Meningioma Presenting Research Articles

Concurrent meningioma and intracranial aneurysm: Insights from an updated systematic review and a case report

Background: The concurrent presentation of meningioma and intracranial aneurysm (IA) poses diagnostic and therapeutic challenges, with no standardized management protocol available. This study aims to address this through an updated systematic review, delineating optimal strategies for managing this dual pathology. Methods: A systematic review was conducted across PubMed, Web of Science, and Embase databases. Articles were screened independently by two reviewers. Treatment strategies and patient outcomes were comprehensively analyzed to formulate a treatment framework based on several characteristics. In addition, one concurrent meningioma and IA case from our institution was presented. Results: A total of 69 articles comprising 115 patients were included in the study. The cohort exhibited a female predominance (80%) with a mean age of 56 (±13) years. Meningiomas were primarily localized to the frontotemporal and sellar regions, while aneurysms favored the anterior circulation – notably, 16.5% of cases presented with ruptured aneurysms. Management strategies varied based on the spatial relationship between lesions and aneurysm rupture status. In unruptured cases, 34% underwent a single craniotomy for simultaneous resection of both pathologies, while endovascular intervention was favored when the IA originated from an artery feeding the meningioma (73%). Remarkably, postoperative aneurysm rupture occurred in 33% of cases managed solely through tumor resection (range 0–30 days postop). Conclusion: This study proposes a comprehensive treatment algorithm to guide neurosurgeons in managing concurrent meningioma and IA cases. By considering individual patient intricacies, the feasibility of simultaneous management, aneurysm rupture risk, and symptomatology, this framework is a valuable tool for clinical decision-making in these complex scenarios.

Case Report: Unmasked: Deceptive pediatric spinal meningioma

Introduction Pediatric meningiomas are rare tumors originating from the meninges’ arachnoid cap cells, representing a small fraction of all meningiomas. The clinical presentation of pediatric meningiomas varies widely depending on their location within the central nervous system. We report a case of pediatric spinal meningioma revealed by gait disturbance. We emphasize clinical and imaging features, as well as therapeutic management of spinal meningiomas. Case presentation We present the case of a 15-year-old boy with a one-year history of chronic thoracic back pain, worsening gait disturbances, and difficulty walking. Neurological examination revealed a spastic gait with increased muscle tone and bilateral pyramidal syndrome. Magnetic resonance imaging (MRI) demonstrated a posterior intradural extramedullary mass at the T6-T7 level, causing dorsal spinal cord compression. The patient underwent complete resection of the tumor, and histological examination confirmed the diagnosis of a WHO grade I psammomatous spinal meningioma. Conclusion This case highlights the clinical and imaging characteristics of spinal meningiomas in pediatric patients. MRI remains the gold standard for diagnostic imaging, effectively narrowing down differential diagnoses. However, a definitive diagnosis requires histological examination. The primary therapeutic approach for pediatric meningiomas is surgical resection.

Metachronous intracranial meningiomas without dural attachment in a child - Rare case report and review of literature.

Meningiomas in children are rare, constituting less than 5% of all paediatric brain tumours and less than 2% of all meningiomas. Multiple meningiomas (synchronous or metachronous) are even more uncommon, typically occurring due to radiation exposure or in patients with phacomatoses like Neurofibromatosis II. This report presents the case of a child with metachronous meningiomas without dural attachment in unusual locations, along with their management. This report aims to describe a rare paediatric case of metachronous meningiomas without dural attachment, detailing their presentation, treatment, and outcomes. A 2-year-old female presented with headaches, irritability, and excessive crying for one year. A CT scan revealed a mass in the fourth ventricle, causing obstruction, which was surgically decompressed. The biopsy confirmed a clear cell meningioma, WHO grade II. A follow-up MRI identified a new lesion in the suprasellar area six months later, for which she underwent right pterional craniotomy and gross total resection, which turned out to be a clear cell meningioma, WHO grade II. The patient recovered well and remained asymptomatic, with no recurrence on MRI at one-year follow-up. This case highlights the unusual presentation of metachronous clear cell meningiomas without dural attachment in a young child. Surgical excision resulted in a favourable outcome, though long-term follow-up is essential due to the high propensity for recurrence.

