Meningioangiomatosis: clinical-radiological features and surgical outcome

Pure and non-pure meningioangiomatosis of 36 Chinese patients: an analysis of clinical presentation, diagnosis, histopathology and prognosis

Meningioangiomatosis (MA) is a disease that is extremely rarely reported. Sporadic MA is occasionally combined with meningioma or other lesions (identified as non-pure MA). This retrospective study investigated the difference between pure MA and non-pure MA by exploring clinical manifestations, histopathology characteristics, and outcomes of MA after surgery. We reviewed the medical records of 36 histopathologically confirmed MA patients (18 pure MA and 18 non-pure MA) who received surgery at our institution between 2012 and 2021. We compared differences in demographic, clinical, imaging, pathological features, and surgical outcomes between pure MA and non-pure MA through descriptive statistics. Compared to non-pure MA, pure MA presented with a more prominent male predilection (5:1 vs. 1.57:1, P = 0.264), a higher seizure incidence (83.3% vs 50.0%, P = 0.038), a more seizure type of GTCS (14/15 vs 5/9, P = 0.047), a less prominent enhancement on MRI (27.8% vs 88.9%, P < 0.001) and a preference of temporal and frontal lobe (100% vs 44.4%, P < 0.001). The differences in clinical characteristics between pure MA and non-pure MA demonstrate their disparate biological natures. Pure MA seems to be a non-neoplastic lesion, while non-pure MA is commonly combined with meningioma, which is a neoplastic lesion. A correct differential diagnosis can be achieved via a triad of the type of seizure, the location of lesion and the radiological presentation. MA is curable and the prognosis is excellent as most patients are free of seizure and recurrence after surgical treatment.

Meningioangiomatosis: an uncommon cause of focal epilepsy with characteristic neuroimaging and neuropathology

A 3-year-old boy presented with acute onset of prolonged right sided focal seizures with secondary generalisation. The investigation findings were suggestive of a neoplastic process more than an inflammatory process. Decision to perform brain biopsy from the lesion to establish the precise nature of lesion was undertaken.

Meningioangiomatosis: Multimodal Analysis and Insights From a Systematic Review

BACKGROUND

Meningioangiomatosis is a poorly studied, rare, benign, and epileptogenic brain lesion.

OBJECTIVE

To demonstrate that surgical resection and a short-time interval to surgery improves epileptic seizure control, we performed a systematic review and meta-analysis of meningioangiomatosis cases.

METHODS

Using PRISMA-IPD guidelines, the authors performed a systematic review and meta-analysis of histopathologically-proven meningioangiomatosis cases. Literature search in French and English languages (PubMed, Embase, the Cochrane Library, and the Science Citation Index) including all studies (January 1981 to June 2020) dealing with histopathologically-proven meningioangiomatosis, without age restriction. We assessed clinical, imaging, histomolecular, management, and outcome findings of patients with meningioangiomatosis.

RESULTS

Two-hundred and seven cases of meningioangiomatosis from 78 studies were included. Most meningioangiomatosis was sporadic, preferentially concerned male patients, younger than 20 years old, and allowed a functionally independent status. Epileptic seizure was the main symptom, with 81.4% of patients having uncontrolled seizures at the time of surgery. Meningioangiomatosis mainly had frontal (32.3%) or temporal (30.7%) locations. Imaging presentation was heterogeneous, and the diagnosis was often missed preoperatively. The histopathologic pattern was similar whatever the clinical presentation, and immunohistochemistry had limited diagnostic value. On molecular analysis, allelic loss at 22q12 was more frequent in samples of meningioangiomatosis-associated meningioma (37.5%) than in isolated meningioangiomatosis (23.1%). Time interval from diagnosis to surgery (p = 0.011) and lack of surgical resection of the meningioangiomatosis (p = 0.009) were independent predictors of postoperative seizure control.

CONCLUSIONS

Owing to low scientific evidence, a multicentric prospective study should help refining the management of meningioangiomatosis.

Sporadic Meningioangiomatosis Presenting as a Middle Cranial Fossa Arachnoid Cyst

BACKGROUND

Meningioangiomatosis is an extremely rare meningovascular disease of the central nervous system that is characterized by the proliferation of leptomeninges, cortical vessels, and perivascular spindled cells. Although it is a benign, neoplastic disorder that carries a good prognosis after surgical excision, initial diagnosis may be challenging as radiologic findings are often variable and nonspecific.

CASE DESCRIPTION

In this report, we describe an unusual presentation of meningioangiomatosis presenting as a symptomatic middle cranial fossa arachnoid cyst.

