Cystic Meningioma Research Articles

Magnetic Resonance Imaging of Cystic Meningiomas and Its Surgical Implications

Magnetic Resonance Imaging of Cystic Meningiomas and Its Surgical Implications

Cystic intracranial mass lesions: Possible role of in vivo MR spectroscopy in its differential diagnosis

Thirty-four patients showing cystic intracranial mass lesions on MR imaging were evaluated by in vivo proton MR spectroscopy (MRS) with the aim of detecting lesion-specific spectral patterns that may assist imaging in better tissue characterization. In vivo spectroscopy was performed using stimulated echo acquisition mode with echo times 20 and 270 m in all, and spin echo with echo time 135 m in 11 patients. All primary neoplasms (intra-as well as extra-axial) showed choline (3.22 ppm) resonance along with lipid and/or lactate (1.3 ppm). It was not possible to grade cystic gliomas based on N-acetyl asparate-to-choline ratio. High-grade gliomas (n = 8) showed lipid/lactate and low-grade gliomas (n = 6) showed only lactate. Seven patients with brain abscess showed resonances only from acetate (1.92 ppm), lactate (1.3 ppm) and alanine (1.5 ppm). Two cases of metastatic adenocarcinoma showed only lipid/lactate. In 7 patients with epidermoid cyst, lactate along with an unassigned resonance at 1.8 ppm was observed and could be easily differentiated from arachnoid cysts (n = 2), which showed only minimal lactate. A case of cystic meningioma could be differentiated from cystic schwannoma by the presence of alanine in the former. It is concluded that MR imaging, when combined with in vivo MRS, may help to better characterize intracranial cystic mass lesions.

Cystic lumbar meningioma presenting as a ring enhancing lesion on MRI

Cystic lumbar meningioma presenting as a ring enhancing lesion on MRI

Cystic papillary meningioma in the sella turcica of a dog

Cystic papillary meningioma in the sella turcica of a dog

Magnetic resonance imaging of a cystic meningioma

A rare case of meningioma with multiple cysts is reported. The tumor provided an unusual MR image after administration of Gd-DTPA

Cyst Fluids of Malignant Human Brain Tumors Contain Substances That Stimulate the Growth of Cultured Human Gliomas of Various Histological Type

Abstract The contents of 14 cysts that were located within human intracranial tumors were obtained at surgery by needle aspiration. These tumor cyst fluids (TCFs) were mostly derived from glial tumors (10 cases). TCFs from one metastasis from a mammary carcinoma, one cystic meningioma, one hemangioblastoma, and a cystic acoustic neurinoma were also included. These TCFs were added to primary cultures of human gliomas, established human glioma cell lines, and normal human arachnoid cells in culture. The presence of proliferation-promoting factors in all cyst fluids could be demonstrated. On the basis of the response patterns of the cultures, it was possible to distinguish different levels of growth autonomy and growth factor sensitivity among these cultures and to speculate about varying degrees of cellular autocrine activation. The TCFs appear to contain factors that are not normally present in fetal calf serum, which is a regular constituent of most cell culture media. Some primary cultured cells as well as cell lines react in an oversensitive manner to the addition of TCFs.

Cyst fluids of malignant human brain tumors contain substances that stimulate the growth of cultured human gliomas of various histological type.

The contents of 14 cysts that were located within human intracranial tumors were obtained at surgery by needle aspiration. These tumor cyst fluids (TCFs) were mostly derived from glial tumors (10 cases). TCFs from one metastasis from a mammary carcinoma, one cystic meningioma, one hemangioblastoma, and a cystic acoustic neurinoma were also included. These TCFs were added to primary cultures of human gliomas, established human glioma cell lines, and normal human arachnoid cells in culture. The presence of proliferation-promoting factors in all cyst fluids could be demonstrated. On the basis of the response patterns of the cultures, it was possible to distinguish different levels of growth autonomy and growth factor sensitivity among these cultures and to speculate about varying degrees of cellular autocrine activation. The TCFs appear to contain factors that are not normally present in fetal calf serum, which is a regular constituent of most cell culture media. Some primary cultured cells as well as cell lines react in an oversensitive manner to the addition of TCFs.

Cerebral meningiomas in children

Cerebral meningiomas are rare tumors in children that represent 1.4% of CNS tumors and 1.5% of intracranial meningiomas. We have analyzed 197 cases of cerebral meningiomas under 16: 178 cases were taken from the available literature and 19 from our series. When comparing pediatric meningiomas with those of adults, we noted some differences. Before the age of 16 there is a slight preference for males; the intraventricular variety is more frequent; cystic meningiomas and the absence of dural attachment are more frequent findings; the neuroradiological diagnosis is more difficult.