Primary pulmonary meningioma presenting as a pulmonary ground glass nodule: a case report and review of the literature

BackgroundA primary pulmonary meningioma is an extremely rare entity. Primary pulmonary meningiomas manifested with a ground glass nodule are a very rare occurrence in clinical practice.Case presentationIn this study, we report a case of a primary pulmonary meningioma with atypical computed tomography features. A 59-year-old Han Chinese female came to our hospital for treatment and reported that her physical examination revealed a ground glass nodule in the right lung for over 3 months. The histologic result revealed a primary pulmonary meningioma. The patient underwent a thoracoscopic lung wedge resection of the right upper lobe for a ground glass nodule. After 1 year of follow-up, the patient is still alive without evidence of metastasis or recurrence.ConclusionsPrimary pulmonary meningiomas could have a variety of radiological findings. As there are no specific radiologic features for the diagnosis of primary pulmonary meningiomas, complete resection of the lesion is required for both diagnosis and treatment. It is necessary to note the imaging features of primary pulmonary meningiomas, presenting as a ground glass nodule; this rare tumor should be considered in differential diagnoses.

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.

Neglected Spheno-orbital Meningioma Presenting with Unilateral Blindness

Sphenoorbital meningiomas (SOM) constitutes 9% of all intracranial meningiomas and are originated from sphenoid wing dura. They are also called en plaque meningioma. They cause hyperostosis of involved bone and their soft tissue growth may spread the orbit, the infratemporal fossa, and the temporal fossa. Most patients with SOM are middle- aged women and most commonly presents with unilateral, nonpulsating, progressive proptosis. Recently a woman with unilateral progressive proptosis from a remote area of Bangladesh presented to us with blindness of her left eye due to diagnostic delay. After thorough evaluation and imaging studies, she was diagnosed with a large spheno-orbital meningioma with extensive bony involvement of skull base and orbit. Objective: This report highlights the necessity of creating awareness among optometrists, undergraduate medical students as well as and ophthalmologists who are practicing in remote areas of Bangladesh about clinical presentation of sphenoorbital meningiomas which is a benign lesion but may be a cause of unilateral blindness if remain undiagnosed for long Bang. J Neurosurgery 2023; 13(1): 51-54

A case of cerebellopontine angle meningioma presenting as neurovascular compression syndrome of the 8th cranial nerve

A 54-year-old female patient presented with paroxysmal tinnitus and vertigo for 2 years, which have repeatedly occurred while rotating her neck, and lasted about 10 seconds. An anticonvulsant medication was prescribed with a diagnosis of microvascular compression syndrome on the 8th cranial nerve and audiovestibular evaluation and magnetic resonance imaging (MRI) scan were appointed a week later. In her next visit, she reported the disappearance of paroxysmal audiovestibular symptoms after medication. In the left ear, canal paresis and abnormal auditory brainstem response were observed. In MRI, a large meningioma in the cerebellopontine angle in the vicinity of the internal auditory canal orifice was detected, that was surgically resected by a neurosurgeon. After surgical removal of the tumor, she reported continuous dizziness due to vestibular nerve injury, but the paroxysmal attack of tinnitus and vertigo disappeared without anticonvulsant medication. This case suggests that an imaging study is mandatory when diagnosing microvascular compression syndrome on the 8th cranial nerve.

Rare Presentation of Meningioma as an External Auditory Canal Mass

Rare Presentation of Meningioma as an External Auditory Canal Mass

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.

Ectopic meningioma presenting as a neck mass: case report and review of literature

BackgroundEctopic meningiomas are rare neoplasms that occur entirely outside the intracranial and intraspinal cavities and account for only 1–2% of all meningiomas. These tumors have been reported at various sites, however they are predominantly observed in the head and neck region. Here, we detail a case of an adult diagnosed with ectopic meningioma of the neck.Case presentationA 26-year-old woman underwent evaluation for a neck swelling associated with difficult in swallowing. Clinical examination revealed a firm, non-tender and non-pulsatile swelling in the right side of neck. On imaging, a soft tissue mass lesion was seen involving the right supra-hyoid neck, centered at the right carotid space/retro-styloid parapharyngeal space. She underwent maximal safe resection of the tumor and a consensus was reached regarding the diagnosis of ectopic meningioma based on the histopathological, clinical and radiological findings. Relevant literature is reviewed.ConclusionsThe diagnosis of ectopic meningioma may pose difficulties due to their occurrence in uncommon sites. The primary approach to treatment entails the surgical removal of the neoplasm, and a multidisciplinary strategy is pivotal for achieving the best possible clinical outcomes for patients with this rare entity.

