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Valente Aguiar P, Gonçalves M, Vaz R, Linhares P. A rare case of meningioma recurrence on a titanium mesh cranioplasty. Br J Neurosurg 2024; 38:1027-1030. [PMID: 34726561 DOI: 10.1080/02688697.2021.1995592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
Cranioplasty with titanium mesh provides a stable and cosmetically sound option for the correction of extensive skull bone defects following trauma or tumour surgery with osseous involvement. Meningiomas are for the most part benign lesions that are amenable to surgical cure, however lesions with extradural extension pose additional challenges not only due to increased technical difficulty in achieving gross total resection but also because of distinct biological behaviour. We describe the case of a 43-years-old woman that had been submitted to gross total resection of a WHO grade I falcine and superior sagittal sinus secretory meningioma with extradural and bone extension and cranioplasty with a titanium mesh who had a recurrence 4 years later as two tumour masses on top of the titanium mesh with no adjacent soft tissue invasion, and without dural involvement. To our knowledge, this is the first reported case of meningioma growth on top of titanium cranioplasty material. Seeded or incompletely removed tumoral cells might have exploited the biocompatibility of titanium to promote tumour regrowth.
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Affiliation(s)
- Pedro Valente Aguiar
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Gonçalves
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Neurosciences Centre, Hospital CUF, Porto, Portugal
| | - Paulo Linhares
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Neurosciences Centre, Hospital CUF, Porto, Portugal
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Javed S, Khan A, Khalid A, Scalia G, Umana GE, Mahmood A, Yaqoob E, Pahwa B, Chaurasia B. Scalp metastasis from atypical meningioma: A case report and literature review. Clin Case Rep 2024; 12:e8789. [PMID: 38681044 PMCID: PMC11053248 DOI: 10.1002/ccr3.8789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/17/2024] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Key Clinical Message Scalp metastasis from atypical meningioma, though rare, underscores the importance of meticulous surgical techniques to prevent tumor cell implantation. Early detection and comprehensive management, including surgery and adjuvant therapy, are crucial for optimal outcomes. Abstract Meningiomas are tumors of the meninges that originate in the arachnoid layer from arachnoid cap cells. Atypical meningiomas, classified as WHO grade 2 tumors, tend to metastasize and recur if not surgically managed properly. Scalp metastasis is a rare occurrence that presents as a subcutaneous elevation. A 33-year-old patient presented with a complaint of a constant, dull pressure headache persisting for the past 12 months, exacerbated by exertion, along with seizures and neuropsychiatric symptoms. The patient had no significant medical history but had undergone surgery 4 years ago for a WHO grade 2 meningioma. The current brain MRI revealed a dural tail sign, along with masses on both the left and right sides of the frontal lobe, extending to involve the skin on the forehead and scalp. The patient underwent surgical resection and adjuvant radiation therapy. At the 12-month follow-up, no neurological deterioration or tumor recurrence was observed. A literature review on scalp metastasis in patients with atypical meningioma was also conducted, including eight articles published up to September 2023. The mechanism of metastasis development appears to be consistent in all eight reported cases, involving the implantation of tumor cells during resection. Therefore, there is a critical need for meticulous intra- and post-operative surgical techniques to prevent such implantation.
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Affiliation(s)
- Saad Javed
- Department of NeurosurgeryRawalpindi Medical UniversityRawalpindiPakistan
| | - Amina Khan
- Department of NeurosurgeryRawalpindi Medical University RawalpindiRawalpindiPakistan
| | - Ayesha Khalid
- Department of NeurosurgeryRawalpindi Medical University RawalpindiRawalpindiPakistan
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck SurgeryGaribaldi HospitalCataniaItaly
| | | | - Ashraf Mahmood
- Department of NeurosurgeryRawalpindi Medical University RawalpindiRawalpindiPakistan
| | - Eesha Yaqoob
- Department of Public HealthHealth Services Academy, Ministry of National Health Services Regulations and Coordination, Government of PakistanIslamabadPakistan
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB HospitalDelhiIndia
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Hachicha A, Ghedira K, Bouhoula A, Bouali S, Zehani A. Recurrent subcutaneous metastasis of a convexity meningioma: a case report and literature review. Int J Neurosci 2023:1-5. [PMID: 37929581 DOI: 10.1080/00207454.2023.2279499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Subcutaneous metastasis in the operative route after intracranial meningioma resection is extremely rare. Here we describe the case of a 69-year-old male who was operated on in our department for a convexity meningioma that spread a few years after surgery in the soft tissues next to the craniotomy site. Twenty-one other cases have been found in the medical literature. In this article, we discuss mechanisms of growth, presentation and management of subcutaneous meningiomas.
