| Article Access Statistics|
| Viewed||9185 |
| Printed||255 |
| Emailed||8 |
| PDF Downloaded||154 |
| Comments ||[Add] |
| Cited by others ||3 |
Click on image for details.
|Year : 2003 | Volume
| Issue : 2 | Page : 263-265
Simultaneous occurrence of multiple meningiomas in different neuraxial compartments
Department of Neurosurgery, Command Hospital (CC), Lucknow-226002
Department of Neurosurgery, Command Hospital (CC), Lucknow-226002
The simultaneous occurrence of multiple meningiomas in different neuraxial compartments is rare. A 35-year-old female patient had multiple meningiomas involving both the supratentorial compartments and in the upper dorsal spine. The patient underwent excision of 2 cranial and 2 spinal meningiomas, and has remained asymptomatic over a follow-up period of 18 months.
|How to cite this article:|
Bhatoe H S. Simultaneous occurrence of multiple meningiomas in different neuraxial compartments
. Neurol India 2003;51:263-5
The term multiple meningioma is used to describe the simultaneous or sequential appearance of 2 or more independently situated meningiomas, not necessarily of the same pathologic subtype. In the pre-CT (computed tomography) era, the frequency of multiple meningiomas without neurofibromatosis was reported to be less than 3%., Since the introduction of CT scan, the frequency of multiple meningiomas has ranged between 4.5% and 10.5%., Nevertheless, the concomitant occurrence of multiple intracranial and spinal (S) meningiomas in the same patient is rare. A case having 4 meningiomas is reported.
A 35-year-old female patient had a three-month history of generalized headaches and progressive stiffness and weakness of all four limbs. She had no stigmata of neurofibromatosis. On examination, she had bilateral papilloedema, left-sided lower motor neuron type facial paresis and sensorineural hearing impairment. There was spastic grade 3-4 quadriparesis. T1 and T2 weighted magnetic resonance imaging (MRI) showed an isointense mass in the left infratentorial-cerebellopontine angle. Contrast enhanced MRI revealed small multiple meningiomas over the parietal parasagittal and convexity regions on both sides and a large meningioma arising from the tentorium [Figure:1a] & [Figure:1b]. MRI spine showed two isointense tumors on T1& T2 at D1 & D3 region, one lying ventral and the other lying dorsal to the cord, sandwiching the cord between them [Figure - 2]. The spinal tumors were excised initially and 4 days later, the left tentorial meningioma was resected by left temporal craniotomy. After 2 weeks, a nodular parasagittal vertex meningioma was excised. Following the surgeries, she showed symptomatic improvement.
Histological examination of the 2 spinal meningiomas revealed atypical and fibroblastic meningioma respectively. The tentorial meningioma was of the transitional variety, while the parasagittal tumor was a meningothelial meningioma. At a follow-up after 18 months, she is asymptomatic.
Multiple meningiomas were first described by Anfimow and Blumenau. Cushing and Eisenhardt classified them as a discrete clinical entity. Multiple meningiomas were associated with neurofibromatosis. However, the current concept is that these tumors are due to inherent multicentricity of the dural foci, possibly influenced by hormonal factors. The incidence of multiple intracranial meningiomas in the post-CT era has been reported to be between 5.4 and 8.9%, while the incidence as seen in autopsy series is between 8.2 and 16.9 %. The majority of these are located in a hemicranial distribution., Multiple spinal meningiomas are rarer than multiple cranial (C) meningiomas. Multiple meningiomas occurring in different neuraxial compartments are distinctly rare, with only 17 well-documented cases reported in world literature [Table - 1]. Only 4 of these occurred in males (M:F-1:4), out of which 2 were children. The relationship between isolated multiple meningiomas and neurofibromatosis is unsettled. In cases with reported cranial and spinal meningiomas, 5 (27.77%) had more than 1 intracranial tumor,,, and only 2 reports (mentioned earlier), had more than 1 spinal tumor.
