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Roy A, Shashidhar A, Birua GJS, Rao S, Kulanthaivelu K, Arimappamagan A. Metachronous intracranial meningiomas without dural attachment in a child - Rare case report and review of literature. Childs Nerv Syst 2024:10.1007/s00381-024-06582-7. [PMID: 39180697 DOI: 10.1007/s00381-024-06582-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION Meningiomas in children are rare, constituting less than 5% of all paediatric brain tumours and less than 2% of all meningiomas. Multiple meningiomas (synchronous or metachronous) are even more uncommon, typically occurring due to radiation exposure or in patients with phacomatoses like Neurofibromatosis II. This report presents the case of a child with metachronous meningiomas without dural attachment in unusual locations, along with their management. PURPOSE This report aims to describe a rare paediatric case of metachronous meningiomas without dural attachment, detailing their presentation, treatment, and outcomes. CASE DETAILS A 2-year-old female presented with headaches, irritability, and excessive crying for one year. A CT scan revealed a mass in the fourth ventricle, causing obstruction, which was surgically decompressed. The biopsy confirmed a clear cell meningioma, WHO grade II. A follow-up MRI identified a new lesion in the suprasellar area six months later, for which she underwent right pterional craniotomy and gross total resection, which turned out to be a clear cell meningioma, WHO grade II. The patient recovered well and remained asymptomatic, with no recurrence on MRI at one-year follow-up. CONCLUSION This case highlights the unusual presentation of metachronous clear cell meningiomas without dural attachment in a young child. Surgical excision resulted in a favourable outcome, though long-term follow-up is essential due to the high propensity for recurrence.
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Affiliation(s)
- Anup Roy
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Gyani J S Birua
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India.
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Intervention Radiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India
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Papic V, Lasica N, Jelaca B, Vuckovic N, Kozic D, Djilvesi D, Fimic M, Golubovic J, Pajicic F, Vulekovic P. Primary Intraparenchymal Meningiomas: A Case Report and a Systematic Review. World Neurosurg 2021; 153:52-62. [PMID: 34242832 DOI: 10.1016/j.wneu.2021.06.139] [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: 06/05/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Primary intraparenchymal meningiomas are exceedingly rare and often challenging to diagnose, given their misleading radiologic features. It is hypothesized that they arise from the cap cells of the pia mater that enter the brain via penetrating blood vessels during brain development. We systematically reviewed and analyzed previously reported features of primary intraparenchymal meningiomas in terms of radiography, presenting symptoms, and histopathology. METHODS A literature search of the Web of Science and PubMed databases and crossed references was performed in March 2021, per PRISMA guidelines, with no restrictions regarding publication date. Data regarding demographic features, clinical, radiographic, and histopathologic characteristics were extracted. RESULTS A total of 52 patients (including the reported case) were included in this review. The mean age was 21.1 years (range, 0.3-66 years) with a male/female ratio of 1.9:1. The most common localizations of intraparenchymal meningiomas were in the frontal (30.8%) and temporal (21.2%) lobes. Cyst formation was more readily observed and was noted in 51.4% of patients. Histopathology showed a higher incidence of World Health Organization grade II (14/52, 26.9%) and World Health Organization grade III (7/52, 13.5%) of primary intraparenchymal meningiomas. CONCLUSIONS We present a comprehensive analysis of every reported primary intraparenchymal meningioma. Because of their rarity and capacity to mimic other more common intra-axial tumors, they represent a diagnostic challenge. This systematic review highlights the importance of paying attention to atypical intra-axial lesions, with a particular reflection on the discrepancy between clinical characteristics and imaging features.
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Affiliation(s)
- Vladimir Papic
- Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nebojsa Lasica
- Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Bojan Jelaca
- Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
| | - Nada Vuckovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Pathology and Histology Center, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Dusko Kozic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Center for Diagnostic Imaging, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Djula Djilvesi
- Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Miroslav Fimic
- Department of Neurosurgery, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Jagos Golubovic
- Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Filip Pajicic
- Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Petar Vulekovic
- Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Cai C, Zhu Z, Guo X, Guo X, Jiang H, Zheng Z, Zhang J, Shao A, Zhu J. Sylvian Fissure Meningiomas: Case Report and Literature Review. Front Oncol 2020; 10:427. [PMID: 32373509 PMCID: PMC7176925 DOI: 10.3389/fonc.2020.00427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
Meningiomas are primary intracranial tumors derived from arachnoid cap cells or meningothelial cells and usually display dural attachment. However, a small proportion of meningiomas that arise from the Sylvian fissure do not manifest dural attachment. Sylvian fissure meningiomas are relatively rare and have differential characteristics as compared with typical meningiomas. Herein, we reported a special case of atypical meningioma in the Sylvian fissure, that showed non-enhancement after contract management. The patient was a 30-year-old woman with a 2-year history of seizures. Preoperative computerized tomography and magnetic resonance imaging scans showed a calcific, non-enhancing lesion in the right insula lobe. The lesion was excised surgically for seizure control. Intraoperatively, the tumor was observed to be closely adhered to the middle cerebral artery (MCA), resulting in mild arterial damage. A case of Sylvian fissure meningioma was ultimately diagnosed by histopathological examination of the resected specimens. Sylvian fissure meningiomas are closely associated with the MCA and exhibit unusual imaging characteristics. Preoperative misdiagnosis may have serious adverse consequences and may result in incorrect surgery. To improve awareness of Sylvian fissure meningiomas on the differential diagnosis of Sylvian fissure lesions among clinicians, we present this report and briefly summarize previously reported cases to describe the clinical, pathological, radiological, and surgical features.
