Cystic Meningioma Research Articles

Parasagittal and parafalcine cystic meningiomas, as well as other cystic meningiomas case series and systematic literature review

Background and Importance: Cystic components in meningiomas are an infrequent finding and pose diagnostic and therapeutic challenges to neurosurgeons. This study aims to conduct a comprehensive assessment of the clinical characteristics and management approaches for cystic meningiomas (CMs). Case Presentation: The current research investigated rare cases of CM. In the first case (case 1), benign parasagittal CM showed malignant features, including brain swelling and midline shifting. In the second case (case 2), parafalcine CMs demonstrate rare histopathological analysis and have not been documented in previous studies. The third case involved a pregnant woman, while the fourth case showed improvement in an older patient after surgery and indicated that the removal of a CM can result in a good prognosis. All tumors were surgically removed at stage 1 (Simpson stage), and histopathology confirmed World Health Organization (WHO) grade 1 syncytial meningioma in cases 1, 3, and 4. Only case 2 showed grade 3 rhabdoid meningioma. Conclusion:We found that benign CM may cause more brain edema than high-grade meningiomas, especially when they invade the sinus. Parasagittal and parafalcine CM invade the superior sagittal sinus (SSS), making complete excision more challenging and riskier. The presence of the cyst facilitates the removal of the tumor and reduces the risks.

Massive cystic falcine meningioma presented with slight symptoms: a case report

Introduction and importance: Meningiomas are the most common intracranial tumors while their presence with cysts is relatively low. In general, large ones usually present with severe symptoms and have a high recurrence rate even after total resection which is also difficult. Case presentation: The authors present a case of an elderly patient with a large Falcine meningioma associated with peritumoral cysts. The patient presented with mild symptoms despite the tumor’s significant size. Imaging studies revealed a large mass in the falcine region with peritumoral cysts. The patient underwent surgical resection of the tumor, which was completed without complications. Clinical discussion: The atypical presentation of this large Falcine meningioma with peritumoral cysts highlights the variability in clinical manifestations of these tumors. Despite the tumor’s size and the presence of peritumoral cysts, the patient experienced mild symptoms and recovered after relatively easy surgery challenging conventional expectations. Conclusion: The successful outcome of this case demonstrates that even large meningiomas can present with mild symptoms. Medical practitioners should not always link the tumor size to the severity of symptoms, recurrence rate, and complexity of surgery.

Cystic meningioma of the brain

ABSTRACTMeningiomas with a cystic component are quite rare and account for 1.7–7.3 % of all intracranial meningiomas. The incidence of cystic meningioma in adults is 2–4 % of all meningiomas. Women have a higher incidence rate in comparison to men. Between 2014 and 2019, at the State Institution Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine, we collected data for a database of cystic meningioma cases. The data included preoperative imaging, surgery notes, and pathology reports. Over the course of 6 years, 1408 meningioma cases have been observed, and 1326 of those instances have undergone surgical treatment for intracranial meningioma. 73 (5.5 %) cases of cyst-associated meningiomas have been analyzed: 26 (2.0 %) of true cysts (primary), 47 (3.5 %) cases of pseudocysts (secondary). Nauta type IV was the most common cyst type accounting for 52.1 %, whereas atypical (27.4 %) and anaplastic (17.8 %) meningioma types were the most common histological subtypes. All patients were monitored for 24 months; only 73 patients had access to long-term monitoring, which lasted for an average of 49 months (range 36–96 months). The majority of atypical (2.7 %) and anaplastic (5.5 %) types of pseudocystic meningioma relapsed after radical tumor surgery removal. The preoperative diagnosis needs to be integrated with the examination performance, the surgical treatment is selected based on the Nauta classification, and most of the surgical operations can result in the complete resection of the tumor.

Imaging and Pathological Features and Recurrence Causes of Cystic Meningioma

Objective: This study aims to establish preoperative imaging features, establish how they are correlating with post-operative pathological features, and discover the causes of recurrence. Results: Data on imaging procedures in the preoperative period, records of surgical operations, and reports from pathology conclusions were collected. Among 623 patients who were undergoing neurosurgery resection of intracranial meningioma, 24 cases of cystic meningioma were identified, corresponding to a world incidence of 3.8 %. The hemispheric convexity was the most frequent place of localization. The apparent diffusional coefficient was significantly lower in grade 2 and grade 3 tumors if compared to grade 1. Full resection of the cystic component was possible in 18/24 cases. Partial resection in 3/24 cases. In 2/24 cases, it was not possible to make total or partial resection, but multiple biopsies were performed from the cystic walls.

