Benign meningioma manifesting with acute subdural hematoma and cerebral edema: a case report and review of the literature

Abstract Background Spontaneous subdural hematoma rarely presents with a hypervascular or malignant tumor but even less frequently in a benign tumor like meningioma. We encountered a patient with acute subdural hematoma associated with benign meningioma. Here, we report this case along with a review of previous reports, especially focusing on their clinical features and possible bleeding mechanisms. Case presentation A 53-year-old Asian woman presented with severe headache and progressive neurologic deterioration due to cerebral edema. The patient was submitted to open surgery for evacuation of the subdural hematoma and concurrent tumor removal on the ipsilateral parietal convexity. A hypervascular, encapsulated mass was identified during surgery and completely removed including the adjacent dura mater (Simpson grade 0). The tumor was histologically confirmed as an angiomatous meningioma (World Health Organization grade I). Her clinical course was uneventful after surgery. Conclusions Although meningiomas are commonly benign according to their histological traits, they can lead to spontaneous bleeding and cause neurologically unstable condition. Therefore, meningiomas need to be considered as a cause of spontaneous subdural hematoma if radiologically suspicious, which should be reflected by proper management for a positive outcome.

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A convexity meningioma presenting with an acute subdural hematoma

Surgical Neurology International ◽

10.25259/sni_328_2020 ◽

2020 ◽

Vol 11 ◽

pp. 263

Author(s):

Masahiko Itani ◽

Satoshi Shitara ◽

Yoshinori Akiyama

Keyword(s):

Subdural Hematoma ◽

Sudden Onset ◽

World Health ◽

Acute Subdural Hematoma ◽

Pathological Examination ◽

Pia Mater ◽

Subdural Hematomas ◽

Detailed Medical History ◽

Precise Diagnosis ◽

Health Organization

Background: Meningiomas presenting with acute subdural hematomas are extremely rare. To the best of our knowledge, only 45 cases have been reported to date. We report on a case of a meningioma mimicking an acute subdural hematoma as well as a thorough literature review. Case Description: A 67-year-old man with no history of trauma was referred to our hospital with sudden onset of decreased level of consciousness and left hemiplegia. Computed tomography revealed an acute convexity subdural hematoma. Emergency surgery to remove the hematoma was performed. The hematoma was found to exist in the extra-axial space and the attached dura mater and pia mater remained intact. Pathological examination revealed a transitional meningioma, the World Health Organization Grade 1. Detailed medical history taken postoperatively revealed that a convexity meningioma had been diagnosed incidentally at another facility 1 year earlier. Conclusion: Acute subdural hematomas due to meningiomas are rare, and establishing the cause is challenging. Prompt and precise diagnosis of such entities may afford patients a better prognosis.

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Benign meningiomas (WHO Grade I) with atypical histological features: correlation of histopathological features with clinical outcomes

Journal of Neurosurgery ◽

10.3171/2015.1.jns142228 ◽

2016 ◽

Vol 124 (1) ◽

pp. 106-114 ◽

Cited By ~ 27

Author(s):

Ariel E. Marciscano ◽

Anat O. Stemmer-Rachamimov ◽

Andrzej Niemierko ◽

Mykol Larvie ◽

William T. Curry ◽

...

Keyword(s):

Prognostic Significance ◽

Risk Groups ◽

World Health ◽

Who Grade ◽

Simpson Grade ◽

Atypical Features ◽

Additional Surgery ◽

Increased Risk ◽

Grade Ii ◽

Health Organization

OBJECT World Health Organization (WHO) Grade I (benign) meningiomas with atypical features may behave more aggressively than similarly graded tumors without atypical features. Here, the prognostic significance of atypical features in benign meningiomas was determined. METHODS Data from patients diagnosed with WHO Grade I benign meningiomas per the 2007 WHO criteria and who underwent surgery between 2002 and 2012 were retrospectively reviewed. Patients were stratified by the absence or presence of 1 to 2 atypical features with review of the clinical and histological factors. RESULTS A total of 148 patients met the inclusion criteria (n = 77 with atypia; n = 71 without atypia). The median follow-up duration after pathological diagnosis was 37.5 months. Thirty patients had progression/recurrence (P/R) after initial treatment, and 22 (73%) of 30 patients with P/R had 1–2 atypical features. The presence of atypical features was significantly associated with P/R (p = 0.03) and independent of the MIB-1 labeling index. The 1-year and 5-year actuarial rates of P/R were 9.6% versus 1.4% and 30.8% versus 13.8% fortumors with and without atypical features, respectively. Higher Simpson grade resection (II–IV vs I) was associated with the increased risk of P/R (p < 0.001). Stratification of patients into low-risk (Simpson Grade I), intermediate-risk (Simpson Grade II–IV with no atypical features), and high-risk groups (Simpson Grade II–IV with atypical features) was significantly correlated with increased risk of P/R (p < 0.001). CONCLUSIONS Patients with benign meningiomas with atypical features and those undergoing Simpson Grade II–IV resection are at significantly increased risk of P/R. Patients with these features may benefit from the consideration of additional surgery and/or radiation therapy.

