Implantation meningioma in temporalis muscle: case report

Recurrent subcutaneous metastasis of a convexity meningioma: a case report and literature review

Subcutaneous metastasis in the operative route after intracranial meningioma resection is extremely rare. Here we describe the case of a 69-year-old male who was operated on in our department for a convexity meningioma that spread a few years after surgery in the soft tissues next to the craniotomy site. Twenty-one other cases have been found in the medical literature. In this article, we discuss mechanisms of growth, presentation and management of subcutaneous meningiomas.

Clinical Applications of Poly-Methyl-Methacrylate in Neurosurgery: The In Vivo Cranial Bone Reconstruction

Background: Biomaterials and biotechnology are becoming increasingly important fields in modern medicine. For cranial bone defects of various aetiologies, artificial materials, such as poly-methyl-methacrylate, are often used. We report our clinical experience with poly-methyl-methacrylate for a novel in vivo bone defect closure and artificial bone flap development in various neurosurgical operations. Methods: The experimental study included 12 patients at a single centre in 2018. They presented with cranial bone defects after various neurosurgical procedures, including tumour, traumatic brain injury and vascular pathologies. The patients underwent an in vivo bone reconstruction from poly-methyl-methacrylate, which was performed immediately after the tumour removal in the tumour group, whereas the trauma and vascular patients required a second surgery for cranial bone reconstruction due to the bone decompression. The artificial bone flap was modelled in vivo just before the skin closure. Clinical and surgical data were reviewed. Results: All patients had significant bony destruction or unusable bone flap. The tumour group included five patients with meningiomas destruction and the trauma group comprised four patients, all with severe traumatic brain injury. In the vascular group, there were three patients. The average modelling time for the artificial flap modelling was approximately 10 min. The convenient location of the bone defect enabled a relatively straightforward and fast reconstruction procedure. No deformations of flaps or other complications were encountered, except in one patient, who suffered a postoperative infection. Conclusions: Poly-methyl-methacrylate can be used as a suitable material to deliver good cranioplasty cosmesis. It offers an optimal dural covering and brain protection and allows fast intraoperative reconstruction with excellent cosmetic effect during the one-stage procedure. The observations of our study support the use of poly-methyl-methacrylate for the ad hoc reconstruction of cranial bone defects.

Subcutaneous Metastasis of Atypical Meningioma: Case Report and Literature Review

BACKGROUND

Meningioma, a neoplasm of the meninges, is usually a benign localized tumor. Extraneural metastasis is an extremely rare complication of meningiomas, and only a few cases have been reported to date. The present study reports a case of scalp metastasis of an atypical meningioma and discusses the types of atypical meningiomas and their management options.

CASE DESCRIPTION

A 69-year-old man presented with scalp metastasis of an atypical meningioma. Six years after the right frontoparietal meningioma lesion was completely resected, an isolated subcutaneous metastasis developed at the right frontal region of the scalp, originating at the scar left by the first surgery. Postoperative histologic examination of the subcutaneous tumor revealed the features of an atypical meningioma.

CONCLUSIONS

This study highlights that resection of meningiomas is still associated with a risk of iatrogenic metastasis. Surgeons should carefully wash out the operative field and change surgical tools frequently to avoid the potential risk of metastasis.

The possibility of seeding vestibular schwannomas through surgery: Limited experience with two cases

Background:

We present two exceptional cases of possible tumor seeding in benign vestibular schwannoma (VS) patients occurring years after initial microsurgical resection.

Case Description:

We retrospectively analyzed the surgical management, histology and documented the growth of new tumor occurrence in close vicinity of the original schwannomas by serial magnetic resonance imaging over a period of 10 years. None of the patients had stigmata of neurofibromatosis, making it a reasonable assumption that the second tumor was due to surgical seeding during the first surgery. Moreover, in the second case, a microsurgical re-exploration showed that the recurrent tumor did not show any adhesion or contact to the caudal cranial nerves as anticipated had this been a new cranial nerve schwannoma.

Conclusions:

Surgical seeding of VSs is a rare complication but can occur despite benign histology and generous irrigation during surgery.

Brain meningioma invading and destructing the skull bone: replacement of the missing bone in vivo

Background

Meningiomas are frequently encountered tumours. In those invading locally into the adjacent tissue, reconstructions may pose a problem.

Case report

We report a case of a benign convexity brain meningioma with invasion into the skull bone and subcutaneous tissue. The tumour was removed completely, together with the infiltrated tissue and the defects were successfully closed with in vivo bone reconstruction.

Conclusions

The reconstruction of the skull bone is sometimes needed after the benign meningioma excision. Artificial bone may be a suitable material, allowing fast intraoperative reconstruction with excellent brain protection and cosmetic effect during the one-stage procedure.

Hepatic Metastasis via a Ventriculo-Peritoneal Shunt from an Intracranial Meningioma: Case Report and Review of the Literature

Meningiomas are slow-growing intracranial/intraspinal tumours, with a wide range of histopathological variants. The more aggressive atypical and malignant types can disseminate via the venous system, lymphatics or cerebrospinal fluid, with the lungs and pleura being the most common site of extracranial metastasis. We look at a 68-year-old woman presenting with abdominal pain, who had previously been treated for an intracranial meningioma with a ventriculo-peritoneal shunt in situ. Investigation revealed a lesion in segment 4 of the liver with the shunt tip being in close proximity. Biopsy was consistent with metastatic meningioma. A liver resection was subsequently performed. We postulate that this is the first reported case of dissemination of an intracranial meningioma via cerebrospinal fluid by means of a ventriculo-peritoneal shunt.