MENINGIOMA-06 CYSTIC MENINGIOMA CASE STUDY AND LITERATURE REVIEW

Abstract BACKGROUND Intracranial meningiomas are generally solid tumors with a characteristic radiological appearance. The incidence of cystic meningioma is very low. withe an estimated frequency of 1.6 to 11.7%. It is often misinterpreted on radiological only the anatomopathological exams study can confirm the diagnosis. We report an unusual case of cystic meningioma through which we discuss pathogenic, clinical, radiological and therapeutic characteristics. CASE The patient is a 46 years old woman, with left parieto-occipital headaches for three months with recent appearance of right hemiparesis. The brain scan showed a lesion occupying the left posterior cystic parietal space with a solid nodule and perilesional edema, and enhancement of the solid component and cystic wall. The patient was operated using a left posterioparietal approach.The intraoperative appearance was that of a well defined encapsulated lesion attached to the dura mater, whitish in colour with a cystic part containing xanthochromic liquid and a solid nodule. The tumor is completely extra-axial with a plane of cleavage relative to the peritumoral cortical surface having facilitated its complete excision. Histological examination of the resected confirmed the diagnosis of cystic meningioma. There was no recurrence after 20 months of follow up. CONCLUSION Cystic meningioma is a rare entity. The diagnosis is often difficult to make preoperatively. Dural tail is a specific radiological sign, but not enough to evoke the diagnosis of meningioma with total precision. The surgical excision must be complete especially before signs of contrast of the cystic wall, in order to avoid a possible recurrence or anaplastic transformation.

Outcomes following surgical resection of cystic intracranial meningiomas.

Cystic meningiomas are rare, accounting for 2-7% of all intracranial meningiomas. Little is known regarding whether these meningiomas behave differently compared to solid meningiomas. We sought to study this relatively uncommon imaging appearance of meningioma and to evaluate its clinical significance. A single-institution retrospective cohort study of surgically-treated meningioma patients between 2000 and 2019 was conducted. Cystic meningioma was defined as a tumor with an intratumoral or peritumoral cyst present on preoperative imaging. Demographics, preoperative imaging, histopathology characteristics, operative data, and surgical outcomes were reviewed. Imaging variables, histopathology and outcomes were reported for cystic meningiomas and compared with non-cystic meningiomas. Univariate/multivariable analyses were conducted. Of 737 total meningiomas treated surgically, 38 (5.2%) were cystic. Gross total resection (GTR) was achieved in 84.2% of cystic meningioma patients. Eighty-two percent of cystic meningiomas were WHO grade I (n = 31), 15.7% were grade II and 2.6% were grade III. Most cystic meningiomas had low Ki-67/MIB-1 proliferation index (n = 24, 63.2%). A total of 18.4% (n = 7) patients with cystic meningioma had recurrence compared to 12.2% (n = 80) of patients with non-cystic meningioma (p = 0.228). No significant difference in median time to recurrence was observed between cystic and non-cystic meningiomas (25.4, Q1:13.9, Q3:46.9months vs. 13.4, Q1:8.6, Q3:35.5months, p = 0.080). A small portion of intracranial meningiomas have cystic characteristics on imaging. Cystic meningiomas are frequently WHO grade I, have low proliferation index, and had similar outcomes compared to non-cystic meningioma. Cysts in meningioma may not be a surrogate to determine aggressive meningioma behavior.

Atypical Cystic Meningioma:Report of One Case

The diagnosis of atypical cystic meningioma is difficult because of the atypical MRI findings.This paper reported a case of atypical cystic meningioma and described the detailed MRI findings,which would provide valuable imaging evidence for the localization and classification of cystic meningioma.

Lipomatous Cystic Meningioma Mimicking High Grade Glioma: A Rare Case Report with Brief Review of Literature

Lipomatous meningioma is rare variant of meningioma. A 34 year old male was presented with intermittent headache, dizziness, slurring of speech and right hand numbness and weakness since 15days. Patient came at OPD with Computed Tomography (CT) scan and it reported that a well defined thick walled heterogeneous mass. Brain magnetic resonance imaging (MRI) was done where it reported that large (6.3 x 6.5 x 4.7 cm) T1 hypo-intense and T2 hyer-intesne enhancing mass with non-enhancing cystic lesion and surrounding edema in left parietal lobe suggesting high grade glioma. Left parietal craniotomy and total excision of mass was performed. Histopathology diagnosis was a rare Lipomatous Meningioma.

