eMedicine Specialties > Neurology > Neuro-oncology

Meningioma: Multimedia

Author: Georges Haddad, MD, Clinical Assistant Professor, Department of Medicine, Division of Neurosurgery, American University of Beirut, Lebanon
Coauthor(s): Ali Turkmani, MD, Staff Physician, Department of Neurosurgery, American University Hospital; Tarafa Baghdadi, MD, Staff Physician, Department of Neurosurgery, American University Hospital; Roukoz B Chamoun, MD, Staff Physician, Department of Neurosurgery, American University of Beirut Medical Center
Contributor Information and Disclosures

Updated: Jun 30, 2009

Multimedia

Case 1: MRI of a meningioma on plaque.Media file 1: Case 1: MRI of a meningioma on plaque.
Case 1: MRI of a meningioma on plaque.

Case 1: MRI of a meningioma on plaque.

Case 1: Bone-window CT reveals calcification of t...Media file 2: Case 1: Bone-window CT reveals calcification of the meningioma.
Case 1: Bone-window CT reveals calcification of t...

Case 1: Bone-window CT reveals calcification of the meningioma.

Case 1: Surgical view of the tumor. The dura is o...Media file 3: Case 1: Surgical view of the tumor. The dura is opened, and the meningioma can be seen extending en plaque over the surface of the brain.
Case 1: Surgical view of the tumor. The dura is o...

Case 1: Surgical view of the tumor. The dura is opened, and the meningioma can be seen extending en plaque over the surface of the brain.

Case 1: Bone flap seen along the removed meningio...Media file 4: Case 1: Bone flap seen along the removed meningioma in toto.
Case 1: Bone flap seen along the removed meningio...

Case 1: Bone flap seen along the removed meningioma in toto.

Case 2: Gadolinium-enhanced MRI of a meningioma i...Media file 5: Case 2: Gadolinium-enhanced MRI of a meningioma invading the overlying dura and bone. Compare with appearance in Case 1.
Case 2: Gadolinium-enhanced MRI of a meningioma i...

Case 2: Gadolinium-enhanced MRI of a meningioma invading the overlying dura and bone. Compare with appearance in Case 1.

Case 2: Bone-window CT scan reveals the skull in...Media file 6: Case 2: Bone-window CT scan reveals the skull involvement. Note the absence of tumoral calcification.
Case 2: Bone-window CT scan reveals the skull in...

Case 2: Bone-window CT scan reveals the skull involvement. Note the absence of tumoral calcification.

Case 2: Intraoperative view shows the skull invol...Media file 7: Case 2: Intraoperative view shows the skull involvement.
Case 2: Intraoperative view shows the skull invol...

Case 2: Intraoperative view shows the skull involvement.

Case 2: Bone flap was removed. Note tumoral breac...Media file 8: Case 2: Bone flap was removed. Note tumoral breach of the dura. The dura and overlying skull were removed surgically. Duraplasty and cranioplasty were performed
Case 2: Bone flap was removed. Note tumoral breac...

Case 2: Bone flap was removed. Note tumoral breach of the dura. The dura and overlying skull were removed surgically. Duraplasty and cranioplasty were performed

Case 2: Surgical specimen. Complete resection was...Media file 9: Case 2: Surgical specimen. Complete resection was achieved.
Case 2: Surgical specimen. Complete resection was...

Case 2: Surgical specimen. Complete resection was achieved.

Case 3: Tentorial meningioma. A, Contrast-enhance...Media file 10: Case 3: Tentorial meningioma. A, Contrast-enhanced CT scan shows the enhancing meningioma. Transverse T1-weighted MRIs shows isointensity of the tumor compared with the surrounding brain (B) and its homogenous enhancement (C). Coronal (D), coronal enhanced (E), and sagittal enhanced (F) T1-weighted MRIs. Posterior circulation angiograms show tumoral blush (arrow in G) and the Bernasconi-Cassinari artery (arrow in H).
Case 3: Tentorial meningioma. A, Contrast-enhance...

Case 3: Tentorial meningioma. A, Contrast-enhanced CT scan shows the enhancing meningioma. Transverse T1-weighted MRIs shows isointensity of the tumor compared with the surrounding brain (B) and its homogenous enhancement (C). Coronal (D), coronal enhanced (E), and sagittal enhanced (F) T1-weighted MRIs. Posterior circulation angiograms show tumoral blush (arrow in G) and the Bernasconi-Cassinari artery (arrow in H).

Case 3: Tentorial meningioma. Gadolinium-enhanced...Media file 11: Case 3: Tentorial meningioma. Gadolinium-enhanced T1-weighted MRI immediately (A) and 2 years after surgery (B-D). Transverse images show posterior (arrow in B) and anterior (arrow in C) recurrence involving the tentorium. Sagittal images show posterior (D) and anterior (E) recurrence involving the tentorium. Lower vignette reveals complete excision of the recurrence after a second operation.
Case 3: Tentorial meningioma. Gadolinium-enhanced...

