Frontal Meningioma Research Articles

Preoperative executive functioning impairments in patients with a meningioma: does a frontal location matter?

AbstractPatients with meningiomas frequently exhibit impairments in executive functioning. There are few studies specifically examining the role of frontal meningioma localization in executive functioning impairments. This study examines whether frontally located meningiomas are specifically associated with executive functioning impairments in a large sample of meningioma patients before treatment, using an axis-wise and lobe-based approach to meningioma localization. We retrospectively examined cognitive performances in 353 patients with frontal, frontally-involved and non-frontal meningiomas on a battery of tests including tests of executive functioning. We applied an axis-based approach to meningioma location, in addition to qualitative lobe-based localization. We examined the association between meningioma coordinates on an anterior-posterior axis and continuous cognitive performance scores in univariate correlations and linear regression analyses. We also examined the association between meningioma coordinates on an anterior-posterior axis with cognitive impairments in multivariable logistic regression analyses. Meningioma position on the anterior-posterior axis was only univariately associated with mean performance on the Stroop test Interference ratio and Symbol Digit Coding task. There was no (multivariable) association with impairments on tests of executive or non-executive domains. Increased odds of impairment on executive functioning tasks were associated with left-localization (Verbal Fluency) and larger meningioma volumes (Shifting Attention). We did not find a specific relation between a frontal meningioma location and executive functioning impairments, which may be explained by widespread organization of executive functioning throughout the brain, diffuse cognitive effects of the mass of meningiomas, functional reorganization due to neuroplasticity, or functional involvement of less-anteriorly located frontal areas.

Case Report and Literature review. Neuropsychiatry Manifestation of Frontal Lobe Neoplasm- Meningioma. Prevalence, Presentation and Pathogenesis

IntroductionMeningiomas are the most frequent primary brain tumor. Although most Meningiomas are benign, their location in the central nervous system can predict symptomatology which could result in significant morbidity and mortality. However, due to the slow-growing nature, meningiomas are usually asymptomatic, and diagnosis is often made incidentally on neuroimaging or at an autopsy. The incidence rate is 1.2-fold higher in Black Americans than White Americans. Neuropsychiatry manifestation might be only initial presentation; thus, psychiatrists are often the first to see these patients, and the correct diagnosis may be made only when the tumor has grown to a considerable size and begun to displace the brain.ObjectivesThe aim of this study is to understand the biological basis of psychiatry symptoms in patients with Frontal Lobe meningiomas.MethodsA review of literature and individual patient data analysis was conducted. The literature review was conducted on PubMed, Medline, MeSH, Google Scholar, and mount Sinai’s levy Library using the key words; meningioma, meningioma with psychiatric symptoms, psychosis, depression, neuropsychiatry manifestation of meningiomas.ResultsThe review revealed that 88% of brain tumors and psychiatric symptoms are located in the frontal region. Meningiomas accounts for 13%-26% of intracranial tumors. There is a reported low incidence due to its slow growing nature and are usually asymptomatic. Incidence of meningiomas is predominant in females, and is attributed to hormonal factors, this is associated with estrogen and progestogen cycles. Reports shows that smoking has been linked to increase risk of meningiomas in men. Frontal lobe meningiomas may present with only psychological symptoms that resemble depression, anxiety states, hypomania and schizophrenia. Personality and mental status changes are also noted in Frontal lobe tumors. Left sided lesions are associated with inhibition of motor activity, impairment in motor and initiative aspect of speech, diminished generalization ability and general inertia of mental process.Conclusions Given the absence of frank neurological symptoms, to help localize the lesion, most meningiomas are missed due to diagnostic overshadowing of the primary psychiatric illness. Peritumoral edema indicates the underlying mechanism and location of the lesion predicts symptomatology. Like our patient who is an 81-year-old male with no past psychiatry history, presenting to our comprehensive psychiatry emergency program with psychiatric manifestation as the initial presentation and subsequently with MRI suggestive of Right Frontal extra-axial meningioma. This study shows that primitive frontal lobe tumors are likely to be misdiagnosed as patients with such tumors are often referred first to psychiatrist. High index of suspicious is needed.Disclosure of InterestNone Declared

