Atypical meningioma and acute subdural hemorrhage

Systematic Review of Meningiomas Revealed by Spontaneous Intracranial Hemorrhage: Clinicopathological Features, Outcomes, and Rebleeding Rate

BACKGROUND

Meningiomas are rarely revealed by an intracranial hemorrhage (ICH). Rebleeding occurrence rate and time of onset are unknown. Here, we performed a systematic review of the literature of meningiomas revealed by ICH.

METHODS

We retrospectively collected all meningiomas revealed by spontaneous ICH published between January 1980 and December 2021. We reported clinicopathological features of meningiomas revealed by ICH. We also estimated rebleeding rate and time to onset.

RESULTS

Ninety-two studies met all inclusion criteria, led to a total of 120 cases. The mean age was 56.3 years, with 66 (55%) female. Seventy-nine (66%) cases were conscious before surgery, 20 (17%) were in coma, and 17 (14%) were unconscious after deterioration. The most frequent bleeding type was subdural hemorrhage (N = 49, 41%) followed by intraparenchymal hemorrhage (IPH) (N = 44, 37%), subarachnoid hemorrhage (SAH) (N = 22, 18%), and intraventricular hemorrhage (IVH) (N = 5, 4%). IPH and hindbrain/ventricular locations are associated with poor outcomes (P = 0.031 and < 0.001, respectively). Among the 19 patients who did not undergo surgical resection of the meningioma, 14 (74%) experienced rebleeding with a median occurrence of 120 days (interquartile, [90; -]). Rebleeding occurs earlier if the type of bleeding is SAH or IVH and for hindbrain location (both P < 0.01).

CONCLUSIONS

ICH is a rare presentation of meningiomas. Hindbrain and ventricular tumor location and IPH are associated with poor outcomes. Rebleeding rate is high and premature. It occurs earlier if the first bleeding was SAH or IVH and for hindbrain location.

Meningiomas associated with subdural hematomas: A systematic review of clinical features and outcomes

BACKGROUND

Meningiomas associated with subdural hematomas (SDH) are exceedingly rare. As such, the clinical features, optimal medical and surgical management, and outcomes of treatment for these lesions remain unknown.

METHODS

We performed a systematic review of the Pubmed and SCOPUS databases for case reports and case series on patients with presumptive clinical or definitive diagnoses of meningiomas presenting with a subdural hematoma on CT scan or MRI. Data on demographics, clinical manifestations, surgical management, adjuvant treatment, and outcome on last follow-up were collected.

RESULTS

A total of 59 cases met the inclusion criteria, including one described in the current study. The mean age of patients was 62 years (range 5 - 85 years), with a slight female predilection (1.3:1). The most common clinical symptom and sign were headache and focal weakness, respectively. All except two cases underwent surgery - either done singly or staged - for evacuation of hematoma and/or excision of tumor. Treatment for meningiomas associated with SDH was associated with a mortality rate of 12% (6/51) at a median follow up of 3 months. Complete neurologic recovery was reported in 71% of patients.

CONCLUSION

Subdural hematomas are rare presenting manifestations of intracranial meningiomas. Current management is largely surgical for immediate relief of mass effect and oncologic control. Most patients survived with complete neurologic recovery.