Aplasia Cutis Congenita With Cutaneous Meningioma: A Rare Case.

Cutaneous meningioma, characterized by ectopic meningothelial cells in the dermis or subcutis, is a rare neoplasm. Generally, the most common location for cutaneous meningioma is the scalp. We report a case of cutaneous meningioma presenting as soft, light red, atrophic, and smooth patches with central blue spots. On histological examination, the tumor consisted largely of epithelioid cells, whorls, nests, and syncytial sheets of meningothelial cells. HMB-45, Melan-A, and S100 were negative; epithelial membrane antigen and somatostatin receptor 2 were positive. Ultimately, histopathologic examination and immunohistochemistry results supported a diagnosis of cutaneous meningioma. In addition, dermal dysplasia was observed above the tumor, manifested by thinning of the dermis and loss of appendages. No abnormalities were found on brain magnetic resonance imaging. Cutaneous meningioma is an extremely rare tumor, and its manifestation as an atrophic patch is even rarer. There have been mainly clinical reports of cutaneous meningioma. This was a rare case of focal aplasia cutis congenita with cutaneous meningioma. For cutaneous meningioma to be diagnosed earlier, there needs to be greater public awareness about the condition.

Meningioma Presenting as Ischemic Stroke: Case Report and Review of Literature

Meningioma Presenting as Ischemic Stroke: Case Report and Review of Literature

Case Series of Atypical Cisternal Presentation of Meningiomas

Case Series of Atypical Cisternal Presentation of Meningiomas

Metaplastic Meningioma Presenting with Anemia in A Young Boy Case Report and Review of the Literature

Metaplastic Meningioma Presenting with Anemia in A Young Boy Case Report and Review of the Literature

A Case of Meningioma Presenting with Psychiatric Symptoms

A Case of Meningioma Presenting with Psychiatric Symptoms

Teaching NeuroImages: Optic Nerve Sheath Meningioma Presenting as Gaze-Evoked Amaurosis.

Teaching NeuroImages: Optic Nerve Sheath Meningioma Presenting as Gaze-Evoked Amaurosis.

Diagnostic neuroradiology of intracranial meningiomas presenting with hemorrhagic onset: a double center 14-year experience.

This study aims to increase awareness of the hemorrhagic presentation of intracranial meningiomas in the emergency department and present clues for neuroradiological diagnosis, which is crucial for pertinent management. We described the prevalence of hemorrhage in a large population of meningioma patients, with emphasis on clinical presentation, computed tomography (CT), magnetic resonance (MR), and digital subtraction angiography (DSA) findings. This retrospective analysis has been performed at two reference institutions between January 2002 and December 2015, and includes 1304 patients with histologically proven newly diagnosed intracranial meningioma. Clinical features and neuroradiological findings of intracranial meningiomas presenting with hemorrhage have been reviewed. Twenty-four patients (1.8%, 16 females, 8 males, age range: 29-88years) were found to have spontaneous hemorrhagic onset of the newly diagnosed meningioma. A sudden onset occurred in 23/24 patients. Sixteen patients showed isolated intralesional hemorrhage, four had subdural hematomas, and the remaining four presented combined intralesional and subarachnoid (n = 2) or intraventricular (n = 2) hemorrhages. In 13 patients, CT showed both the hemorrhage and the meningioma. In the other 11 patients, diagnosis was achieved by emergency or early surgery (n = 5), MRI (n = 5), and DSA (n = 1). The presence of an underlying meningioma has to be considered in the differential diagnosis of spontaneous intracranial hemorrhage, although this is a rare event. CT, MRI, and occasionally DSA were useful to obtain the diagnosis; however, in up to a fifth of patients, this was achieved at surgery.

