Multiple intracranial meningiomas with different pathological subtype

Abstract

Authors present the case of a 63 years old woman, admitted for left proptosis and hemicrania evolving for three months. At the screening CT scan with contrast were discovered two lesions: a left fronto-temporal mass, intensely contrast enhancing, with peritumoral edema, inserted on the sphenoid wing, extended in the infratemporal fossa and ethmoidal sinus; the other lesion was cystic, located parieto-temporally, in the corticosubcortical area, with a small tumor nodule located deeply. MRI defined the details and the size of the lesions: 63/65/71 mm left solid tumor suggesting a sphenoid wing meningioma, and a 67/62/72 mm right parietal-temporal cystic lesion with moderate mass effect. Authors insist on neurosurgical strategy for treatment of multiple intracranial masses with different consistency-solid and cystic. Adequate surgical planning was done after MRI with contrast examinations, which were strongly suggestive for multiple intracranial meningiomas. Surgical approach was done in two steps according to treat first the cystic lesion because we supposed that is a recent developed lesion with high risk of sudden volume increase followed by neurological deterioration. On another way, attacking first the solid tumor, we could have a high risk to decompensate the cystic lesion. Neurological and general evolution after two steps neurosurgery was without incidents with a very good outcome. Pathological examination revealed two different types of meningioma: microcystic and transitional.