Cystic meningioma with unusual histopathological features

A parasagittal meningioma of an eighty year old female patient showed by light and electron microscopy cystic architecture (forme humide) as well as nuclear vacuoles (indentations) and cytoplasmic inclusions. The latter are the known pseudopsammoma bodies or hyaline inclusions as demonstrated by light and electron microscopy. Light microcopy on paraffin sections and cytological smear preparations revealed, in addition to the cells of endotheliomatous meningioma and those containing the inclusions a third type with small granular cytoplasmic content. Electron microscopy showed characteristic features of meningioma such as folded double membranes, desmosomes and filaments and thus gave evidence of the meningiomatous nature of the tumor. By immunohistochemistry tumor cells in slightly focal distribution contained vimentin, whereas small clusters of cells with hyaline inclusions were strongly positive for cytokeratin. The dispersed cells of granular cytoplasmic content were positive for fibronectin. These findings, especially of the inclusion containing cytokeratin positive cell clusters may shed new light upon the concept of histogenesis and classification.

Cyst fluid of glioma does not inhibit the killing action of lymphokine-activated killer (LAK) cells in vitro.

In theory, lymphokine-activated killer (LAK) cells offer a potential method to treat cerebral gliomas, especially low-grade gliomas. LAK cells would be administered by repeated injections straight into the cavity of a subtotally removed tumour. However, brain-tumour cyst fluid has been shown to be immunosuppressive in lymphocyte stimulation tests. Therefore we wanted to know whether the fluid would reduce the killing efficacy of LAK cells. Using a standard cytotoxity test based on 51Cr release, we compared in vitro the cytotoxity of LAK cells against K-562 tumour cells in brain-tumour cyst fluid, autologous serum and allogeneic serum. Five patients with cystic glioma and one with cystic meningioma were studied and no inhibition of cytotoxity of LAK cells was observed.

CT-findings in cystic meningiomas.

Cystic meningiomas are rare, about 10% occurring in children. Only 61 cases have been reported in the literature. Based on 6 of our own cases and the reports in the literature typical CT-findings are described and differentiating features from other cystic mass lesions discussed. If a tumour on CT shows a cystic component, is smoothly outlined, enhances markedly and is attached to the dura, then a preoperative diagnosis of cystic meningioma should be taken into account. This holds especially true if the patient is a child.

Subarachnoid hemorrhage after preoperative embolization of a cystic meningioma

We present a case of cystic meningioma accompanied by hemorrhage in the cyst and adjacent subarachnoid space that occurred while preoperative embolization in feeders of the tumor was being applied. The possible reason for the hemorrhage was the sudden dynamic changes in blood flow triggered by the embolization. The changes could have caused multiple ruptures of pathologic small vessels. We recommend that preoperative embolization should be used cautiously in treating cystic meningiomas because of a possible increase in bleeding from pathologic weak vessels.

Intracranial Cystic Meningioma associated with Multiple Aneurysms and a Venous Angioma

A 50-year-old male was hospitalized with headache and visual disturbance. Computerized tomography revealed a cystic lesion in the left occipital area as well as a small, hyperdense lesion in the left posterior fossa. On angiograms the left occipital lesion appeared to be a meningioma and the left posterior fossa lesion a venous angioma. In addition, the right carotid angiogram revealed an A2 aneurysm and the right vertebral angiogram showed a basilar top aneurysm. The left occipital lesion and both aneurysms were treated surgically. The left occipital lesion was diagnosed as meningotheliomatous meningioma. Cystic meningioma is rare, accounting for only 1.2-2.2% of all meningiomas. Also, aneurysms are associated with only 2.5-4% of all brain tumors. To the authors' knowledge, this is the first reported case of the cystic meningioma associated with multiple aneurysms and a venous angioma.

Cystic meningiomas—An update

Eighteen unusual cases of intracranial meningioma associated with a cyst are considered. Three patients were operated upon before the introduction of computed tomography scanning, and the discovery of a peritumoral cyst was unexpected. Among 15 patients studied with computed tomography, 8 had a peritumoral cyst, 6 had an intratumoral cyst, and I had a totally cystic meningioma (hypodense on computed tomography). Computed tomography permitted a correct preoperative diagnosis only in four cases. In six additional cases diagnosis was reached by selective angiographic studies. In the remaining cases diagnosis was impossible or incorrect. Different pathogenetic mechanisms underlie different radiologic patterns. The authors comment on the complex processes that lead to cyst formation in meningiomas and stress the necessity of an accurate preoperative study to avoid misdiagnosis.