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Affiliation(s)
- Anis Hachicha
- Neurosurgery Department, Gabes University Hospital, Gabes, Tunisia
- Department of Medicine of Sfax, Institutul National de Metrologie, București, Romania
| | - Khalil Ghedira
- Department of Medicine of Tunis, Tunisia
- Neurosurgery Department, Mongi Ben Hamida National Institute of Neurology, Tunis,Tunisia
| | | | - Sofiene Bouali
- Department of Medicine of Tunis, Tunisia
- Neurosurgery Department, Mongi Ben Hamida National Institute of Neurology, Tunis,Tunisia
| | - Alia Zehani
- Neurosurgery Department, Mongi Ben Hamida National Institute of Neurology, Tunis,Tunisia
- Department of Pathology, Rabta Hospital, Tunis, Tunisia
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Hanna R, Feldman AM, Keller CE, Siddiqui MS. A Grade I Intracranial Meningioma with Metastasis to Multiple Vertebral Bodies: A Case Report and Literature Review. Cureus 2020; 12:e11477. [PMID: 33329973 PMCID: PMC7734695 DOI: 10.7759/cureus.11477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
World Health Organization (WHO) grade I meningiomas are slow-growing and typically benign brain tumors that can often be easily removed by surgery and rarely become malignant. We report the case of a WHO grade I meningioma in a 67-year-old man with multiple extracranial metastases.
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Affiliation(s)
- Renee Hanna
- Radiation Oncology, Henry Ford Health System, Detroit, USA
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Ling M, Acharya J, Patel V. Anaplastic meningioma seeding of the abdominal wall following calvarial bone flap preservation. Radiol Case Rep 2020; 15:683-687. [PMID: 32382362 PMCID: PMC7198915 DOI: 10.1016/j.radcr.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/12/2022] Open
Abstract
Meningiomas are common intracranial tumors that rarely metastasize. We present a highly unusual case of a 42-year-old man with direct seeding of meningioma to the abdominal wall. The patient had a history of multiple operations for a recurrent intracranial meningioma with decompressive craniectomy and preservation of the calvarial bone flap by implantation into the subcutaneous layer of the anterior abdominal wall. Following removal of the bone flap, a new abdominal wall mass was identified, consistent with iatrogenic implantation of anaplastic meningioma.
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Liu Y, Li J, Duan Y, Ye Y, Xiao L, Mao R. Subcutaneous Metastasis of Atypical Meningioma: Case Report and Literature Review. World Neurosurg 2020; 138:182-186. [PMID: 32145423 DOI: 10.1016/j.wneu.2020.02.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Meningioma, a neoplasm of the meninges, is usually a benign localized tumor. Extraneural metastasis is an extremely rare complication of meningiomas, and only a few cases have been reported to date. The present study reports a case of scalp metastasis of an atypical meningioma and discusses the types of atypical meningiomas and their management options. CASE DESCRIPTION A 69-year-old man presented with scalp metastasis of an atypical meningioma. Six years after the right frontoparietal meningioma lesion was completely resected, an isolated subcutaneous metastasis developed at the right frontal region of the scalp, originating at the scar left by the first surgery. Postoperative histologic examination of the subcutaneous tumor revealed the features of an atypical meningioma. CONCLUSIONS This study highlights that resection of meningiomas is still associated with a risk of iatrogenic metastasis. Surgeons should carefully wash out the operative field and change surgical tools frequently to avoid the potential risk of metastasis.
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Affiliation(s)
- Yikui Liu
- Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Jian Li
- Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Yu Duan
- Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Yao Ye
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Li Xiao
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Renling Mao
- Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China.
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Attuati L, Zaed I, Morselli C, Pecchioli G, Fornari M, Picozzi P. Multimodal Management of Metastatic Malignant Meningiomas: The Role of Radiosurgery in Long-Term Local Control. World Neurosurg 2019; 128:562-572. [PMID: 31102770 DOI: 10.1016/j.wneu.2019.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Metastatic meningiomas (MMs) are rare (0.1 of 100 cases). Their treatment requires a multimodal approach, with surgery, radiotherapy, chemotherapy, and radiosurgery, which allows a long-term local control (LC) and an extension of free survival. In this study, the authors performed a review of the literature and reported 2 cases of patients affected by extracranial MMs, with long-term follow-up. CASE DESCRIPTION Case 1: A 48-year-old woman was admitted for resection of an extra-axial falx lesion (meningioma G1). After 2 years, the lesion got a local recurrence, resected with a histologic diagnosis of meningioma G3. During the next 9 years, the patient underwent 5 Gamma Knife radiosurgery (GKRS) procedures for local recurrence. At 56 years, she was readmitted for a surgical local recurrence (histologic definition: anaplastic meningioma G3). At the age of 62, the patient underwent a right lobectomy for a lung mass (histologic diagnosis: anaplastic meningioma G3). After that, multiple lesions at soma L5 and adrenal gland were discovered and then monitored. Case 2: A 48-year-old woman was operated for a lesion involving torcular herophili (meningioma G2). After 3 years, a local recurrence requires GKRS combined with tamoxifen. In the next 7 years, she underwent 5 GKRS procedures for local recurrence. The patient also underwent chemotherapy with octreotide. At the age of 61, she discovered multiple lesions in both lungs, liver, and kidney. A hepatic biopsy showed anaplastic meningioma G3. Also this patient does not suffer from any neurologic or clinical deficits. CONCLUSIONS LC in malignant meningioma is achievable through a multimodal approach; GKRS makes possible LC, but a novel aspect of these lesions is opened to discussion: the metastases. These reports show that multimodal treatment for MMs is an effective approach with good LC and improvement of overall survival. However, a long survival may allow systemic diffusion of the disease, in particular, when sagittal sinus is involved.
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Affiliation(s)
- Luca Attuati
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.
| | - Carlotta Morselli
- Department of Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Guido Pecchioli
- Department of Neurosurgery, Azienda Ospedaliera Careggi, Florence, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Piero Picozzi
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
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