases. Only 2 patients in our series performed CT scans, of which we found perilesional edema and mass effect in 100% of cases. No calcifications or bone abnormalities were detected. MRI was performed on all our patients, allowing us to better specify the topographical diagnosis of meningiomas. Overall, surgical excision was complete (Simpson’s grade I and grade II) in 62.5% of cases. The most common histological types were meningotheliomatous meningioma (4 cases), transitional meningioma (1 case), mucoid fibrous meningioma (1 case), and atypical meningioma (2 cases). The post-operative course was favorable in most patients, and the post-operative complications consisted mainly of wound infection (1 case), CSF leakage (1 case), and hemorrhage (1 case).

Case series report of LINAC-based Stereotactic radiosurgery of Intracranial meningioma – an institutional experience

Stereotactic radiosurgery (SRS) has been widely used for the treatment of intracranial lesions. We have been doing SRS since March 2019. The unique ability of SRS to deliver higher focused dose to the smaller targets preferably in a single exposure in a convenient manner while sparing adjacent critical structures has made a more widely adopted treatment option. This case series is intended to show our institutional experience and procedural technique adapted for treating intracranial meningioma using SRS by Linear accelerators. We present five cases of intracranial meningioma. Four had Grade I meningioma and one patient with Grade III meningioma. One patient had radiological diagnosis only and treated with SRS. Two patients underwent gross total resection and SRS was prescribed on the event of recurrence. Rest two patients had recurrence/progression after subtotal resection and adjuvant radiation. The dose prescription ranged from 13 to 21Gy in one to three fractions which was determined by tumor volume, location, grade, proximity to critical structures, pre-existing neurologic impairment, previous treatment history, time to progression/relapse and the ideal balance of prescription dosage and expected problems. There were no acute side effects from any of the procedures. All five patients had improvement in clinical symptoms in the immediate post-SRS period. One patient who has two-year post-SRS revealed a significant regression in the size of the tumor. This case series summarizes the fact that SRS for intracranial meningioma is safe and effective treatment strategy when appropriate.
 Pulse Volume 12-14 2020-2022 p.40-52

Intracranial meningiomas: Experience at a tertiary health-care center in India

Introduction: Intracranial meningioma is one of the most common primary intracranial tumors. It constitutes 10%–15% of all brain neoplasm across the globe, whereas in India, their occurrence varies from 11.6% to 21%. These tumors are neuroectodermal in origin and are believed to arise from arachnoid cap cells. These tumors are mostly histologically benign with Patients and Methods: The survey intended to study the incidence of meningioma among other intracranial tumors, the clinical profile of the patients, surgical outcomes, and long-term results. The study included all the cases of intracranial meningioma admitted in the Department of Neurosurgery, Rajendra Institute of Medical Sciences, Ranchi, between the time period of January 2012–December 2015. All patients, irrespective of age and sex, who were diagnosed of intracranial meningioma based on clinical data, radiological evidence, and histopathology, were included in the study. A total of 106 patients were included in the study. Results: The study revealed that the incidence of intracranial meningioma among other brain tumors is 14.45% and the disease shows a female preponderance. Meningiothelial meningioma is the most common histological variant reported during the study. Seizure and cranial nerve damage were the common complications observed among the patients during the follow-up study. Total excision of the tumor is the treatment of choice. Seventy-seven percent of the patients show good recovery with Glasgow Outcome Score of 5. Conclusion: Intracranial meningiomas are common intracranial tumors. They affect people in fifth decade of their life and show a female preponderance. They commonly present with symptoms such as seizure and headache. Meningothelial meningioma is the most common histological subtype. Total excision of the tumor mass has been found effective in preventing reoccurrence. Microsurgical techniques give good results with minimum mortality.

Intracranial meningioma with leptomeningeal dissemination : retrospective study with review of the literature.

ObjectiveThe purposes of this article are to present 5 cases of intracranial meningioma with leptomeningeal dissemination (LD) and investigate the characteristics of this disease.MethodsWe present a retrospective case series of 5 females at our institutions (age ranged 21-72 years, mean 54.6 years) diagnosed with LD of an intracranial meningioma after surgery between 1998 and 2013. A database search revealed 45 cases with LD of meningioma in the English literature. Characteristic features were analyzed and compared.ResultsThe incidence rate at our institutions of LD of meningioma was 0.9% (5/534). World Health Organization (WHO) grade was distributed as follows: I : 2, II : 2, and III : 1. Time to LD ranged from 2.5 months to 6.9 years; the patient with WHO grade III had the shortest interval to LD. The patient with an intraventricular meningioma (WHO grade II) had the second shortest interval to LD (1.7 years), and simultaneously revealed both LD and extraneuronal metastases. Four of 5 patients showed a disease progression, with the survival ranging from 1 month to 3.8 years after LD. Based on the literature, the initial tumor was an intraventricular meningioma in 9 patients, and their time to LD was shorter on average (mean 1.9 years). Histologically, 26 of 45 (58%) were initially diagnosed with a WHO grade II or III meningioma, and 6 of 19 patients (32%) with WHO grade I revealed malignant transformation.ConclusionThis study shows that intraventricular location and histologically aggressive features seem to increase the chance of LD of meningioma.

