Different subtypes meningiomas

arising

in the same region

Different subtypes meningiomas

arising

in the same region

M. Neroni, R. Gazzeri, G. Ricci e S. Esposito

U.O.D. Neurosurgery, San Giovanni – Addolorata Hospital

Rome

M. Neroni, R. Gazzeri, G. Ricci e S. Esposito

U.O.D. Neurosurgery, San Giovanni – Addolorata Hospital

Rome

Introduction

- Occurrence of multiple primary brain tumors is uncommon

- Chordoid meningioma is a rare isthological entity

- The association of two different subtypes meningiomas in the same region have not yet been reported

Introduction

- Occurrence of multiple primary brain tumors is uncommon

- Chordoid meningioma is a rare isthological entity

- The association of two different subtypes meningiomas in the same region have not yet been reported

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Case Report

- A 64 y.o. cauc. woman presenting with headaches since 5 months

- Referred to our E.R. after acute onset of seizure

- No neurological deficit were disclosed

Case Report

- A 64 y.o. cauc. woman presenting with headaches since 5 months

- Referred to our E.R. after acute onset of seizure

- No neurological deficit were disclosed

Case Report

- Emergency CT showed a huge pterional hyperdense lesion

- MR revealed two distinct lesions showing a different contrast enhancement

Case Report

- Emergency CT showed a huge pterional hyperdense lesion

- MR revealed two distinct lesions showing a different contrast enhancement

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Widened Pterional approach

- Removing the anterior firm and larger tumor (intra-op histo exam revealed a chordoma) WHO II

- Bone and muscle were infiltrated (Simpson I)

- Cleavage between the lesions

- Posterior mass was easily removed (intra-op histo exam revealed a transitional meningioma) WHO I

Widened Pterional approach

- Removing the anterior firm and larger tumor (intra-op histo exam revealed a chordoma) WHO II

- Bone and muscle were infiltrated (Simpson I)

- Cleavage between the lesions

- Posterior mass was easily removed (intra-op histo exam revealed a transitional meningioma) WHO I

Histology

- Anterior tumor: Chordoid Meningioma (Grade II WHO)

- Posterior mass: Transitional Meningioma (Grade I WHO)

Histology

- Anterior tumor: Chordoid Meningioma (Grade II WHO)

- Posterior mass: Transitional Meningioma (Grade I WHO)

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Conclusion

- At nine months F.U. patient is still free disease

- No radiotherapy was delivered

- Control MR showed no recurrence

Conclusion

- At nine months F.U. patient is still free disease

- No radiotherapy was delivered

- Control MR showed no recurrence