Malignant Intracranial Meningioma With Spinal Metastasis -Case Report-

Abstract

A 48-year-old woman presented with a left cerebellopontine angle mass. Over a 93-month period, the patient underwent seven surgeries, two radiosurgeries, and one external beam radiotherapy. The tumor was histologically benign at the first operation, but exhibited unusually aggressive behavior after failed radiosurgery and demonstrated clinical characteristics of malignancy such as spinal metastasis. The patient underwent gamma knife radiosurgery (GKR) for recurrence after the first operation, despite the tumor being located in a resectable region. The tumor did not respond. Six months after the sixth surgery, the patient presented with progressive lower extremity paraparesis and sensory disturbance below the T11 dermatome. Magnetic resonance imaging revealed multiple intradural mass lesions located at the T2, T11-T12, and L2 levels. She died 4 months after the diagnosis of spinal metastases. Retrospectively, we speculate that if a tumor is located in a resectable region and Simpson grade I or II tumor resection is possible, direct surgery may be a safer option than GKR.

Metastatic meningioma: The role of whole‑body diffusion-weighted imaging

“…They have been reported in the subcutaneous tissue, periostium and as spinal drop metastases through the cerebrospinal fluid route, in both benign and malignant meningiomas (5,6). The subcutaneous lesion in the case reported may be interpreted as secondary to iatrogenic spreading, considering its proximity to the surgical area.…”

“…The most frequent sites for metastases are the lungs, liver, bones and cervical lymph nodes. Remote metastases can occur in histologically benign and atypical or malignant meningiomas, with variable disease-free periods (1)(2)(3)(4)(5)(6).…”

Minimally invasive resection and vertebroplasty for an osteolytic C-1 metastasis of malignant meningioma: case report

“…5 Most case reports imply intradural metastases without bony destruction. 2,6,11,12 In this regard, the presented case is unique because of the exclusively extradural location and concomitant bony destruction. The objective of surgery was to obtain a biopsy specimen and provide stability of the upper cervical spine before administering radiation therapy.…”

“…15 As malignant meningiomas are a rare entity, their metastases to the spine have rarely been reported, 2,6,11,12 despite an overall reported metastatic rate of 43%. 5 Most case reports imply intradural metastases without bony destruction.…”

“…16 The occurrence of malignant intracranial meningiomas with spinal metastases has rarely been reported. 2,6,11,12 To our knowledge, the featured case is the first description of a patient with an osteolytic C-1 metastasis of an intracranial malignant meningioma that was treated with minimally invasive tumor resection and vertebroplasty of C-1.…”