Cystic Meningioma With Interesting Imaging Characteristics in Frontal Region: A Case Report

Introduction: Cystic meningioma is an unusual shape of meningioma, and the imaging manifestations and site of the solid/cystic components of the mass increase our difficulties in making a diagnosis.
 Case report: We report a case of a 78-year-old right-handed woman who presented with right-sided hemiparesis, urinary incontinency, and Broca aphasia. A large left-sided frontal region cystic extra-axial mass with a suspicious small solid nodule and adjacent bony erosion was detected on non-contrast CT of the brain. Brain Magnetic resonance imaging (MRI) with gadolinium depicted the cystic and solid components exactly. A probable diagnosis of cystic meningioma was made and subsequently confirmed by histological study after surgical resection of the tumor. To confirm the category and subtypes of the tumor, a histopathological examination of the tumor cells should be done.
 Conclusion: Cystic or solid cystic intracranial lesions have several differential diagnoses making the final diagnosis difficult in some cases. There are four types of cystic meningiomas according to the Nauta classification that was revised by Jung et al. Determination of the type of cystic meningioma is crucial for surgical planning. To confirm the category and subtypes of the tumor, a histopathological examination of the tumor cells should be done. Our case was a type IV cystic meningioma with a small mural enhancing solid nodule but an associated adjacent bony invasion.

Supratentorial Extra-axial Ependymoma: A Rare Radiological Mimic of Cystic Meningioma

Ependymoma is commonly an intra-axial infratentorial tumour affecting paediatric age group. We report a rare case of supratentorial extra-axial ependymoma in a teenager who presented with worsening headache and mild cognitive impairment. Previously, only few of such cases have been reported in the literature. However, in the last decade, there has been increasing number of this rare entity represented as a solid-cystic mass. In this report, we discuss the radiological features as we think it is mimicking a cystic meningioma and recommend that ependymoma should be considered in the diagnosis of a solid-cystic extra-axial lesion especially when located supratentorially.International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 Page: 338-341

Extra-Axial Cystic Meningioma without Dural Attachment in an Adult: Case Report and Review of Literature.

Intraparenchymal meningiomas, meningiomas without dural attachment, and cystic meningioma are atypical and extremely rare, especially in adults. Only four cases of intraparenchymal cystic meningioma without dural attachment have been reported. A 47-year-old female presented with an altered sensorium. She had a progressive bifrontal headache for 2 months. Computed tomography scan of the brain showed an 8 cm × 6 cm cystic lesion with a solid component in the left frontoparietal region with a midline shift. The solid part of the lesion was enhancing on contrast but the cyst rim was not. Intraoperatively, the cyst was filled with amber-colored fluid, which was drained, and the solid component was completely excised. Histopathological examination of the solid tumor component confirmed cystic meningioma. At 2 years of follow-up, she has no evidence of recurrence. We report the fifth case of this very rare entity and review the literature.

An intraparenchymal meningioma mimicking glioma

Meningiomas rarely exhibit cystic lesions with mural nodules and may be misdiagnosed as intraparenchymal cystic tumors. We herein present a 52-year-old man with amulti-locilar cystic lesion with heterogeneous enhancement in the right frontotemporal lobe accompanied by peritumoral brain edema. Differential diagnoses included low-grade gliomas and cystic meningioma. The patient underwent right frontotemporal craniotomy and near-total excision of the tumor. Intraoperatively tumor is cystic and firm inconsistency with no clear plane of dissection between tumor and brain parenchyma. Histopathological examination revealed grade 2 atypical meningioma

Supratentorial Cystic Meningioma Resembling Pilocytic Astrocytoma: A Case Series and Literature Review

