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Year : 2003  |  Volume : 51  |  Issue : 2  |  Page : 263-265

Simultaneous occurrence of multiple meningiomas in different neuraxial compartments

Department of Neurosurgery, Command Hospital (CC), Lucknow-226002

Correspondence Address:
Department of Neurosurgery, Command Hospital (CC), Lucknow-226002
[email protected]

  »  Abstract

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

How to cite this URL:
Bhatoe H S. Simultaneous occurrence of multiple meningiomas in different neuraxial compartments . Neurol India [serial online] 2003 [cited 2023 May 31];51:263-5. Available from:

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%.[1],[2] Since the introduction of CT scan, the frequency of multiple meningiomas has ranged between 4.5% and 10.5%.[3],[4] Nevertheless, the concomitant occurrence of multiple intracranial and spinal (S) meningiomas in the same patient is rare. A case having 4 meningiomas is reported.

   »   Case Report

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.

   »   Discussion Top

Multiple meningiomas were first described by Anfimow and Blumenau.[5] Cushing and Eisenhardt[2] classified them as a discrete clinical entity. Multiple meningiomas were associated with neurofibromatosis.[6] However, the current concept is that these tumors are due to inherent multicentricity of the dural foci, possibly influenced by hormonal factors.[7] 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.[3],[8] Multiple spinal meningiomas are rarer than multiple cranial (C) meningiomas.[9] 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[10],[11],[12],[13] and only 2 reports (mentioned earlier)[14],[15] 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. 

  »   References Top

1.Abtahi H. Multiple Meningiomas. Acta Neurochir 1975;31:279. (Proceedings).  Back to cited text no. 1    
2.Cushing H, Eisenhardt L. Meningiomas: Their Classification, Regional Behavior, Life History and Surgical End Results. Springfield, III: Charles C Thomas; 1938.  Back to cited text no. 2    
3.Domenicucci M, Santoro A, D'Osvaldo DH, et al. Multiple intracranial meningiomas. J Neurosurg 1989;70:41-4.  Back to cited text no. 3  [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.  Back to cited text no. 4  [PUBMED]  
5.Anfimow J, Blumenau L. Ein Fall multiplier Geschwulste in der Schadelhohle. Neurol Zentralbl 1889;8:585.  Back to cited text no. 5    
6.Androili GC, Rigobello L, Iob I, Casentini L. Multiple meningiomas. Neurochirurgia 1981;24:67-9.  Back to cited text no. 6    
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.   Back to cited text no. 7  [PUBMED]  
8.Butti G, Assietti R, Casalone R, Paoletti. Multiple Meningiomas. A Clinical, Surgical and cytogenetic analysis. Surg Neurol 1989;31:255-60.  Back to cited text no. 8    
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.  Back to cited text no. 9    
10.Arseni C, Dumitrescu IL, Carp N. Orbital, sphenoidal ridge and spinal meningiomas occurring in one patient. Neurochirurgia (Stuttg) 1984;27:84-6.  Back to cited text no. 10    
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.  Back to cited text no. 11  [PUBMED]  
12.Radley MG, McDonald JV. Meningeal hemangiopericytoma of the posterior fossa and thoracic epidural space. A case report. Neurosurgery 1992;30:446-52.  Back to cited text no. 12  [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.  Back to cited text no. 13    
14.Roda JM, Benscosme JA, Perez-Higueras A, Fraile M. Simultaneous multiple intracranial and spinal meningiomas. Neurochirurgia (Stuttg) 1992;35:92-4.  Back to cited text no. 14    
15.Sedzimir CB, Frazer AK, Roberts JR. Cranial and spinal meningioma in a pair of twin boys. J Neurol Neurosurg Psych 1973;35:368.  Back to cited text no. 15    
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.  Back to cited text no. 16    
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.  Back to cited text no. 17    
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.  Back to cited text no. 18    
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.  Back to cited text no. 19    
20.Kamiya K, Inagawa T, Nagasako R. Malignant intraventricular meningioma with spinal metastases through the cerebrospinal fluid. Surg Neurol 1989;32:213-6.  Back to cited text no. 20    


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