CONCLUSIONS

In view of the unexpected diagnosis and infrequency of this condition, the case is discussed in collaboration with current literature and management strategies.

Radiologic and Histopathologic Features in an Intracranial Localized Castleman Disease: A Case Report and Review of Literature

INTRODUCTION

Castleman disease (CD) is a rare pathologic process of unknown etiology, characterized by non-neoplastic lymph node enlargement. Two distinct histologic patterns are recognized; the hyaline-vascular type and the less common plasma cells type. Another intermediate type has been described. The clinical features are classified into 2 categories, localized (unicentric) and generalized (multicentric), the later associated with systemic manifestations and poor prognosis. CD affecting the central nervous system is extremely rare. We report a new case of localized intracranial CD and we accomplish a review of the literature.

CASE REPORT

A 30-year-old man presented with a generalized tonic-clonic seizure. Computerized tomography and magnetic resonance imaging showed a small mass in the right temporoparietal convexity with homogenous enhancement after contrast administration. Extensive vasogenic edema in comparison with the size of the mass was also identified and based on the neuroradiologic finding, a suspected diagnosis of meningoangiomatosis was formulated. The mass was completely resected and his histologic examination identified the hyaline-vascular type of CD. One year after surgery, the patient remains seizure free, without evidence of systemic involvement or recurrence of the mass.

CONCLUSIONS

Our case and review of the literature show the value of the extensive brain edema on neuroimaging finding to the differential diagnosis for a solitary mass arising from the meninges. We emphasize on the need for histologic examination when the diagnosis of meningioma is not entirely clear.

Pediatric Meningeal Tumors of the Sylvian Fissure Region without Dural Attachment: A Series of Three Patients and Review of the Literature

Pediatric meningeal tumors are rare, but those in the region of the sylvian fissure without dural attachment are extremely rare, with only 24 previously reported cases in the world literature. In this series, we report two additional cases of sylvian fissure meningioma without dural attachment and one case of perisylvian meningioangiomatosis in the medial temporal lobe. All three patients presented with complex partial seizures, but the diagnosis was delayed in each case because the symptoms were misinterpreted to be behavioral rather than epileptic. The seizures were eventually confirmed with electroencephalogram, and subsequent imaging showed enhancing masses within the sylvian fissure region that were at least partially calcified in all three cases. Each patient underwent craniotomy. In the first case, gross total resection was achieved, and in the second case, a small residual portion of tumor was densely calcified and adherent to the middle cerebral artery branches. Both of these were World Health Organization (WHO) grade I meningiomas. The third patient underwent biopsy and limited resection of meningioangiomatosis. No dural attachments were noted in any of the tumors, but one of the meningiomas was intraparenchymal in location, surrounding the sylvian fissure in both the frontal and temporal lobes, which has been described in only a small number of these cases previously. The patients underwent pre- and postsurgical neuropsychiatric testing and did not experience any significant cognitive deficits. At 10-year follow-up, the patient who had gross total resection of the tumor has had no recurrence and is seizure-free without anticonvulsant medications. The incompletely resected intraparenchymal meningioma in the second patient recurred after 5 years, however, and at repeat surgery was found to have transformed to a WHO grade II tumor. Radiation therapy was delivered and the tumor has been stable for 2 years, but the patient continues to have occasional seizures despite medication. The patient with meningioangiomatosis has had no further growth and has excellent control of seizures but remains on medication. We review the clinical presentation of these rare tumors and discuss the treatment, outcomes, and possible relationship of meningiomas to meningioangiomatosis.

Sporadic meningioangiomatosis with and without meningioma: analysis of clinical differences and risk factors for poor seizure outcomes

BACKGROUND

Meningioangiomatosis (MA) is a rare cerebral lesion. Sporadic MA occasionally combines with meningioma (MA-M). The aim of the present study was to clarify whether MA-M and pure MA have clinical differences and to determine risk factors for unsatisfactory seizure outcomes in sporadic MA.

METHODS

We reported 14 sporadic MA cases in our center and conducted a literature review. We compared the demographic, clinical, imaging, electrophysiological and pathological features and surgical outcomes. Logistic regression analysis was performed to evaluate the risk factors for poor seizure outcomes.

RESULTS

MA-M cases showed a more prominent male predilection (4.2 times vs. 1.6 times, p = 0.04), a shorter duration of symptoms (2.8 ± 0.8 years vs. 5.2 ± 0.6 years, p = 0.02), and a lower seizure incidence (53.6 % vs. 89.3 %, p < 0.001) as compared to pure MA. A gyriform alteration on imaging was exclusively associated with pure MA. The Ki-67 was higher in the meningioma component than in the MA component in MA-M (1.2 ± 0.3 % vs. 6.1 ± 1.1 %, p < 0.001). Lesions located in the temporal lobe predicted poor seizure outcomes (p = 0.02, OR = 4.4, 95 % confidence interval, 1.24-15.89).

