Meningioangiomatosis in a 5-year-old boy presenting with intractable seizures

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.

Apnea as the sole manifestation of a seizure attributable to meningioangiomatosis of the temporal lobe in an infant

An 8-month-old boy presented with periods of apnea occurring several times daily. Initial clinical and radiologic evaluations could not identify a cause for these episodes. Video electroencephalographic monitoring indicated interictal high-voltage θ and δ activity over the right frontotemporal area. A short ictal run of δ activity over the same region was registered during a brief apneic spell. Cranial magnetic resonance imaging revealed a lesion anteromedial in the right temporal lobe. After epilepsy surgery, anatomopathologic examination indicated meningioangiomatosis. This case demonstrates that a focal lesion in the temporal lobe can present during infancy with apnea as sole seizure manifestation, without other clear clinical evidence.