Iatrogenic metastasis of a benign meningioma to the periosteum at the site of previous craniotomy: a case report

Metastasis formation after resection of meningiomas is a rare event, predominantly occurring with malignant phenotypes. As far as we know, the presented case is the first report in the literature of iatrogenic seeding of a benign meningioma to the scalp following surgery. A 37-year-old woman was admitted because of a relapsing meningioma in the frontal lobe. In 1997, she had undergone complete excision of an atypical meningioma in same location. At follow-up, three new masses were found: a bifrontal meningioma on the edge of the falx, a smaller one in the falx just under the saggital sinus and a small mass, believed to be ectopic, in the periosteum at the site of the previous craniotomy. Surgical therapy was indicated. Histologically, the ectopic tumor was an atypical meningioma, similar to the one excised 10 years previously, with no relation to the other two intracranial masses. Because of the histological similarity and the location in the old craniotomy, the ectopic tumor was believed to have developed from an implantation metastasis as a consequence of the first surgery. The authors suggest that strict adherence to oncological principles should be applied in the case of benign neoplasms in order to prevent contamination of wounds with tumor cells and potential recurrence.

Dural involvement in primary extradural meningiomas of the cranial vault

Object

The authors retrospectively analyzed a consecutive series of patients with cranial vault primary extradural meningioma (PEM), with particular regard to the tumor’s dural involvement. The pertinent literature was reviewed.

Methods

Clinical data were retrospectively obtained in a consecutive series of 16 patients treated for a PEM at two institutions between 1992 and 2004. The authors created a classification system based on dural involvement of the tumors.

Nine women and six men (mean age 55 years) presented with a painless, slowly progressive swelling. Preoperative magnetic resonance (MR) imaging revealed dural enhancement at the site of tumor in 11 patients. On surgical inspection, the tumor infiltrated the dura in all but three patients. Histological examination of tissue samples demonstrated tumor infiltration of the dura in all 14 patients in whom the dura had been resected. Three recurrent tumors were observed on follow-up examination during a mean period of 5.8 years (range 1.5–13 years) and required extirpation. In addition to one patient in whom there was histological evidence of malignancy, the other two cases involved two patients in whom no apparent dural involvement was observed during the first surgery. In a review of the literature, the authors found that histological examination showed dural involvement in 22%; the dura was not histologically evaluated in the remaining patients (78%). Postoperative follow-up data exceeding 2 years were only provided in two of the reported cases.

Conclusions

Tumor infiltration of the dura should be assumed in PEMs of the cranial vault, and resection of the dura at the site of craniotomy is recommended to prevent tumor recurrence.

Recurrent Meningioma With Metastasis to the Skin Incision-Case Report-

A 70-year-old woman presented with meningioma with metastasis to the skin incision. Neuroimaging demonstrated a tumor of the falx extending to the frontal bone. The tumor was grossly totally resected through a coronal skin incision. The histological diagnosis was meningotheliomatous meningioma. The tumor recurred in the ethmoid sinus 2 years later, and was resected through the transfacial approach. One year later, the tumor recurred in the ethmoid sinus and orbit, and was resected through the transcranial approach. Six months later, she noticed an isolated small mass under the skin incision, distant from a further recurrence of the tumor. Both tumors were resected. The histological diagnosis was atypical meningioma. Resection of atypical meningioma carries the risk of iatrogenic metastasis. Surgeons should wash out the operative field carefully and change surgical tools frequently.

Cutaneous meningioma of the scalp: a case report and review of literature

Ectopic meningioma outside the skull and spinal column is uncommon. We report a cutaneous meningioma of the scalp in a 77-year-old man. A review of types and their management options are discussed. We also highlight that in certain carefully selected cases, these lesions can be treated conservatively.

Factors affecting morbidity and mortality following surgical intervention in patients with intracranial meningioma

BACKGROUND

Meningiomas usually grow slowly but they may cause recurrences despite surgical resection. The impact of clinical, neuroradiological and surgical characteristics on operative morbidity and mortality of patients operated on for intracranial meningioma was analysed.

METHODS

A series of 450 patients operated on for intracranial meningiomas at the Department of Neurosurgery, Hacettepe University Hospital during the period 1964-1992 is reported. The surgical results were analysed with regard to intracranial site, extent of removal, histological type, and different time periods. Computed tomography (CT) and magnetic resonance imaging (MRI) facilitated the diagnosis and helped with the planning of treatment.

RESULTS

Two hundred and ninety-two patients were examined with both CT and MRI. Overall mortality was 4% but showed a decline from 9% in the pre-CT era to 3% in the post-CT era and to 1% in the past 3 years.

CONCLUSIONS

Operative mortality and recurrence rates are affected by the intracranial location of the tumour, histological type, and extent of tumour removal. Emphasis is also given to the importance of the introduction of the imaging techniques, and the microsurgical techniques with the Cavitron ultrasonic surgical aspirator (CUSA), laser, and/or bipolar coagulator which have further improved the operative mortality and recurrence rates.