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Affiliation(s)
- Chengwei Cai
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhoule Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xinxia Guo
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoming Guo
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hongjie Jiang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Zheng
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Anwen Shao
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Junming Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Pediatric meningiomas: a report of 5 cases and review of literature. Childs Nerv Syst 2019; 35:2219-2225. [PMID: 31001646 DOI: 10.1007/s00381-019-04142-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/28/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this paper is to provide novel insight into the rare pediatric meningiomas. METHODS We retrospectively analyzed pediatric surgical cases of meningioma during 2002 to 2017 in our institution. The preoperative, intraoperative, and the postoperative status were collected to find any unique features that has not reported in the past. RESULTS Nine surgeries out of 5 patients were identified. The mean age was 7 years old (range 1-14 years old). Four patients were females. The mean tumor diameter was 52 mm (range 23-81 mm). The tumor locations were optic nerve sheath, Sylvian fissure, parasagittal, trigone of the lateral ventricle, and cerebellopontine angle. The Sylvian fissure meningioma without dural attachment (MWODA) was found in a 15-month-old female. A relapsed parasagittal meningioma showed regression in histological grade and residual tumor demonstrated spontaneous regression. In the initial surgeries, Simpson grade 1 resection was achieved in 2 cases. The pathological diagnoses were 1 meningothelial, 1 metaplastic, 2 atypical, and 1 clear cell meningiomas. The mean postoperative follow-up period was 71 months. Three patients experienced recurrence of the tumor. At the latest follow-up, all patients were free of radiological tumor recurrence or regrowth with a mean follow-up of 4 years (range 1-6.9 years). All patients were in the modified Rankin scale of 0-1. CONCLUSIONS MWODA is not considered to be rare in pediatric meningioma and should be included in the differential diagnosis. We presented a histologically regressed relapsed meningioma, which spontaneously regressed after subtotal resection. In the case of recurrent meningioma, surgical resection and adjuvant radiation therapy could be effective for long-term control of the tumor.
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Yamagishi M, Bohara M, Komasaku S, Yamada M, Kawahara D, Sadamura Y, Mori M, Nishimuta Y, Ishii T, Tokimura H. Deep Sylvian Meningioma without Dural Attachment - A Case Report. NMC Case Rep J 2019; 6:51-55. [PMID: 31016101 PMCID: PMC6476818 DOI: 10.2176/nmccrj.cr.2018-0215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/07/2018] [Indexed: 11/20/2022] Open
Abstract
Deep Sylvian meningiomas are rare, accounting for 0.3–0.4% of all meningiomas, and mostly present in young adults and children. We report on a 32-year-old man who presented with headache but had no neurological deficits. Computed tomography of brain revealed a 24 × 19 × 21 mm3 mass lesion in the right Sylvian fissure with calcification. Magnetic resonance imaging showed that the lesion was isointense on T1- and T2-weighted images (WI), with homogenous enhancement on post-gadolinium T1WI. The lesion was surgically removed via right fronto-temporal craniotomy. The tumor was located in deep Sylvian fissure and had no dural attachment. Histopathological examination of the lesion revealed both meningothelial and fibroblastic features, thereby suggesting the diagnosis of transitional meningioma (WHO grade I), with Ki-67 labeling index of 6.9%. Thus, meningioma should be considered as a differential diagnosis of enhancing mass lesions in the Sylvian fissure even in the absence of dural tail sign, especially in young adults and children.
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Affiliation(s)
- Masayuki Yamagishi
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Manoj Bohara
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Soichiro Komasaku
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Masahiko Yamada
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Dan Kawahara
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Yuko Sadamura
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Masanao Mori
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Yosuke Nishimuta
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Takeshi Ishii
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Hiroshi Tokimura
- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
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Amirjamshidi A, Khalatbari MR, Abbasioun K, Ghasemi B. Sylvian Fissure Meningioma in Childhood: Report of 3 Cases and Review of the Literature. Pediatr Neurosurg 2019; 54:270-276. [PMID: 31238311 DOI: 10.1159/000500765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/05/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sylvian fissure-based meningioma is a rare occurrence during childhood. We report a small series including 3 such cases, all attached to the arachnoid leaflets of the Sylvian fissure. We present a review of the literature and discuss the impact of possibly effective clinical, imaging, and surgical variables on the outcome. METHODS In a retrospective chart review of children with intracranial meningioma, we encountered 3 cases with Sylvian fissure meningioma operated within the past 32 years. RESULTS Two girls, 5 and 7 years old, and 1 boy, 7 years of age, presented with epilepsy, headache, diplopia, and hemiparesis. The duration of illness was 3, 4, and 2 months, respectively. All three tumors were attached to the arachnoid layer of the adjacent Sylvian fissure, and they were not dural based. Gross total resection could be achieved, and no recurrences were encountered after 13, 7, and 2 years. CONCLUSION We report 3 very rare cases of Sylvian arachnoid-based meningiomas. To our knowledge, this is the study with the longest follow-up period (mean 7.3 years, median 7 years). Even though the overall prognosis of pediatric meningiomas may be worse than that of adult illness, we would like to emphasize that the "rare location" of the Sylvian fissure was not an important factor contributing to the outcome in our children.
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Affiliation(s)
- Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital and Children's Hospital Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran,
| | | | | | - Babak Ghasemi
- Department of Neurosurgery, Arad Hospital, Tehran, Iran
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Roux A, Mellerio C, Lechapt-Zalcman E, Still M, Zerah M, Bourgeois M, Pallud J. Left Frontal Meningioangiomatosis Associated with Type IIIc Focal Cortical Dysplasia Causing Refractory Epilepsy and Literature Review. World Neurosurg 2018; 114:281-288. [DOI: 10.1016/j.wneu.2018.03.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 01/29/2023]
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