Early‐onset Lewy body dementia associated with PRKN gene mutation

AbstractBackgroundA 42‐year‐old woman presented with a 1‐year history of head tremors, visual hallucinations, and concentration difficulty. On initial evaluation by a neurologist, she was told that her symptoms were due to anxiety, and no further workup was done. After seeking a second opinion, further workup was pursued.MethodThe patient underwent cognitive testing, with Montreal Cognitive Assessment revealing a normal score of 29/30. MRI Brain revealed a midline frontal meningioma without mass effect. Routine EEG revealed no evidence of seizure tendency. Due to persistent head tremors and visual hallucinations, further testing was considered.ResultPET‐FDG CT Brain revealed bilateral parietotemporal and occipital hypometabolism with preserved cingulate gyrus metabolism, consistent with Lewy body dementia. Another PET‐FDG MRI Brain performed 13 months later revealed a similar hypometabolism pattern. Genetic testing revealed a heterozygous mutation for the PRKN gene.ConclusionIn this case, a patient showing clinical signs of a potential neurodegenerative disorder was initially dismissed as having anxiety, but further workup with appropriate neurological studies revealed a genetic basis for early‐onset Lewy body dementia. This case demonstrates a unique association with the PRKN gene mutation with Lewy body dementia even though it is typically associated with Parkinson’s disease. This case also highlights the underrepresentation of young patients with neurodegenerative diseases, which is reinforced by biases against pursuing appropriate workup for young patients showing relevant clinical signs.

Early‐onset Lewy body dementia associated with PRKN gene mutation

AbstractBackgroundA 42‐year‐old woman presented with a 1‐year history of head tremors, visual hallucinations, and concentration difficulty. On initial evaluation by a neurologist, she was told that her symptoms were due to anxiety, and no further workup was done. After seeking a second opinion, further workup was pursued.MethodThe patient underwent cognitive testing, with Montreal Cognitive Assessment revealing a normal score of 29/30. MRI Brain revealed a midline frontal meningioma without mass effect. Routine EEG revealed no evidence of seizure tendency. Due to persistent head tremors and visual hallucinations, further testing was considered.ResultPET‐FDG CT Brain revealed bilateral parietotemporal and occipital hypometabolism with preserved cingulate gyrus metabolism, consistent with Lewy body dementia. Another PET‐FDG MRI Brain performed 13 months later revealed a similar hypometabolism pattern. Genetic testing revealed a heterozygous mutation for the PRKN gene.ConclusionIn this case, a patient showing clinical signs of a potential neurodegenerative disorder was initially dismissed as having anxiety, but further workup with appropriate neurological studies revealed a genetic basis for early‐onset Lewy body dementia. This case demonstrates a unique association with the PRKN gene mutation with Lewy body dementia even though it is typically associated with Parkinson’s disease. This case also highlights the underrepresentation of young patients with neurodegenerative diseases, which is reinforced by biases against pursuing appropriate workup for young patients showing relevant clinical signs.

Case of Metastatic Atypical Meningioma to Lung: Utility of Cytological Preparations for Intraoperative Diagnosis

Abstract Introduction/Objective Meningiomas are the most common primary intracranial and intraspinal tumors. They are typically benign with an indolent behavior but can metastasize extracranially to the skin, bone, lymph node and liver. Lung metastasis is exceptionally rare, and the diagnosis can be challenging, especially during intraoperative diagnosis without ancillary studies. We describe a metastatic atypical meningioma to the lung for which intraoperative cytology facilitated the diagnosis and guided management. Methods/Case Report A 53-year-old woman with a history of left frontal atypical meningioma and multiple surgical resections for recurrences at outside hospitals, presented with an incidental left lung nodule. A lung wedge resection was performed and submitted for intraoperative diagnosis. Gross examination revealed a well-circumscribed, tan- white, and rubbery subpleural nodule. Cytological preparations— Diff-Quik and H&E stains—and frozen section were prepared. Cytologically, the nodule displayed cohesive distinctive papillary whorls of uniform eosinophilic cells with indistinct cell membranes, round to oval nuclei with central nucleoli and intranuclear pseudoinclusions. The frozen section exhibited similar cytological features, few identifiable whorls and predominantly solid sheets of tumor cells typical of non-small cell carcinoma. Based primarily on the cytological findings, the intraoperative diagnosis was a neoplasm with papillary growth pattern, and a metastasis was favored based on the whorled pattern and clinical history; no further resection was performed. Permanent sections displayed mitoses and no necrosis. Immunohistochemical analysis revealed positivity for somatostatin receptor 2a, progesterone receptor, and EMA (focal); no staining was seen with pancytokeratin, TTF-1, or p40. A diagnosis of atypical meningioma, WHO grade 2, was rendered. Subsequently, an atypical cranial and temporalis muscle meningioma at the site of the prior craniotomy bone flap was resected and had an identical molecular profile (1p36 deletion) to that in the lung, further supporting metastasis to the lung. Results (if a Case Study enter NA) NA Conclusion This case illustrates a rare presentation of metastatic atypical meningioma and highlights the distinctive intraoperative utility of cytology preparations—architectural and cytological details—for diagnosis and appropriate management. Cytology preparations can be a valuable tool and complement frozen sections, in which certain morphological features may be less obvious or confounded by freezing artifact.

