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| CASE REPORT |
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| Year : 2003 | Volume
: 51
| Issue : 2 | Page : 263-265 |
Simultaneous occurrence of multiple meningiomas in different neuraxial compartments
Bhatoe HS
Department of Neurosurgery, Command Hospital (CC), Lucknow-226002
Correspondence Address:
Department of Neurosurgery, Command Hospital (CC), Lucknow-226002
[email protected]
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%.[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.
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.[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.
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