Case 3: Tentorial meningioma. Gadolinium-enhanced T1-weighted MRI immediately (A) and 2 years after surgery (B-D). Transverse images show posterior (arrow in B) and anterior (arrow in C) recurrence involving the tentorium. Sagittal images show posterior (D) and anterior (E) recurrence involving the tentorium. Lower vignette reveals complete excision of the recurrence after a second operation.

Case 3: Tentorial meningioma A, Pathology showed ...Media file 12: Case 3: Tentorial meningioma A, Pathology showed syncytial meningioma. Note hypercellularity and minimal whorling (hematoxylin-eosin, original magnification X400). B, MRI performed 4 years after the first operation reveals a recurrence over the posterior tentorium. C, Two-dimensional planning for stereotactic radiosurgery. Three recurrences lie in the plane of the tentorium on a single line. D, Three-dimensional planning for stereotactic radiosurgery. Three arcs were used to irradiate the largest recurrence.
Case 3: Tentorial meningioma A, Pathology showed ...

Case 3: Tentorial meningioma A, Pathology showed syncytial meningioma. Note hypercellularity and minimal whorling (hematoxylin-eosin, original magnification X400). B, MRI performed 4 years after the first operation reveals a recurrence over the posterior tentorium. C, Two-dimensional planning for stereotactic radiosurgery. Three recurrences lie in the plane of the tentorium on a single line. D, Three-dimensional planning for stereotactic radiosurgery. Three arcs were used to irradiate the largest recurrence.

Case 4: Recurrent subcutaneous meningioma. A, Pa...Media file 13: Case 4: Recurrent subcutaneous meningioma. A, Patient underwent surgery for a parieto-occipital meningioma in 1978. She was lost to follow-up until 1996, when this transverse T2-weighted MRI was obtained. Arrow indicates surgical bed of the resected meningioma. B, Although the initial surgical bed is tumor-free, sagittal T2-weighted MRI shows a large subcutaneous recurrence. C, Lower transverse section also shows recurrence. Note variegated appearance of the tumor. D, Transverse section at a lower level. Postoperative sagittal (E) and transverse (F, G) enhanced T1-weighted MRI shows gross total removal of the tumor. H and I, Tumoral recurrence 3 months after surgery, at the same level as in G and F, respectively. Patient received repeat surgery for subtotal removal of the tumor; a pediculated subcutaneous flap was used to close the surgical defect. After surgery, patient received conventional radiotherapy.
Case 4: Recurrent subcutaneous meningioma. A, Pa...

Case 4: Recurrent subcutaneous meningioma. A, Patient underwent surgery for a parieto-occipital meningioma in 1978. She was lost to follow-up until 1996, when this transverse T2-weighted MRI was obtained. Arrow indicates surgical bed of the resected meningioma. B, Although the initial surgical bed is tumor-free, sagittal T2-weighted MRI shows a large subcutaneous recurrence. C, Lower transverse section also shows recurrence. Note variegated appearance of the tumor. D, Transverse section at a lower level. Postoperative sagittal (E) and transverse (F, G) enhanced T1-weighted MRI shows gross total removal of the tumor. H and I, Tumoral recurrence 3 months after surgery, at the same level as in G and F, respectively. Patient received repeat surgery for subtotal removal of the tumor; a pediculated subcutaneous flap was used to close the surgical defect. After surgery, patient received conventional radiotherapy.

Case 5: Bilateral olfactory meningioma invading t...Media file 14: Case 5: Bilateral olfactory meningioma invading the facial sinuses. Coronal (A), transverse (B), and sagittal (C) gadolinium-enhanced T1-weighted MRI shows bilateral olfactory meningiomas, and the falx dividing the tumor in 2. Arrow indicates tumor invasion of the sinuses. D, Postoperative enhanced T1-weighted MRI shows that the tumor was completely removed by means of craniotomy and a transfacial approach. E, Tumor was first approached intracranially. Enhanced T1-weighted MRI reveals complete excision of the intracranial component. Arrow indicates residual in the sinuses. F, Residual was completely excised by means a transfacial approach performed with the otolaryngology team.
Case 5: Bilateral olfactory meningioma invading t...

Case 5: Bilateral olfactory meningioma invading the facial sinuses. Coronal (A), transverse (B), and sagittal (C) gadolinium-enhanced T1-weighted MRI shows bilateral olfactory meningiomas, and the falx dividing the tumor in 2. Arrow indicates tumor invasion of the sinuses. D, Postoperative enhanced T1-weighted MRI shows that the tumor was completely removed by means of craniotomy and a transfacial approach. E, Tumor was first approached intracranially. Enhanced T1-weighted MRI reveals complete excision of the intracranial component. Arrow indicates residual in the sinuses. F, Residual was completely excised by means a transfacial approach performed with the otolaryngology team.