CONCLUSION

Clinical differences may be caused by the different biological natures. MA-M seems to be a neoplastic lesion, while pure MA seems to be a non-neoplastic lesion. Long-term follow-up is required for MA-M. Because the coexistence of hippocampal sclerosis may explain the poor seizure outcomes of MA located in the temporal lobe, it is important to identify underlying hippocampal sclerosis and to perform complete resection.

Three cases of sporadic meningioangiomatosis with different imaging appearances: case report and review of the literature

Background

Meningioangiomatosis (MA) is a rare meningiovascular malformation or hamartomatous lesion in the central nervous system. Radiographic findings of MA may show a variety of characteristics according to different histological components. We present three cases of sporadic MA with different imaging appearances in an attempt to identify specific imaging characteristics.

Case presentation

In case 1, an irregular hyperdense solid mass was localized in the left middle cranial fossa, demonstrating low and equal signal intensity on T1-weighted imaging (T1WI; TR/TE 2,048.9 ms/26.1 ms), high signal intensity with multiple flow void effect on T2-weighted imaging (T2WI; TR/TE 4,000 ms/106.4 ms), and significant and homogeneous enhancement on post-contrast magnetic resonance imaging (MRI). In case 2, the lesion in the right insular lobe showed a cystic-mural nodule pattern. The cystic content demonstrated similar density or signal intensity as cerebrospinal fluid, while the mural nodule demonstrated equal density or signal intensity on computed tomography (CT) and MRI. On post-contrast MRI, the mural nodule showed significant enhancement, but the cystic wall and content showed no enhancement. In case 3, a remarkably enhanced solid nodule was found in the cortex of the left parietal lobe with multiple small cysts surrounding it. This nodule showed low signal intensity on T2WI and diffusion-weighted imaging (DWI; TR/TE 6,000 ms/96.8 ms, b = 1,000 s/mm²). The preoperative diagnoses of the above three cases were meningioma, hemangioblastoma, and ganglioglioma. However, all were pathologically diagnosed as MA.

Conclusion

The presented cases demonstrate that MA may present with solid and cystic imaging patterns, which may include large cystic-mural nodules and small intra- and extra-cystic patterns. Although MA imaging diagnoses are difficult, several MRI signs may include specific characteristics, such as a flow void effect on T2WI and separating cysts in the cystic MA (as shown in our cases), gyriform hyperintensity on T2-fluid attenuated inversion recovery (FLAIR) sequence, and susceptibility artifacts on T2 gradient echo (GRE) sequences (as found in the literature).

Clinicopathological features of meningioangiomatosis associated with meningioma: a case report with literature review

Aim. To analyze the clinicopathological features of meningioangiomatosis (MA) associated with meningioma. Methods. We present one case of MA associated with meningioma. Histopathological examination and immunohistochemistry were used. Results. The age of the patient was 33-year-old man. Histopathologically, MA was characterized by vascular proliferation with perivascular meningothelial cells and/or fibroblast proliferation, entrapped glial islands. In addition, MA was associated with transitional meningioma. The patient was alive without evidence of recurrence at 18 months after mass resection. Conclusion. MA associated with meningioma is an extremely rare lesion. The differential diagnosis includes cortical invasion by meningioma and intracerebral schwannoma. Patients with MA associated with meningioma often have a good prognosis after operation.

Meningioangiomatosis Without Neurofibromatosis Type 2

Meningioangiomatosis (MA) is a rare, benign hamartomatous lesion found in cerebral cortex and leptomeninges. It occurs mostly in 5 - 15 year old children in form isolated or diffuse; the diffuse form may be associated with neurofibromatosis type 2 (NF2). The sporadic type in the adults is less common.The patient was a 37 year-old man with a long history of frontal headache. In suspected sinusitis, the patient underwent cerebral MRI that showed hypointense lesion in the right frontal lobe with heterogeneous contrast enhancement after gadolinium administration. There were no stigmata or family history of neurofibromatosis. A right pterional approach with a supraorbital craniotomy was performed. The lesion was removed with complete remission of the headache in the postoperative time. MA enters into differential diagnosis with several other diseases and a correct diagnosis is mandatory. The total surgical removal is the treatment of choice, and the prognosis after surgery is usually excellent for the absence of recurrence in sporadic cases.