Refractory seizures secondary to radiation-induced focal cortical dysplasia/neuronal gigantism: illustrative case.

Focal cortical dysplasia is a structural cause of drug-resistant epilepsy commonly identified in childhood. In rare cases, radiation-induced injury has led to radiation-induced cortical dysplasia, also known as "focal neuronal gigantism." The authors present a 53-year-old woman with recurrent status epilepticus events after she had radiation therapy and surgery for a left frontal meningioma several years prior. Imaging revealed findings consistent with radiation necrosis and possible recurrence. The patient's status epilepticus events required escalating therapies to manage. Scalp electroencephalography indicated that the seizure's origin was in the left hemisphere. A craniotomy was performed to remove the left frontal lesion, and histopathology was consistent with radiation-induced focal cortical dysplasia/neuronal gigantism. The patient's seizures ceased following the surgery, and she remains on maintenance antiseizure medications. Radiation-induced focal cortical dysplasia/neuronal gigantism is an incredibly rare complication of therapy. However, it warrants consideration in the context of radiation necrosis and intractable epilepsy.

Case Report: Maternal death due to frontal lobe meningioma mimicking postpartum depression

Meningiomas are among the most frequent primary brain tumors. Meningiomas can present with psychiatric manifestations such as depression in the absence of any neurological signs and symptoms. This case illustrates a rare and fatal complication of frontal lobe meningioma that finally mimicked postpartum depression in a woman who relied on non-professional sources of help and died without proper diagnosis and treatment. The case reported here highlights the significance of considering frontal lobe meningioma as a possible cause of psychiatric symptoms in postpartum women and recommends performing a thorough neurological examination and neuroimaging if necessary. Clinicians should be aware of this possibility and perform neuroimaging studies in patients with postpartum depression who have atypical features such as persistent headaches. Overall, this paper emphasizes the significance of early diagnosis and intervention of frontal lobe meningiomas to improve patient outcomes and prevent fatal complications.

Gigantic Exteriorized Frontal Meningioma: An Exceptional Clinical Entity

Background and Importance: Meningiomas are usually benign tumors. Depending on their location and size, dealing with them can be problematic. We report an exceptional case of gigantic frontal meningioma. Its diagnosis was misleading and the excision laborious. Case Presentation: A 29-year-old patient who presented gradually over 5 years, developed behavioral disorders then swelling of the vertex at the frontal level and decreased visual acuity. Physical examination on admission revealed a median frontal swelling slightly lateralized to the left axis of approximately 10 cm, hard, covered with the healthy, severe frontal syndrome, and decreased visual acuity. Computerized tomography (CT) scan showed a voluminous medial frontal lesion lateralized to the left, with irregular limits, superior sagittal sinus invasion, brain engagement under the scythe, heterogeneous contrast taking, and significant osteolysis first evoking tumor metastasis. Magnetic resonance imaging (MRI) suggested a meningioma. The resection was macroscopically complete. Dural and cranial plasty was performed. The postoperative follow-up was simple. Histology concluded that the meningioma was grade 1 based on the world health organization (WHO) classification. Conclusion: Late-diagnosis meningiomas can take on very large proportions and pose management problems while seriously engaging the patient functional and vital prognosis.