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Acute Subdural Hematoma in a High School Football Player Requiring Emergent Decompressive Craniectomy

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2019-0049 ◽

2020 ◽

Vol 25 (3) ◽

pp. 131-133

Author(s):

Christine C. Center ◽

Samuel J. Wilkins ◽

Ross Mathiasen ◽

Adam B. Rosen

Keyword(s):

High School ◽

Decompressive Craniectomy ◽

Subdural Hematoma ◽

Brain Injuries ◽

Action Plan ◽

Football Player ◽

Positive Outcome ◽

Acute Subdural Hematoma ◽

High School Football ◽

Surgical Treatments

The purpose of this report is to present the case of a high school football player who sustained an injury during a game, resulting in an acute subdural hematoma (SDH). The patient underwent an emergent decompressive craniectomy. The uniqueness of the case is due to both rare pathology and treatment. The athlete had a positive outcome due to prompt on-field assessment and advanced surgical treatments. Athletic trainers should know how to recognize symptoms of emergent traumatic brain injuries and be prepared to implement an emergency action plan when necessary.

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The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2011.03.011 ◽

2011 ◽

Vol 2011 ◽

pp. 225-226

Author(s):

I. Yang

Keyword(s):

World Health Organization ◽

World Health ◽

Simpson Grade ◽

Neurosurgical Treatment ◽

Health Organization

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Simpson Grade I-III Resection of Spinal Atypical (World Health Organization Grade II) Meningiomas is Associated With Symptom Resolution and Low Recurrence

Neurosurgery ◽

10.1227/neu.0000000000000720 ◽

2015 ◽

Vol 76 (6) ◽

pp. 739-746 ◽

Cited By ~ 21

Author(s):

Sam Q. Sun ◽

Chunyu Cai ◽

Vijay M. Ravindra ◽

Paul Gamble ◽

Chester K. Yarbrough ◽

...

Keyword(s):

Radiation Therapy ◽

Confidence Interval ◽

World Health ◽

Gross Total Resection ◽

Adjuvant Radiation ◽

Total Resection ◽

Adjuvant Radiation Therapy ◽

Symptom Resolution ◽

Simpson Grade ◽

Health Organization

Abstract BACKGROUND: Because of their rarity, outcomes regarding spinal atypical meningiomas (AMs) remain unclear. OBJECTIVE: To describe the recurrence rate and postoperative outcomes after resection of spinal AMs, and to discuss an appropriate resection strategy and adjuvant therapy for spinal AMs. METHODS: Data from all patients who presented with spinal AMs to 2 tertiary referral centers between 1998 and 2013 were obtained by chart review. RESULTS: From 102 patients with spinal meningioma, 20 AM tumors (7 cervical, 11 thoracic, 2 thoracolumbar) were identified in 18 patients (median age, 50 years [range, 19-75] at time of resection; 11% male; median follow-up, 32 months [range, 1-179] after resection). Before resection, patients had sensory deficits (70%), pain (70%), weakness (60%), ataxia (50%), spasticity (65%), and incontinence (35%). One tumor presented asymptomatically. Simpson grade I, II, III, and IV resection were achieved in 3 (15%), 13 (65%), 2 (10%), and 2 (10%) tumors, respectively. One patient that underwent Simpson grade III resection received adjuvant radiation therapy. After Simpson grade I-III or gross total resection, no tumors recurred (0%; confidence interval, 0%-17.6%). After Simpson grade IV resection, 1 tumor recurred (50%; confidence interval, 1.3%-98.7%). With the exception of 1 patient who had bilateral paraplegia perioperatively, all other patients experienced improvement of preoperative symptoms after surgery (median time, 3.6 months [range, 1-13] after resection). CONCLUSION: Despite published cases suggesting an aggressive clinical course for spinal AMs, this series of spinal AMs reports that gross total resection without adjuvant radiation therapy resulted in symptom resolution and low recurrence.

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Recurrent thymoma in the retroperitoneal space: a rare case report

Clinics and Practice ◽

10.4081/cp.2015.746 ◽

2015 ◽

Vol 5 (2) ◽

Cited By ~ 3

Author(s):

Jun Yang ◽

Qin-qing Li ◽

Ying-ying Ding ◽

Cheng-de Liao

Keyword(s):

Anterior Mediastinum ◽

Retroperitoneal Space ◽

World Health ◽

Asian Woman ◽

Retroperitoneal Mass ◽

World Health Organization Classification ◽

The World ◽

Rare Case Report ◽

Health Organization

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and recurrences of thymoma generally are locally, and retroperitoneal recurrence is considered to be rare. A 46-year old Asian woman with invasive thymoma had undergone thymectomy 10 years ago. Computed tomography demonstrated a wellcircumscribed mass in the left retroperitoneal space. The patient had not any symptom including myasthenia gravis. Because on the anterior mediastinum area shows no sign of tumor recurrence and the mass adjacent to the vertebral body, neurogenic tumor was suspected. Surgical resection was performed using a retroperitoneal approach, which revealed the tumor adhering neighboring diaphragm. The tumor was histologically diagnosed to be type B1 thymoma according to the World Health Organization classification. The retroperitoneal mass was an unusual local recurrence after thymectomy. The patients whose had under invasive thymectomy should be evaluated carefully when finding retroperitoneal mass during follow-up.

