Multidisciplinary approach to anaplastic and metastatic meningioma: A case report and review of the literature

Abstract

Background: Meningiomas are slow-growing neoplasms, accounting for 20% of all primary intracranial neoplasms and 25% of all intraspinal tumors. Atypical and anaplastic meningiomas are infrequent, representing fewer than 5% of all meningiomas. Unusually, they can show aggressive behavior, and extracranial metastases are extremely rare, representing approximately 0.1% of all reported cases. Case Description: Fifty-six-year-old male patient diagnosed with atypical basal frontal meningioma with multiple resections, both endoscopic endonasal and transcranial. After hypofractionated radiosurgery, the patient showed new tumor recurrence associated to right cervical level II ganglionic metastasis. We opted for complete resection of the meningioma and reconstruction with anterior rectus abdominis muscle flap, as well as selective cervical ganglionectomy. Anatomical pathology showed neoplastic proliferation of meningothelial cells in syncytial cytoplasm, oval or spherical nuclei with slight anisocariosis and hyperchromasia, and intranuclear vacuoles, all compatible with anaplastic meningioma. Conclusion: Due to a lack of consensus on how to treat a metastatic malignant meningioma, this pathology requires a multidisciplinary approach, and treatment needs to be adapted to each particular case. Complete resection of the lesion is the primary goal, and this requires complex procedures involving endocranial as well as extracranial surgeries, which result in composite defects difficult to resolve. Microvascular free flaps are considered the gold standard in reconstructions of large skull base defects, with high success rates and few complications.

Challenging diagnosis and management of anaplastic meningioma in a pediatric patient: A case report

“…The standard treatments for anaplastic meningioma are surgical resection and adjuvant radiotherapy [ 1 , 3 , 6 , 8 ]. However, the use of radiotherapy in infants and young children remains a topic of debate due to the increased vulnerability of their central nervous system to potential long-term radiation-related complications [ 14 ].…”

“…Anaplastic meningioma, classified as a WHO grade III, is a rare subtype, accounting for 1%-3% of all meningiomas [ 1 ]. They are highly aggressive with a worse clinical course, including a higher risk of recurrence ranging from 50% to 94%, and increased mortality, with the median survival typically less than 2 years and the 5-year survival ranging from 35% to 61% [ [2] , [3] , [4] ]. Pediatric meningioma, while rare, also presents a worse prognosis compared to adults [ 5 ].…”