Bilateral Orbital Compartment Syndrome Following a Craniotomy With Coronal Incision.

Orbital compartment syndrome is a rare ophthalmic emergency characterized by increased intraorbital pressure and hypoperfusion of critical neural structures, most of which were caused by trauma, and can also be caused by periorbital surgery, local injections, other preexisting medical conditions and so on. It requires rapid identification and immediate treatment for the preservation of vision. A 61-year-old female with left frontal lobe-parafalcine meningioma underwent a craniotomy with a bicoronal incision. Postoperatively, the patient presented absence of pupillary reaction in both eyes, and complained loss of vision after recovery from anesthesia. Bilateral orbital compartment syndrome was considered 18 hours postoperatively since the marked bilateral proptosis with eyelid edema and conjunctival chemosis. The patient was treated with methylprednisolone, mannitol, hyperbric oxygenation, and neurotrophic agents as recommended by the ophthalmologist. There was no improvement in visual acuity at discharge or at 3-month follow-up postoperatively. This is a rare case of bilateral irreversible blindness caused by orbital compartment syndrome after a craniotomy with coronal incision. Neurosurgeons need to improve the awareness of this complication for adequate prevention, such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection, and also earlier recognition and management.

Bipedicled Scalp Flap for Coverage of a Frontal Loss of Substance: About One Case

Introduction: Scalp defects are frequent in the daily practice of plastic surgeons. Their etiologies are multiple; they can be of tumoral origin, infectious, secondary to a burn, post-traumatic… The great vascular richness of the scalp explains the possibility of using local flaps. Clinical Case: This is an 80-year-old patient with ATCD: arterial hypertension under treatment. The onset of symptoms dates back 10 years when the patient was operated on by neurosurgeons for a frontal meningioma for which she underwent excision + cranioplasty. The patient presented after 10 years for cranioplasty rejection with signs of local infection. The decision to remove the prosthetic material and cover the loss of substance was taken. After removal of the cranioplasty material by the team of neurosurgeons, we decided to perform a bi-pedicled scalp flap vascularized by the occipital pedicle and the posterior auricular pedicle, the donor area was grafted. The postoperative course was unremarkable. The result was considered good without complications. Conclusion: The anatomical particularities of the scalp explain all the originality of the reconstructions of this region. In our patient, the advantage of using the bipediculated flap is its extreme reliability, especially when the cranial vault has to be sacrificed.

Coexistence of Cerebellopontine Angle Tumor and Frontal Convexity Meningioma at Distinct Location – A Rare Case Report and Review of Literature

The perioperative management of brain tumors can be significantly impacted by the presence of another intracranial tumor at a distinct location. We report a rare case of an adult who developed two primary brain tumors, a frontal convexity meningioma and a cerebellopontine angle (CPA) tumor at anatomically disparate locations. In our patient, it was unambiguously decided to address the CPA tumor first as it had led to multiple cranial nerve palsies and obstructive hydrocephalus. The relevant literature helped us better extrapolate the patient presentation and management of this disastrous presentation swiftly.

Organic affective disorder due to meningioma, case report

IntroductionBrain tumors can be associated with psychiatric symptoms in up to 50% of cases. The most frequent primary is meningioma and the clinic will depend on its location. Since surgical treatment does not always guarantee complete resolution of the condition, concomitant psychopharmacological treatment is usually recommended.ObjectivesTo review about organic mania and its differential diagnosis.MethodsWe carry out a literature review about organic affective disorder accompanied by a clinical description of one patient with organic mania.ResultsA 50-year-old woman admitted due to psychotic symptoms. She had a diagnosis of frontal and parietal meningioma treated with surgical treatment 10 years ago. In this context she had a diagnosis of Organic Affective Disorder and 3 previous psychiatric admissions due to affective or psychotic symptoms. Current episode consisted in dysphoria, magalomanic ideation, delusional ideation of harm and mystical-religious content, high speech pressure and insomnia with little awareness of the disease. Cranial magnetic resonance showed postoperative right frontal changes and stability in parietal meningioma, with no significant differences compared to the previous study. Diagnosis of Organic Affective Disorder is maintained and reintroduced treatment with aripiprazole withdrawaled by the patient weeks before. Because of adverse effects and persistence of the symptoms described, it was changed to olanzapine with good response and tolerability. The behavior was progressively adapted with improvement of the dysphoria and without psychotic symptoms at discharge.ConclusionsAffective symptons due to organic disorders such as brain tumors can be treated surgically and with psychopharmacological treatment.Disclosure of InterestNone Declared