Introduction: Cystic meningioma is a rare subtype of meningioma. Various brain tumors may mimic cystic meningioma in imaging appearance. Herein, we reported a series of cases with cystic meningiomas primarily misdiagnosed as pilocytic astrocytoma due to a similar radiological appearance. Methods: This case-series study included 20 patients with cystic meningiomas admitted to the Ghaem Hospital, Mashhad, Iran, between 2012 and 2019. The findings of magnetic resonance imaging (MRI), computed tomography, and neurological examination were recorded preoperatively. All the patients underwent surgery, and biopsies were obtained, confirming the histopathological diagnosis of the tumor. Results: The patients’ mean age was 40.7±12.5 years, including 11 men and nine women. Most of the patients presented with headaches (50.0%), and hemiparesis (60.0%) was the most found in the neurological examination. All neuroimaging studies revealed solid-cystic supratentorial tumors, in which cysts were intratumoral, larger than solid components, and eccentric relative to them. Most of the cysts were located in the frontal lobe. The T2 weighted MR images’ signal intensity showed hypointense lesions in 25.0% of the cases; however, 45.0% of the patients were hyperintense and 30.0% of them were isointense to grey matter. After contrast injection, the tumor’s solid and periphery experienced a homogeneous enhancement. The most common histopathological finding was meningothelial cells (30.0%) followed by fibroblastic cells (25.0%). Conclusion: Cases with an initially diagnosed pilocytic astrocytoma in the imaging can turn out to show cystic meningioma after pathological assessments, which deserves clinicians’ notice.

MENINGIOME KYSTIQUE DE LA FAUX DU CERVEAU : A PROPOS D’UN CAS CLINIQUE ET REVUE DE LITTERATURE.

Cystic meningioma is a rare extra-axial tumor. Represent 4 to 7% of all intracranial meningioma. We report a case of falx cystic meningioma and literature review. Clinical case This is a 23 years old patient with relative personal health history who has presented for nearly two years generalized headache associated with left hemiparesia. The head scan and IRM showed a right posterior parietal tumor with a cystic and fleshy component which was interpreted as glioma. The patient was operated and the intraoperative aspect was an extra axial lesion inserted to the middle tierd of the falx cerebri with a clear cleavage plan with the cerebrum. A total exeresis of the lesion was down and the histological study confirm the diagnosis. Conclusion The cystic meningioma is a rare variant of intracerebral meningioma of which only histology makes it possible give the diagnosis of certainty. Keyword: Meningioma, Cystic, IRM, CT scan, falx cerebri

Cystic Meningioma in an Adult: Unusual Radiologic Appearance of a Common Intracranial Tumor

Meningiomas are common intracranial brain tumors. However, cystic meningiomas are very rare, accounting for 2%-4% of intracranial meningiomas. In this article, we report a 52 years old female patient with a parasagittal right frontal cystic meningioma type V recognized by its neuroimaging features on CT scan and MRI. Imaging modalities can play a crucial role in the appreciation of subtypes of cystic meningiomas, and the radiological analysis for appropriate surgical treatment.

A SILENT CASE OF LARGE CYSTIC MENINGIOMA

Meningiomas are the most common extra-axial neoplasms. Meningiomas, in general may be benign or malignant. Cystic meningiomas are one of the subtypes of meningioma, mimicking an intra-axial lesion radiologically and clinically. The common clinical manifestations may include but not limit to headache, vomiting, seizures & focal neurological decits. The cystic component is an uncommon nding that makes it difcult to distinguish between a meningioma and a glial neoplasm radiologically. Here, we discuss a 54-year-old female patient who presented with subacute onset of transient memory disturbances and a sudden neurological deterioration who was found to have a cystic meningioma.