A case of intracranial meningioma detected by 18F-choline PET/CT and examined by PET/MRI fusion imaging

A case of intracranial meningioma detected by 18F-choline PET/CT and examined by PET/MRI fusion imaging

Imaging Features of Intracranial Meningiomas with Histopathological Correlation: A Relook into Old Disease

Background and Purpose: Imaging characteristics of meningiomas have been discussed previously in many studies; however complete imaging features involving general features, MRS and DWI of both typical and atypical meningiomas have been discussed in very few studies. CT and MR imaging findings in 46 cases of intracranial meningioma are reviewed to define specific imaging features. Methods: The present study was carried on 46 patients in the Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University during June 2009 to July 2011.The investigation was carried out by GE-VCT 64 Slice Scanner machine and Magnetic resonance imaging was contemplated using 1.5 Tesla SIEMENS-MAGNETOM AVANTO. CT and MR imaging studies were reviewed to characterize mass location, imaging characteristics, atypical features and advanced imaging features. Clinical presenting signs and symptoms were correlated with imaging findings. Results: a). Forty six cases of intra cranial meningiomas were studied prospectively in 24 women and 22men, aged 11 – 80 years. Meningiomas were stratified into typical and atypical and also depending upon intra cranial location. b). 73.91% of the cases in showed supratentorial location, rest were infratentorial (26.08%).CT/MRI revealed well defined margins in 84.78% with homogenous consistency in 73.91% of lesions. Foci of necrosis were noted in 32.60% of cases and 15.22% of cases showed calcification foci in meningioma. Sinus invasion noticed in 15.22% of cases, whereas adjacent bony reaction noticed in 30.43% of cases. c). Majority of Meningioma showed broad dural base (89.10%), adjacent white matter buckling (71.74%) and surrounding CSF cleft (52.17%). Displaced subarachnoid vessels were demonstrated in 30.43%, where as the pathognomonic dural tail was present in only 23.91% of the cases. d). All the cases of Meningioma demonstrated restriction on diffusion weighted sequences suggestive of high cellularity of the lesions. On CT angiography, neovascularity was noticed in 85.71% and tumor blush was noticed in 71.42% incidence. On MR Spectroscopy, all demonstrated choline peak and in one third cases alanine peak was discernible. Conclusion: In view of the observed evidence, it was concluded that understanding the classification, pathology and imaging appearance meningioma are essential for treatment planning. CT and MR imaging play indispensable role in the localization & characterization of these tumors, and MR have virtually yielded its position of dominance in characterizing these tumors. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 14-32 DOI: http://dx.doi.org/10.3126/njr.v3i1.8713

Abnormal F-18 Fluoride Uptake in Intracranial Meningiomas on PET/CT

The association between breast carcinoma and meningioma is a well-recognized phenomenon that may have important clinical implications, particularly in intracranial lesions. We report 2 cases of intracranial meningioma in adult women with a history of breast cancer, who were imaged with positron emission tomography/computed tomography (PET/CT) for evaluation of possible bone metastases. Whole-body F-18 fluoride PET demonstrated an intense intracranial focal radiotracer accumulation in both patients. Simultaneous CT showed a corresponding calcified space-occupying lesion, consistent with meningioma. Early and correct diagnosis of synchronous meningioma in F-18 fluoride bone scans might prevent relevant neurologic comorbidity.

Case Report: Meningioma with Granulofilamentous Inclusions

The authors report a case of intracranial meningioma with granulofilamentous inclusions. A 50-year-old man had right trigeminal neuralgia due to trigeminal nerve compression by a petroclival tumor and received tumor resection. Microscopically, tumor cells containing eccentric nuclei and intracytoplasmic hyaline inclusions were arranged in sheets and whorls. The inclusions were negative for periodic acid-Schiff reaction. No histological anaplasia was seen. Immunohistochemistry showed epithelial membrane antigen reactivity on the cytoplasmic membrane. Immunoreactivity for vimentin was recognized in cytoplasm adjacent to inclusions. However, confocal laser microscopic study revealed immunoreactivity for vimentin even inside some inclusions. Ultrastructurally, interdigitation of cytoplasmic processes and desmosomes connecting adjacent cells were noted. Inclusions were composed of numerous fine osmiophilic granules attached by intermediates filaments. These findings were consistent with a meningioma with the granulofilamentous inclusions described earlier. The findings demonstrated by confocal laser microscopy and electron microscopy suggest that these granular materials may be the metabolic products of vimentin filaments.