Sinonasal Bone Destruction caused by Frontal Meningioma Invasion related with Respiratory Tract Infection Incident: A Case Report

Meningioma is uncommonly found in extracranial. Extracranial meningioma can be extension from primary intracranial tumors that accompany osteolytic changes in the skull or causes bone destruction. In this article, we report about intracranial meningioma in the frontal region that extend to the sinonasal bone causes bone destruction and being predisposing factor for respiratory tract infection. A 47-years old female brought to the emergency department due to dyspnea and fever since a week ago and there was found a lump in the frontal region. During the surgical procedure, there was invasion of tumor and caused sinonasal bone destruction. The endotracheal tube (ETT) can be seen from the surgical field. In this case the patient was threated pneumonia infection, it can be related as complication of sinonasal bone destruction that caused by invasion of meningioma to extracranial manifestation. The clinical important that must be informed to the patient the possibility of recurrent respiratory tract infection incidents.

RADT-30. RADIATION INDUCED MENINGIOMA IN BACKGROUND OF CHILDHOOD CRANIAL IRRADIATION: A CASE SERIES

Abstract BACKGROUND Cranial irradiation as part of prophylactic (PCI) or radical treatment for childhood malignancies can be associated with late consequences such as radiotherapy induced meningioma. METHODS We are reporting 5 such patients treated at our institute. RESULTS Case 1: 24y female received PCI for Acute Lymphoblastic Leukemia at the age of 2, and developed right frontal meningioma which was resected and pathology confirmed grade 2 atypical meningioma. It was treated with radiotherapy 60Gy/30fr and 2 year follow up scans remain stable. Case 2: 31y male received PCI as a child, and developed parieto-occipital meningioma which was excised multiple times. Pathology revealed Grade 2 atypical meningioma and was treated with radiotherapy 60Gy/30fr. Follow up scans 3.5 yrs later remain stable.Case3: 37y male received PCI at the age of 3, and developed multiple site meningiomas which were excised. Pathology showed likely Grade 2 meningioma. The sphenoid wing lesion progressed 2 years later, was re-excised and treated recently with radiotherapy 60Gy/30fr. Case 4: 52y female treated with radiotherapy for retinoblastoma at the age of 6-8 wks, developed left sphenoid wing meningioma which was resected and pathology revealed malignant meningioma. Radiotherapy 60Gy/30fr was recently completed.Case 5: 24y female treated with radiotherapy for medulloblastoma at the age of 5, developed meningiomas at multiple sites. Over the span of 10 years the frontal and clinoid lesions increased in size, and were treated with SRS/SRT recently. CONCLUSION All patients had background of cranial radiation and developed meningioma with latency period ranging 19 to 52 years. It is not possible to make an inference on gender, site of meningioma or craniaI dose correlation because of small number of cases and lack of data on dose. Further research is needed on how to prevent secondary malignancies in such patients and on standard of care for secondary meningiomas.

A rare case report of recurrent atypical meningioma with multiple metastases treated with anti-PD-1 and anti-VEGF therapy

BackgroundMeningioma is the most common type of primary intracranial tumor with 0.1–1% of all primary meningiomas have been reported to develop into metastases. However, there is no proven therapeutic strategy for multiple metastases of meningiomas.Case presentationA 60-year-old female accepted total tumor resection of a right frontal lobe meningioma in September 2018, In October 2021, the patient was admitted to hospital because of cough and shortness of breath and diagnosed with metastatic meningiomas. The computed tomography (CT) scan revealed the presence of large masses in the right thoracic and abdominal cavity. After two cycles of anti-PD-1 and anti-VEGF treatment, the symptoms were relieved and the tumor was necrotic. Follow up to June 21, 2022, the patient has been given eleven cycles of the treatment every 3 weeks without tumor progression.ConclusionsThis case showed combined anti-PD-1 and anti-VEGF treatment stimulates peripheral blood immune cells to kill metastatic meningioma cells. Whether combined immunotherapy is more effective for metastatic meningioma needs further exploration.