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Use of Saito technique to resect an anterior lumbar spine meningioma: Technical note

Surgical Neurology International ◽

10.25259/sni_383_2021 ◽

2021 ◽

Vol 12 ◽

pp. 276

Author(s):

Ignacio J. Barrenechea ◽

Luis M. Marquez ◽

Marcelo Pastor

Keyword(s):

Insertion Site ◽

Technical Note ◽

World Health ◽

Total Removal ◽

Total Resection ◽

Dural Repair ◽

Simpson Grade ◽

Grade Ii ◽

Spinal Meningiomas ◽

Health Organization

Background: Complete (Simpson Grade I: total removal) resections for anterior spinal meningiomas are especially challenging. This is largely attributed to difficulty obtaining a water-tight dural repair where the tumor has infiltrated the dura requiring duroplasty, thus often resulting in just a Simpson Grade II resection (i.e. coagulation of the dural implantation site). Here, we present a 56-year-old female who underwent resection of a ventral lumbar meningioma utilizing the Saito technique, that effectively separated the dura into two layers, removing just the inner layer but leaving the outer layer intact for direct dural repair. Methods: A 56-year-old female underwent a L1–L2 laminectomy. The anterior intradural resection of tumor was achieved with the Saito technique; this required cutting circumferentially around the tumor insertion site, and removing only the inner layer. Results: Postoperatively, the patient did well without tumor recurrence over 8 years. The postoperative biopsy confirmed a World Health Organization Grade I meningothelial meningioma. Conclusion: Saito’s technique proved to be a safe and effective method for achieving gross total resection of an anterior lumbar meningioma.

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Incidental Metastatic Meningioma Presenting as a Large Liver Mass

Case Reports in Hepatology ◽

10.1155/2018/1089394 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Ifeyinwa E. Obiorah ◽

Metin Ozdemirli

Keyword(s):

Previous History ◽

Clinical History ◽

World Health ◽

Intracranial Meningioma ◽

Liver Mass ◽

Benign Meningioma ◽

Who Grade ◽

Precise Diagnosis ◽

History Of ◽

Health Organization

Meningiomas are slow growing neoplasms of the central nervous system (CNS). Most of the tumors are benign and distant metastasis from a benign meningioma is rare. Metastasis to the liver, although rare, usually presents with hypoglycemia or occurs in conjunction with a clinical history of an intracranial meningioma or following the resection of a prior CNS meningioma, thus making clinical diagnosis relatively easy. Here we present an unusual case of metastatic meningioma to the liver in a 54-year-old female who presented with an incidental liver mass by ultrasound. Her clinical history and physical examination were unremarkable. A partial hepatectomy revealed a meningioma on histology. Further investigation by imaging studies showed a frontal parasagittal dural mass which was confirmed to be a World Health Organization (WHO) grade 1 meningioma. To our knowledge, this is the first report of a clinically silent metastatic meningioma to the liver without either a concurrent or a previous history of meningioma. Precise diagnosis of this challenging case requires high clinical suspicion, histopathology, and immunohistochemistry.

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Malignant Subdural Hematoma Associated with High-Grade Meningioma

The Surgery Journal ◽

10.1055/s-0038-1660511 ◽

2018 ◽

Vol 04 (02) ◽

pp. e91-e95

Author(s):

Shinichiro Teramoto ◽

Akira Tsunoda ◽

Kaito Kawamura ◽

Natsuki Sugiyama ◽

Rikizo Saito ◽

...

Keyword(s):

Subdural Hematoma ◽

Superior Sagittal Sinus ◽

Chronic Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Tumor Removal ◽

Sagittal Sinus ◽

Simpson Grade ◽

Grade Ii ◽

Bilateral Chronic Subdural Hematoma ◽

Parasagittal Meningioma

AbstractA 70-year-old man, who had previously undergone surgical resection of left parasagittal meningioma involving the middle third of the superior sagittal sinus (SSS) two times, presented with recurrence of the tumor. We performed removal of the tumor combined with SSS resection as Simpson grade II. After tumor removal, since a left dominant bilateral chronic subdural hematoma (CSDH) appeared, it was treated by burr hole surgery. However, because the CSDH rapidly and repeatedly recurred and eventually changed to acute subdural hematoma, elimination of the hematoma with craniotomy was accomplished. The patient unfortunately died of worsening of general condition despite aggressive treatment. Histopathology of brain autopsy showed invasion of anaplastic meningioma cells spreading to the whole outer membrane of the subdural hematoma. Subdural hematoma is less commonly associated with meningioma. Our case indicates the possibility that subdural hematoma associated with meningioma is formed by a different mechanism from those reported previously.

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