An unusual indication of maxillectomy—a case presentation of sphenoid wing meningioma

BackgroundSphenoid wing meningiomas (SWMs) are named because of their site of origin which is in the vicinity of the sphenoid wing. They are further classified into globoid type and en plaque (aka spheno-orbital meningiomas). These tumours are known for their difficult management because of their invasion to various neurovascular structures and bones. Surgical removal of these tumours is challenging. Complete surgical excision of the tumour is not always guaranteed; hence, intentional incomplete removal sometimes is mandatory to reduce postoperative morbidity. The purpose of this case report is to emphasize and describe the unexplored role of total maxillectomy in the excision of the extensive skull base tumours involving the orbit and infratemporal fossa.Case presentationIn this case report, we are presenting a case of a 50-year-old male diagnosed a case of atypical sphenoid wing meningioma with orbital and paranasal sinus extension who was previously operated on by extracranial approach and presented with the recurrence. Here, we are providing insight and surgical management of this case using total maxillectomy as an approach to access the intracranial approach.ConclusionMaxillectomy with orbital exenteration can be used as a successful surgical approach to manage skull base lesions and intracranial tumours without any evident post-op complications.

Study of Clinico-Pathological Spectrum of Meningioma with WHO Grading

Introduction: Meningiomas are the most frequent non glial primary Central Nervous System (CNS) tumour. Several histopathological patterns of meningiomas are classified and graded. A standard classification system aims at providing a tool for estimating the recurrence and overall survival of meningioma patients. Aim: The aim was to study clinical, radiological and pathological presentation of Meningioma and to grade meningiomas according to 2016 WHO classification in a tertiary care centre. Materials and Methods: It is an observational study of 51 cases of meningioma conducted in the department of Pathology, SDM college of Medical sciences and Hospital, Dharwad from June 2011 to June 2021. The demographic details, clinical features, radiological findings, histopathological findings and grading of meningioma according to 2016 WHO classification were analysed. Results: A total of 51 meningioma cases were studied in which age ranged between 16 and 79 years. Among 51 cases, 33 (64.70 %) were females and 18 (35.29 %) were males. The most common symptom was headache seen in 39 patients (76.47%) followed by vomiting in 11 patients (21.56%). Radiologically, commonest lobe involved was frontal lobe in 22 cases (43.13%). The most common histological subtype was meningothelial meningioma in 18 (35.29%) cases followed by psammomatous meningioma in 13 (25.49%), transitional meningioma in 12 (23.52%), fibroblastic meningioma in 4 (7.84%), atypical meningioma in 2 (3.92%), secretory meningioma 1 (1.96%) and microcystic meningioma in 1 (1.96%) case. A total of 49 (96.07%) cases of meningiomas were of Grade-I & 2 (3.92 %) were of Grade-II with none in Grade-III. Conclusion: Meningiomas occur more commonly in females than in males with multiple clinical presentation. Histopathological examination helps to type the meningioma and grade them accordingly.

Meningioma Presenting with Spontaneous Venous Intraparenchymal Hemorrhage

A 65-year-old woman with a known right-sided, dural-based lesion and metastatic pancreatic neuroendocrine tumor presented with multiple days of progressive lethargy and left-sided weakness culminating with obtundation and dilated pupils. Computed tomography demonstrated an acute right convexity subdural hematoma and a frontotemporal intraparenchymal hemorrhage with 1.3 cm of midline shift, uncal herniation, and an increase in size of now a hemorrhagic dural-based lesion. She underwent emergency hemicraniectomy for evacuation of subdural hematoma and resection of hemorrhagic meningioma with excellent postoperative result including improvement in midline shift and gross total resection of lesion. Pathology was consistent with a World Health Organization grade II meningioma with a chordoid component. She underwent adjuvant stereotactic radiosurgery and cranioplasty and made a full neurologic recovery. Identification of hemorrhagic meningioma as the underlying pathology causing multicompartmental hemorrhage is crucial. We recommend single-stage decompression with extraaxial clot evacuation and resection of the meningioma when feasible.