Extensive Oedema Surrounding Meningioma

We report a case of intracranial meningioma surrounded by severe oedema, unusually extending to the anterior segment of the internal capsule. The possible mechanisms involved in oedema formation are discussed.

Intracranial meningiomas. Analysis of 344 surgically treated cases.

The authors present 344 (230 females, 114 males) surgical cases of intracranial meningioma. A total of 370 interventions (344 primary procedures, 10 reexplorations for neurologic deterioration, 16 operations for recurrence) were made. Mean follow-up was 38 months. The overall evaluation revealed that 306 (88.95%) patients were completely normal or in a better condition than before operation. 18 (5.23%) were in a worse condition after operation and 20 (5.81%) died. Results suggested that complications and mortality were mostly related to localization and large volume; we also still have problems with aggressive and malignant meningiomas.

Aneurysm occurring within a meningioma: case report

Aneurysms can be expected to be found in approximately 0.5% of patients with brain tumours; nevertheless, the real incidence is difficult to assess because angiography is now seldom performed for brain tumours. In the literature, 42 cases of meningioma associated with aneurysms are reported, but in none was the aneurysm intratumoural. We describe a case of intracranial meningioma with an intratumoural aneurysm in a 48-year-old woman.

Suprasellar meningioma and blindness: A unique experience in Saudi Arabia

The natural history of intracranial meningioma is no different in the Arabian peninsula than in other countries. The extent of the total loss of vision in one or both eyes, however, is unique to this area. A retrospective study was conducted at King Faisal Specialist Hospital and Research Centre, a tertiary care institution in Saudi Arabia, on all cases of intracranial meningioma seen over a period of 9 years. The following data were collated: clinical presentation, site and size of tumor, radiologic features, surgical methods, and preoperative and postoperative visual status. Seventy of 232 cases (30.1%) of intracranial meningioma presented in the suprasellar area; the majority of these were more than 5 cm in diameter. Because of the large size it was not always possible to identify the exact point of origin or to achieve complete tumor removal. Deteriorating vision was the cardinal presenting feature and the incidence of blindness in one or both eyes at presentation was high (42.2%); 12.8% were totally blind on admission. None of these patients showed improvement after surgery (complete or subtotal removal of tumor). Lack of understanding of the symptoms and cultural influences are direct contributing factors to this complication of a benign intracranial lesion. This represents a serious public health concern in the Arabian peninsula.

Meningiomas intracraneales y edema cerebral. Estudio correlativo de diversos factores etiopatogénicos

Summary Meningiomas although generalIy benign tumors, can be associated with extensive peritumoral brain edema. In this paper we have analyzed the statistical relationship between peritumoral edema and several others factors in 29 cases of intracranial meningioma. The only stadisticalIy positive correlation was found between the presence of perilesional edema and tumor size (p < 0,05).

Immunological studies in patients with central nervous system tumors.

Impairment of cell-mediated immunity in patients with primary central nervous system (CNS) tumors has repeatedly been reported but data to demonstrate the underlying immunological defect are not univocal. This report concerns a series of 31 patients harboring a glioma in which we studied: peripheral blood T-lymphocyte subpopulations by monoclonal antibody analysis; cellular responsiveness to mitogens; serum immunoglobulin values. The same parameters were also evaluated in 7 cases of intracranial meningioma and in 8 patients affected by non-proliferative, non-inflammatory CNS diseases. Thirty age-matched healthy volunteers formed the control group. Neither impairment of T-cells as regard to number, responsiveness and subsets, nor abnormal Ig values were found in these groups. However two patients, harboring respectively a third ventricle low grade astrocytoma and an anterior callosal glioblastoma, presented a striking T-cells impairment. These findings might suggest a correlation between hypothalamus and immune system, as already postulated by several previous experimental and clinical studies.

Meningioma cysts.

We studied six cases of intracranial meningioma with cyst formation. Manifestations included focal neurologic signs (four cases), seizures (three cases), headache (three cases), and personality changes (two cases). CT revealed a cystic enhancing supratentorial lesion in five cases. Angiographic changes of meningioma were observed in only three cases, and correct preoperative diagnosis was made in only half the cases so studied. Histologically, all lesions were syncytial meningiomas. Cyst fluid was always xanthochromic, acellular, and highly proteinaceous. The variety of anatomic configurations suggests several pathophysiologic mechanisms in formation of the cysts that are commonly misdiagnosed preoperatively. Tissue analysis is needed for all cystic, enhancing lesions of the brain.

Metastatic meningioma

A case of intracranial meningioma that metastasizes outside the central nervous system is presented along with a brief review of such cases previously reported.