Case 6: Subfrontal meningioma in a patient with a...Media file 15: Case 6: Subfrontal meningioma in a patient with abnormal behavior. A, Contrast-enhanced CT scan clearly shows bilateral subfrontal meningioma. B, Transverse T1-weighted MRI of same lesion. C, Intense gadolinium enhancement of the tumor. Coronal (D) and sagittal (E) gadolinium-enhanced T1-weighted MRIs. F, Anterior circulation angiogram reveals posterior displacement of the anterior cerebral artery by tumor. G, Postoperative MRI shows complete removal of the tumor. H-I, Pathology slides (hematoxylin-eosin; original magnification X100 in H, X400 in I) show syncytial meningioma with well-identified whorls and no psammoma bodies.
Case 6: Subfrontal meningioma in a patient with a...

Case 6: Subfrontal meningioma in a patient with abnormal behavior. A, Contrast-enhanced CT scan clearly shows bilateral subfrontal meningioma. B, Transverse T1-weighted MRI of same lesion. C, Intense gadolinium enhancement of the tumor. Coronal (D) and sagittal (E) gadolinium-enhanced T1-weighted MRIs. F, Anterior circulation angiogram reveals posterior displacement of the anterior cerebral artery by tumor. G, Postoperative MRI shows complete removal of the tumor. H-I, Pathology slides (hematoxylin-eosin; original magnification X100 in H, X400 in I) show syncytial meningioma with well-identified whorls and no psammoma bodies.

Case 7: Parasagittal meningioma invading the supe...Media file 16: Case 7: Parasagittal meningioma invading the superior sagittal sinus (SSS). A, Sagittal T1-weighted MRI shows a meningioma (arrow). B, T2-weighted MRI. Note midline shift and tumoral invasion of the skull (arrow). C, Transverse T2-weighted MRI. D, Angiogram shows invasion of the SSS, which remains patent. Sagittal (E, G), transverse (F) postoperative T1-weighted MRI. H, Gadolinium-enhanced postoperative T1-weighted MRI shows residual tumor, which was intentionally left to preserve patency of the SSS. I, Pathology slide (hematoxylin-eosin, original magnification X100) shows a highly vascular syncytial meningioma.
Case 7: Parasagittal meningioma invading the supe...

Case 7: Parasagittal meningioma invading the superior sagittal sinus (SSS). A, Sagittal T1-weighted MRI shows a meningioma (arrow). B, T2-weighted MRI. Note midline shift and tumoral invasion of the skull (arrow). C, Transverse T2-weighted MRI. D, Angiogram shows invasion of the SSS, which remains patent. Sagittal (E, G), transverse (F) postoperative T1-weighted MRI. H, Gadolinium-enhanced postoperative T1-weighted MRI shows residual tumor, which was intentionally left to preserve patency of the SSS. I, Pathology slide (hematoxylin-eosin, original magnification X100) shows a highly vascular syncytial meningioma.

Pathology slides (hematoxylin-eosin; original mag...Media file 17: Pathology slides (hematoxylin-eosin; original magnification X400 in A-B, X100 in C-D). A, Fibroblastic meningioma (arrowheads) abutting the dura (arrow). B, Psammomatous meningioma (arrow indicates psammoma body). C, Meningothelial meningioma, tumor in case 4. E, Meningioma with marked vascularity (arrowheads indicate meningioma cluster; arrow, vessel wall).
Pathology slides (hematoxylin-eosin; original mag...

Pathology slides (hematoxylin-eosin; original magnification X400 in A-B, X100 in C-D). A, Fibroblastic meningioma (arrowheads) abutting the dura (arrow). B, Psammomatous meningioma (arrow indicates psammoma body). C, Meningothelial meningioma, tumor in case 4. E, Meningioma with marked vascularity (arrowheads indicate meningioma cluster; arrow, vessel wall).

Case 4: Pathology slides (hematoxylin-eosin, orig...Media file 18: Case 4: Pathology slides (hematoxylin-eosin, original magnification X400). A, Meningioma with malignant features, as evinced by prominent nucleoli (yellow dot) and mitoses (arrows). B, Intranuclear cytoplasmic intrusion (pseudoinclusion).
Case 4: Pathology slides (hematoxylin-eosin, orig...

Case 4: Pathology slides (hematoxylin-eosin, original magnification X400). A, Meningioma with malignant features, as evinced by prominent nucleoli (yellow dot) and mitoses (arrows). B, Intranuclear cytoplasmic intrusion (pseudoinclusion).

