Reverse Seeding of Recurrent Intraspinal Malignant Meningioma

Abstract

Meningiomas are common intracranial and intraspinal tumors and constitute 15–20% of all primary brain tumors. Ten to 15% of all meningiomas are considered malignant. The main treatment of meningiomas is surgical resection. Meningioma recurrence following surgery is frequent. However, it is not clear whether recurrent meningiomas, close or distant to the primary resection site, arise from incomplete resection, dissemination of tumor fragments or from independent tumor growth. We herein describe a 40-year-old woman with intraspinal malignant meningioma recurring each time upwards, i.e. apparently by reverse way of seeding, via cerebrospinal fluid.

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

“…In addition to dissemination of tumor fragments during surgery, direct tumor growth and incomplete resection are also possible [2]. In our patient these were unlikely to be the reasons for the recurrence: the tumor was excised completely and neither continuous physical connection with other intracranial meningiomas nor recurrence at the primary location were observed during the follow-up.…”

“…Meningiomas are common neoplasms, representing 15-20% of all primary intracranial tumors [1,2]. Usually slow growing and benign, meningiomas remain localized at the site of origin, behaving as expanding intracranial masses causing pressure effects and erosion in neighboring tissue [3,4].…”

“…Surgical excision is the principal form of treatment and must be preceded by radiographical determination of the extent of the primary lesion and possible metastatic deposits [2,4,8]. Electroencephalography may case report 767 sometimes also be a helpful tool in both the diagnostics of meningiomas and the postoperative follow-up period [9].…”

Paediatric clear cell meningioma with multiple distant recurrences after presumed intra-operative cell spread

“…a The tumour is located between CN VII/VIII (number sign) and the anterior inferior cerebellar artery above and is lying on top of and being strongly adhesive to caudal cranial nerves (asterisk) within the jugular foramen. b After gross total resection and careful dissection, the uninjured lower cranial nerves can be seen as well as the full course of the anterior inferior cerebellar artery below CN VII/VIII demonstrated in anaplastic meningiomas [8,9] but has also been repeatedly reported in clear cell meningiomas after surgical intervention [2,7]. Prognostic markers that might be associated with tumour recurrences remain to be identified.…”

Management of Atypical and Anaplastic Meningiomas

“…27 There are only a few reports of atypical and malignant spinal meningiomas, suggesting that tumors in this location have a different pathological behavior as they rarely show malignant transformation or recurrence even if not totally resected. [27][28][29] The differential meningeal embryogenesis may result in the predominance of one arachnoidal cell type over the other at certain location. 27 Metastases for meningiomas are rare, even for anaplastic meningiomas.…”