Orbital Meningioma Revealed by Papilledema: Case Report and Review of the Literature

Orbital meningioma is a rare benign tumor, it develops from the dura mater and can invade the opposite bone and invade the orbital contents through the superior orbital fissure or optic canal, or more frequently after bone invasion. It frequently occurs in the spheno-orbital region, rarely in the frontal location, as in our case. This is a 58-year-old woman with no pathological antecedents. She consulted with our ophthalmology service with progressively installing low visual acuity with binocular diplopia. Examination of the right eye reveals exophthalmos axial, painless, non-reducible and non-pulsatile, as well as limitation of ocular motility in lateral gaze. Fundus examination showed grade 1 papilledema. Orbitocerebral scanner was favorable for frontal meningioma with grade 1 exophthalmos. Pariente was referred to neurosurgery for possible surgical excision.

A Standardized Approach to Treatment Over Objection in Patients Lacking Decision-Making Capacity Secondary to Neurologic Disease

Neurologic diseases, ranging from Alzheimer dementia to mass lesions in the frontal lobe, may impair decision making. When patients with neurologic disease lack decision-making capacity, but refuse treatment, should they be treated over their objection? To address this type of ethical dilemma in medical illness, Rubin and Prager developed a standardized 7-question approach: (1) How imminent is harm without intervention? (2) What is the likely severity of harm without intervention? (3) What are the risks of intervention? (4) What are the logistics of treating over objection? (5) What is the efficacy of the proposed intervention? (6) What is the likely emotional effect of a coerced intervention? (7) What is the patient's reason for refusal? We describe the application of the standardized Rubin/Prager approach as a checklist to the case of a 50-year-old woman with a large frontal lobe meningioma, who lacked capacity as a result of the meningioma, but refused surgery. This approach may be applied to similar ethical dilemmas of treatment over objection in patients lacking capacity as a result of neurologic disease.

Frontal Region Focal Meningioma Mimicking Ischemic Stroke

Meningiomas typically present with gradual onset of symptoms but on rare occasions may present mimicking an ischemic stroke. The case of a 46-year-old homemaker with a right frontal region focal meningioma mimicking an ischemic stroke is presented here. A review of the literature was carried out, and the important role of radiological evaluation in resolving the diagnostic puzzle and various treatment options are also discussed.

Skin-picking in a patient with frontal meningioma – case report and treatment options

Skin-picking in a patient with frontal meningioma – case report and treatment options

Delayed Bilateral, Post-Traumatic Extra-Subdural Hematomas in a Patient with Meningioma

Concomitant acute epidural hematoma (EDH) and subdural hematoma (SDH) is a rare finding, and its bilateral onset has not yet been reported in literature. We present the first report of a patient affected by post-traumatic concomitant EDH and SDH, with the contralateral, delayed onset of another, associated with meningioma previously treated with gamma knife. A 60-year-old female patient with a history of simple focal seizures with motor symptoms and well-controlled by drugs since childhood, arterial hypertension, and incidental diagnosis of multiple meningiomas was referred to our department after falling down the stairs. Initially, the patient was prescribed gamma knife treatment of the right frontal convexity meningioma. The patient was admitted to our emergency department with Glasgow Coma Scale (GCS) score of 7/15 and isochoric, myotic pupils. An immediate head CT scan revealed a small acute SDH in the right hemisphere and an acute blood collection in the left hemisphere, which exerted mass effect; furthermore, we discovered complex skull fractures across the superior sagittal sinus, and dislocated bone fragments. A left decompressive craniectomy was performed, and intraoperatively we observed a concomitant EDH/SDH. Due to the patient’s anisocoria, an urgent postoperative CT scan was performed, revealing a massive blood collection in the right hemisphere, which was discovered to be another concomitant EDH/SDH, during right trauma flap. Through this approach, we also removed the right frontal convexity meningioma. After 5 days in the intensive care unit (ICU), the patient died because she presented an acute heart failure. The development of a contralateral, delayed EDH/SDH must be considered in severe traumatic patients, especially if associated fractures across major dural sinuses are present. Intraoperative CT scan, if available, or immediate postoperative CT scan, is mandatory for adequate management of complex neurotrauma cases.