Meningioma parasagital atípico abscedado

Abstract

Los meningiomas son los tumores cerebrales no gliales primarios más comunes, con una tasa de incidencia del 13-19% en series grandes de tumores intracraneales primarios13 Los meningiomas se consideran benignos, bien circunscritos y de crecimiento lento4. Están clasificados en grado I, grado II y III por la Organización Mundial de la Salud (OMS) para los tumores del sistema nervioso central9. La tasa de recurrencia de meningiomas atípicos (grado II de la OMS) es del 30-40%13. Resección quirúrgica del tumor y el implante dural es el tratamiento de elección1.
 Descripción del caso. Mujer de 42 años con antecedentes de tumor frontoparietal derecho que requiere craneotomía parietal derecha, resección subtotal de la lesión y colocación del sistema Ommaya; presenta convulsiones clónicas simples de hemicuerpo izquierdo, cefalea holocraneal y hemiparesia izquierda. Tomografía y resonancia magnética (RM) del cráneo, que realza con la administración de contraste, con edema perilesional, hernia transcalvaria y porción proximal del catéter Ommaya.
 Conclusiones. El presente caso de absceso meningioma parasagital atípico recurrente, es un caso raro en la literatura. La colocación de cualquier tipo de drenaje adyacente al tumor funciona como un cuerpo extraño y aumenta el riesgo de infecciones y, por lo tanto, de abscesos intratumorales, lo que infiere un pronóstico peor.

Intratumoral abscess complicating a postradiation-induced World Health Organization grade II meningioma: illustrative case

“…14 The lipid-and glycoprotein-rich tissue in the tumor center provides fertile ground for abscess formation; this paired with the lack of immune response intratumorally provides a highly favorable environment for abscess development. 14,18 In our patient, without a clearer inciting event or infective source, we believe that the long-term use of steroids likely contributed to a relatively immunocompromised state, which facilitated abscess formation secondary to S. hominis bacteremia. Long-term steroid use has been linked to abscess development in glioblastoma multiforme in several cases, and, certainly, immunosuppression is a risk factor for cerebral abscess formation in general.…”

“… 12 Other signs associated more specifically with intrameningioma abscess can include fever, migraine, altered sensation, and multiple seizures. 18 …”

“…Observations According to the literature, there are 18 reported cases of abscesses associated with cerebral meningioma (either peri-or intratumoral) and 15 cases of intrameningioma abcess [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 1). Typically, these abscessed tumors are close to avenues of entry into the cranial vault-that is, near the skull base, sellar region, or sinuses.…”

“…12 Other signs associated more specifically with intrameningioma abscess can include fever, migraine, altered sensation, and multiple seizures. 18 Prior studies have postulated that the increased vascularity, lack of protection from the blood-brain barrier due to increased fenestration, and blood flow pattern within the neoplasm increase the risk of peritumoral abscess development specific to meningioma. 4 Because of their robust blood supply, meningiomas are more susceptible than other tumors to hematogenous seeding, especially by metastatic cancer cells in the bloodstream.…”

“…Brain meningiomas and abscesses are common independently, but intrameningioma abscesses are rare, with only 15 cases previously described in the literature. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In all but one of these cases, either a known source of infection or a likely cause of infection was identified. 20 One prior case describes a "sterile" abscess within a meningioma, or an abscess without microbial growth from its samples.…”