This is an extra-axial tumor. Glioblastoma multif...Media file 19: This is an extra-axial tumor. Glioblastoma multiforme (GBM) and astrocytoma are intraparenchymal tumors, and GBM enhances in a variegated fashion. Acoustic schwannomas are seen in the posterior fossa but not in this location. Fibrous dysplasia involves the skull but does not cause this amount of compression.
This is an extra-axial tumor. Glioblastoma multif...

This is an extra-axial tumor. Glioblastoma multiforme (GBM) and astrocytoma are intraparenchymal tumors, and GBM enhances in a variegated fashion. Acoustic schwannomas are seen in the posterior fossa but not in this location. Fibrous dysplasia involves the skull but does not cause this amount of compression.

More on Meningioma

Overview: Meningioma
Differential Diagnoses & Workup: Meningioma
Treatment & Medication: Meningioma
Follow-up: Meningioma
Multimedia: Meningioma
References
Further Reading

References

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Further Reading

Clinical guidelines

Improving outcomes for people with brain and other CNS tumours.
National Collaborating Centre for Cancer - National Government Agency [Non-U.S.].  2006 Jun. 180 pages.  NGC:005147

Gu ideline for the diagnosis, investigation and management of polycythaemia/erythrocytosis.
British Committee for Standards in Haematology - Professional Association.  2005 Jul.  22 pages. NGC:006179

ACR Appropriateness Criteria® orbits, vision, and visual loss.
American College of Radiology - Medical Specialty Society. 1999 (revised 2006). 9 pages. NGC:005122

Clinical trials

Phase II Trial of Sunitinib (SU011248) in Patients With Recurrent or Inoperable Meningioma

Monthly SOM230C for Recurrent or Progressive Meningioma

Biobank Meningioma: Storing Blood for Analysis of DNA and Protein of Patients With Meningioma


Related eMedicine topics


Meningioma, Brain

Meningioma, Spine

Meningioma, Optic Nerve Sheath

Meningioma, Sphenoid Wing

Skull Base Tumors

Keywords

meninges, meningeal carcinoma, meningeal cancer, arachnoidal cap cells, primary intracranial neoplasms, asymptomatic meningioma, neurofibromatosis-2, NF-2, familial meningiomas, primary intracranial tumors, hyperostosis, seizures, dysphasia, disinhibited behavior, somnolence, urinary incontinence, anosmia, ipsilateral optic atrophy

contralateral papilledema, Kennedy-Foster syndrome, diplopia, facial numbness, contralateral hemianopsia, facial weakness, Brown-Sequard syndrome, hemispinal cord syndrome, exophthalmos, monocular loss of vision, blindness, ipsilateraldilated pupil, monocular optic nerve swelling, optociliary shunt vessels, multiple cranial nerve palsies, paraparesis, sphincteric troubles, tongue atrophy

transient ischemic attack–like episodes, TIA–like episodes, stroke, intraventricular meningiomas, obstructive hydrocephalus, panhypopituitarism, visual field defects, raised intracranial pressure, brain herniation, decreased mentation, decreased facial sensation, facialparesis, decreasedhearing, deviation of uvula, hemiatrophy of tongue, pronator drift,hyperreflexia, positive Hoffman sign, Babinski sign, parietal-lobe syndrome, Gerstmann syndrome, agraphia, acalculia, right-left disorientation, finger agnosia, tactile extinction, neglect of contralateral side

visual extinction, congruent homonymous hemianopsia, spinal meningiomas, decreased pain sensation, quadriparesis, sphincteric weakness, ipsilateral weakness, decrease in position sense, cranial irradiation, chromosome 22q, merlin, schwannomin, anaplastic meningioma, monosomy of chromosome 7, loss of progesterone receptors, increased expression of ornithinedecarboxylase, increased expression of cyclooxygenase 2, radiation-induced meningiomas, matrix metalloproteinases, MMPs, tissue inhibitors of MMPs, TIMPs

Contributor Information and Disclosures

Author

Georges Haddad, MD, Clinical Assistant Professor, Department of Medicine, Division of Neurosurgery, American University of Beirut, Lebanon
Georges Haddad, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Ali Turkmani, MD, Staff Physician, Department of Neurosurgery, American University Hospital
Disclosure: Nothing to disclose.

Tarafa Baghdadi, MD, Staff Physician, Department of Neurosurgery, American University Hospital
Disclosure: Nothing to disclose.

Roukoz B Chamoun, MD, Staff Physician, Department of Neurosurgery, American University of Beirut Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Frederick M Vincent Sr, MD, Clinical Professor, Department of Neurology and Ophthalmology, Michigan State University Colleges of Human and Osteopathic Medicine
Frederick M Vincent Sr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Forensic Examiners, American College of Legal Medicine, American College of Physicians, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jorge Kattah, MD, Head, Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria
Jorge Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences
Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine
Disclosure: Abbott Labs  Honoraria Consulting; Teva Marion Honoraria Consulting; Boeringer-Ingelheim Honoraria Speaking and teaching

 
 
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