Frontal Cystic Meningioma Removed by a Partial Transfrontal Craniotomy in a Cat

Background: Meningiomas are the most frequently reported intracranial tumors in cats. It is known to arise at the point of arachnoid cells project into the dural venous sinuses. Cats with intracranial meningiomas are treated by surgical management as the tumors are commonly delineated from normal brain tissue and are not likely to adhere to the cerebral parenchyma. Although meningioma is the most common intracranial tumor in cats, the incidence of cystic meningioma is low. The objective of the current study is to report a case of frontal cystic meningioma with peritumoral cystic structure removed by a partial transfrontal craniotomy. Case: A 10-year-old castrated British shorthair cat was referred to the Baeksan Feline Medical Center with a recent onset of seizures. On the physical examination, the patient was bright and alert. Neurological examinations were unremarkable at the time of presentation. Hematologic examinations were within normal limits. Thoracic and abdominal radiography, and abdominal ultrasonography revealed unremarkable findings. Magnetic resonance imaging revealed an extra-axial mass cranial to the frontal lobe. On the sagittal plane, a cystic structurewas identified in the frontal areaon post-contrast T1W images. No contrast enhancement of the cystic wall was identified after intravenous injection of contrast medium on T1W. On the transverse plane of T2W images, midline shift to the left due to peritumoral edema was observed. The mass was removed via partial transfrontal craniotomy. Postoperative radiography was performed to ensure appropriate placement of the mesh. The patient recovered uneventfully after anesthesia. After the surgery, the patient was closely monitored in an intensive care unit between 24 and 48 h. Based on the histologic findings, the final diagnosis was a fibroblastic meningioma. Nineteen months after the surgery, there was no seizure activity identified by the owner.Discussion: Depending on the location of the cyst, meningiomas can be classified into 4 types according to the human literature. In types 1 and 2, the whole cyst is located within the tumor, resulting in contrast enhancement of the cystic wall. In types 3 and 4, the cysts are located outside the tumor, and no contrast enhancement of the cystic wall is observed. In type 3, the cyst lies adjacent to the brain parenchyma rather than adjacent to the tumor and the meningioma is related to a cerebrospinal fluid cyst bordered by the arachnoid. It is important to classify the type of cystic meningioma prior to surgery in order to decide whether to remove the cystic wall. In type 2, the cystic wall is infiltrated by tumor cells, while the cystic wall of type 3 meningioma is composed of gliotic tissue without any tumor cells. Therefore, in type 2, the meningiomas with cystic walls should be removed for the prevention of recurrence, while in type 3 meningioma, the tumor can be managed by cyst decompression and excision of the solid component. Based on the Nauta classification, the cystic meningioma reported here was considered to be type 3. Therefore, the surgical procedure aimed to remove the solid component of the mass, leaving the cystic wall attached to the normal brain. As the solid part of the meningioma was located beneath the internal plate of the left frontal bone, the partial transfrontal craniotomy was sufficient to expose and remove the entire mass. To the author’s knowledge, this is first case report describing a patient with frontal meningioma with a peritumoral cyst removed by a partial transfrontal craniotomy based on the Nauta classification.

Cystic Meningioma, an Uncommon Entity: A Case Report

Cystic meningioma refers to meningothelial neoplasms or meningiomas associated with cyst formation. Clinical features depend on the tumors’ size and location, and include symptoms of increased intracranial pressure, seizures, and focal neurological deficit. Four types of cystic meningiomas are described in the literature, suggested by Nauta et al., based on radiologic findings: Type I: Intratumoral cysts in which the tumor, macroscopically visible on all sides of the cyst, surrounds the cavity; Type II: Intratumoral cysts, lying at the periphery of the tumor and surrounded by a row of neoplastic cells, detectable microscopically; Type III: Peritumoral cysts, whose walls consisted partly of adjacent parenchyma and partly of the tumor; and Type IV: Peritumoral cysts, whose walls are formed by the arachnoid (arachnoid cyst), separated from the tumor by a distinct capsule. Theories proposed to explain cyst formation include degeneration or necrosis, direct secretion by meningioma, and reactive changes (peripheral arachnoid cysts). The tumor itself has features similar to non-cystic meningiomas. The cysts are usually of variable size and can be entirely surrounded by tumor (types I or II), clearly between the tumor and the brain (type IV), or within the adjacent brain (type III). On imaging, it is sometimes difficult to distinguish between these types. We herewith present two cases of cystic meningiomas.

Peritumoral (pseudo)cystic meningioma in a cat

A nine-year-old, male, neutered domestic shorthair cat was referred with a three-month history of abnormal behavior. On neurological examination, the cat showed circling towards the left. Magnetic resonance imaging of the brain revealed an extra-axial mass at the level of the left forebrain surrounded by a large peritumoral (pseudo)cyst. A left-sided rostrotentorial craniectomy to drain the fluid and to remove the tumor was performed. On histopathologic examination, the presence of a meningioma was confirmed. The owners did not report any clinical signs one year postoperatively.

Cystic Meningioma in the Cerebellopontine Angle Mimicking Vestibular Schwannoma: A Case Report

Cystic meningioma in the cerebellopontine angle (CPA) is an extremely uncommon disease. It is often misdiagnosed as other diseases. Its clinical features, surgical strategies and prognosis are not clearly understood. We reported a case of cystic meningioma in the CPA with tumor invasion into the internal auditory canal (IAC). Based on the typical preoperative symptoms, signs, hearing tests, and enhanced magnetic resonance imaging (MRI), the 36-year-old female patient was diagnosed with vestibular schwannoma and underwent surgical resection. Postoperative pathology revealed that the tumor was meningioma. It was totally removed without any new neurological dysfunction, and no recurrence was observed in the follow-up within 24 months. Cystic meningioma in the CPA is considered to have a high pathological grade and recurrence rate. Considering this situation, total intraoperative resection, including the enhanced wall of the tumor and postoperative follow-up may be critical.