Operative management of multiple meningiomas occupying both cranial and spinal compartments poses special problems. A decision is made regarding which lesion, or lesions should be removed initially. Small or asymptomatic tumors may be followed up with serial imaging. Histologically, each of these tumors may be a different variant of meningioma.
|1.||Abtahi H. Multiple Meningiomas. Acta Neurochir 1975;31:279. (Proceedings). |
|2.||Cushing H, Eisenhardt L. Meningiomas: Their Classification, Regional Behavior, Life History and Surgical End Results. Springfield, III: Charles C Thomas; 1938. |
|3.||Domenicucci M, Santoro A, D'Osvaldo DH, et al. Multiple intracranial meningiomas. J Neurosurg 1989;70:41-4. [PUBMED] |
|4.||Kandel E, Sungurov E, Morgunov V. Cerebral and two spinal meningiomas removed from the same patient. Case report. Neurosurgery 1989;25:447-50. [PUBMED] |
|5.||Anfimow J, Blumenau L. Ein Fall multiplier Geschwulste in der Schadelhohle. Neurol Zentralbl 1889;8:585. |
|6.||Androili GC, Rigobello L, Iob I, Casentini L. Multiple meningiomas. Neurochirurgia 1981;24:67-9. |
|7.||Santoro A, Tacconi L, Paolini S, Bristot R, Bastianello S. Multiple meningiomas in different neuraxial compartments. Report of two cases. J Neurosurg Sci 1999;43:211-4. [PUBMED] |
|8.||Butti G, Assietti R, Casalone R, Paoletti. Multiple Meningiomas. A Clinical, Surgical and cytogenetic analysis. Surg Neurol 1989;31:255-60. |
|9.||Rosa L, Luessenhop AJ. Multiple Meningiomas. In: Schmidek HH, editor. Meningiomas and their surgical management. Philedelphia: W B Saunders Co; 1992. pp. 73-92. |
|10.||Arseni C, Dumitrescu IL, Carp N. Orbital, sphenoidal ridge and spinal meningiomas occurring in one patient. Neurochirurgia (Stuttg) 1984;27:84-6. |
|11.||Kannuki S, Soga T, Hondo H, et al. Coexistence of intracranial and spinal meningiomas - report of two cases. Neurol Med Chir (Tokyo) 1991;31:720-4. [PUBMED] |
|12.||Radley MG, McDonald JV. Meningeal hemangiopericytoma of the posterior fossa and thoracic epidural space. A case report. Neurosurgery 1992;30:446-52. [PUBMED] [FULLTEXT]|
|13.||Zervas NT, Shintani A, Kellar B, Berry RG. Multiple meningiomas occupying separate neuraxial compartments. Case report. J Neurosurg 1970;33:216-20. |
|14.||Roda JM, Benscosme JA, Perez-Higueras A, Fraile M. Simultaneous multiple intracranial and spinal meningiomas. Neurochirurgia (Stuttg) 1992;35:92-4. |
|15.||Sedzimir CB, Frazer AK, Roberts JR. Cranial and spinal meningioma in a pair of twin boys. J Neurol Neurosurg Psych 1973;35:368. |
|16.||Yamashita K, Akimura T, Kawano K, et al. Multiple meningiomas of the spinal canal and posterior fossa - case report. Neurol Med Chir (Tokyo) 1989;29:834-7. |
|17.||Schiffer J, Mundel G, Lahat E, Schwarzmann H, Shental I. Multiple meningiomas in separate neuraxial compartments in a child. Child's Brain 1980;6:281-8. |
|18.||Distalmaier P, Lins E, Kolberg T. Multiple meningiomas. Two patients with a spinal and an intracranial meningioma. Radiological diagnosis. Neurochirurgia (Stuttg) 1976;19:114-7. |
|19.||Harish Z, Schiffer J, Rapp A, Reif RM. Intracranial and spinal multiple meningioma appearing after an interval of 22 years. Neurochirurgia (Stuttg) 1985;28:25-7. |
|20.||Kamiya K, Inagawa T, Nagasako R. Malignant intraventricular meningioma with spinal metastases through the cerebrospinal fluid. Surg Neurol 1989;32:213-6. |