Recurrent cystic meningioma

The authors report a case of recurrent meningothelial meningioma with a large cyst. At the first operation, the mural nodule was totally resected and the cyst wall was removed as much as possible. This cystic tumor recurred six years later at the site where the first operation was performed. Histologically, the cyst wall contained islands of the same neoplastic cells as were previously found in the mural nodule. The authors discuss the preoperative diagnosis and mechanism of cyst formation, and emphasize the importance of complete removal of the cyst wall for permanent cure.

Intraventricular meningioma. A review of 10 cases of the National Hospital, Queen Square (1974-1985) with reference to the literature.

Ten patients with histologically verified intraventricular meningiomas were treated between 1974 and 1985. There were eight female and two male patients, ranging in age from 25 to 72 years with a mean age of 45.5 years. Headache and disturbed mentation were the most common presenting symptoms whereas corticospinal disturbance, altered mentation and homonymous hemianopia were the most common signs on formal neurological examination. Papilloedema was demonstrable in 50% of cases and evidence of dysphasia was apparent in 60% of patients with lesions affecting their dominant hemisphere. A single instance of drop attack occurred in a patient harbouring a third ventricular meningioma. Computed tomography, with and without contrast enhancement, and angiography were employed in all cases and proved highly sensitive and specific for tumour localisation and tissue diagnosis. In addition, angiography proved invaluable in demonstrating both vascular supply and the effects imposed upon the surrounding cerebral vasculature by tumour mass and hydrocephalus. Nine tumours occurred in the lateral ventricular trigone of which 5 were left-sided. A tenth tumour was located in the third ventricle. Twelve resections were performed in 10 patients. One patient was found to have a highly malignant cystic meningioma which recurred within 10 weeks of the original surgery and proved fatal shortly thereafter. A second patient whose initial resection was subtotal had a recurrence 3 years postoperatively which was totally resected. Lesions were approached most commonly through the posterior middle or posterior inferior temporal gyri. On 3 occasions a right posterior middle frontal gyrus approach was used and in one case a posterior parieto-occipital cortical incision was employed.(ABSTRACT TRUNCATED AT 250 WORDS)

Bifrontal Cystic Falx Meningioma

A case of bifrontal cystic falx meningioma is reported, and the etiological background of cyst formation is conjectured from computed tomography (CT) scan and immunochemical findings. A 58-year-old female was admitted in May, 1983, because of an episode of generalized convulsion. Preoperative diagnosis of cystic meningioma (Nauta's type 2) was made by neuroradiological examinations. Most of the reported cases of Nauta's type 2 cystic meningioma revealed solid enhancement and delicate ring-like enhancement in CT scan and a less vascular mass on cerebral angiography. In surgery, a tumor was found adherent to the falx with bifrontal intratumoral cysts. Histological examination revealed meningotheliomatous meningioma. Microscopic examination disclosed abundant deposition of eosinophilic and hyaline-like substances in the interstitial area and tumor cells. These substances were periodic acid-Schiff negative and Alcian-blue positive, and contained immunoglobulin G. It was the authors' impression that these substances were secreted from the tumor cells, and consequently the tumor formed an encapsulated cyst.

Cystic meningiomas. Report of seven cases.

Seven patients with cystic meningioma are reported. The computerized tomography appearance of these meningiomas may mimic that of a glial or metastatic tumor with cystic or necrotic changes, and lead to an incorrect presumptive diagnosis. Radiological evaluation and recognition are important for the surgical removal of these potentially curable neoplasms.

Recurrent cystic meningioma

A case of a cystic meningioma recurring in its cystic form, two years after the initial removal, is presented. Regarded as a true cystic meningioma, the possible aetiology of the cyst formation is suggested. As the cyst wall itself may give rise to tumour cells, it is recommended that the initial operation should be directed at total removal of the tumour mass and cyst wall, thus reducing the possibility of a tumour recurrence. A CT finding of a hypodense lesion in a patient, operated on previously for a cystic meningioma suggests a recurrence of the tumour. However, other non-neoplastic changes should be considered.

Melanotic meningioma complicated by disseminated intravascular coagulation

The purpose of this paper is fourfold: First, to confirm the rarity of melanotic meningioma, as we have found only 11 reported cases; second to demonstrate that this tumor is not always totally pigmented, a fact that has not been mentioned before; third, to show an unusual recurrence as a hemorrhagic cystic meningioma 10 years and 8 months after removal; and fourth, to describe the association of disseminated intravascular coagulation, a rare disorder with brain tumors