Beruflich Dokumente
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REVIEW ARTICLE
1Department of Radiology
Faculty of Clinical Sciences
ABSTRACT
College of Health Sciences _____________________________________________________
University of Uyo, NIGERIA Background: Intracranial meningioma is the most common
2Neurosurgical Unit primary, intracranial, extra-axial neoplasm. It is mesenchymal in
Department of Surgery origin and arises from meningothelial cells of arachnoid villi of
Faculty of Heath Sciences meninges.
Nnamdi Azikiwe University Objectives: To re-emphasize the regional anatomic localisation
Awka, NIGERIA
3Neurosurgical Unit
and diagnostic radiological features of intracranial meningiomas,
Department of Surgery and do a review of their pathology and management, with a view
University of Douala to highlighting the worrisome clinical behaviour of these tumours
CAMEROON despite improvement in imaging diagnosis and therapeutic
4Polyclinic Bonanjo options.
Douala, CAMEROON Conclusion: Meningiomas can be easily diagnosed radiologically,
and characterised according to their sites and peculiar features, in
Author for Correspondence this era. Though most of them are regarded as benign, their
Dr Felix U Uduma
clinical behaviour in significant number of cases is not typical of
Department of Radiology
Faculty of Clinical Sciences
benign tumours as recurrence rates are still worrisome.
College of Health Sciences
University of Uyo,
Akwa Ibom State, NIGERIA Keywords: Arachnoid villi, cerebral convexity, CT, MRI, recurrence
Email: felixuduma@yahoo.com
Phone: +234-708-000-2265
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Intracranial Meningioma Orient Journal of Medicine Vol 25 [3-4] Jul-Dec, 2013
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Intracranial Meningioma Orient Journal of Medicine Vol 25 [3-4] Jul-Dec, 2013
Figure 6. Enhanced axial T1W MRI showing dural Meningiomas in general are solid tumours of
tail enhancement mesodermal origin that appear as intracranial
or intraspinal space occupying lesions.11 In
both subtypes, there is female predominance
that is more emphasized in the intraspinal
meningioma. Female to male ratio in
intracranial meningioma is 2:1, but this ratio
is rises to 4:1 in intraspinal meningioma. 1,5,9,10
Some of these tumours show some levels of
estrogen or progestin immunoreactivity.10
Progesterone receptors have been found in
80% of meningiomas, thus, leading to an
increase in tumour size during pregnancy
and luteal phase of menstrual cycle. 9
Meningiomas are rare during childhood and
adolescence but more common in the middle-
aged and elderly persons (note our two index
patients).3,7,9
Figure 7. Middle meningeal artery prominence
EPIDEMIOLOGICAL FACTORS
The majority of meningiomas are found
incidentally on serial imaging, accounting for
about 2/3 of all diagnosed meningiomas. 7
They are predominantly sporadic and the
precise aetiology is not known, though there
are risk factors thought to predispose to the
development of these tumours. These factors
include previous cranial irradiation, trauma,
female hormones and neurofibromatosis type
2 (NF2).1,3,7,9,10.
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cases with tumour expansion or cerebral metastatic meningioma has even been
oedema, with the resultant clinical features. reported lately.16
Angiographic pre-operative embolisation,
especially in skull base meningioma, using FOLLOW-UP
particles is favoured 7-9days prior to surgery Recurrence in meningiomas occur on an
to reduce tumour vascularity.1,2 average of 4years after the initial surgery.7 It
could be monitored with contrast-enhanced
Surgical resection is rated using the MRI, and rates vary with grade and length of
Simpsons Grading which is based on the follow-up, for instance, WHO I meningioma
extent of resection and is predictive of local recurrence rate is 6.9% of cases, WHO II
recurrence.1 It ranges from Grade I which is atypical meningioma in 34.6%, and WHO III
complete tumour excision including resection malignant meningioma is 72.7%.1,4,11
of underlying bone and involved dura mater
to Grade V which is decompression with or Brain invasion, malignancy, multiplicity,
without biopsy. Grade I is more difficult if location and incomplete excision (even if the
ever possible to attain in the cavernous sinus, lesion has a benign histology), are factors that
petroclival region, posterior sagittal sinus and predispose to recurrence.3,10 Poor performance
optic nerve meningiomas.1 status of meningioma include brain invasion,
adjuvant radiotherapy, extent of resection, and
Cases of incomplete resection, tumour p53 over-expression.7 Negative prognostic
progression, skull base tumours, tumours factors are high grading, young age,
<3cm, inaccessibility to surgery, chromosome alterations and male gender,
atypical/anaplastic histology and brain whereas positive prognostic factors are elderly
invasion cases for radiotherapy.1,5,6,7 Although age and tumour calcifications.7
radiotherapy only rarely achieves a true
tumour mass reduction, it can arrest growth Although it has been a well stated fact that the
in malignant as well as benign meningiomas extent of resection is the most important factor
for some years.11 Improved outcome has been underlying recurrence, even totally resectable
observed if the dural tail is included in the tumours such as convexity meningiomas have
radiation field.7 a median recurrence rate as high as 10% after
5years, 20% after 10years, and 50% after
The use of systemic chemotherapy for 20years, of follow-up.10 Recurrence rates after
treatment of malignant meningiomas has surgery alone are about 10% in GTR and 40%
been reported recently.6 The after STR.7 With STR, local external-beam
chemotherapeutic regimen includes radiation therapy or stereotaxic radiosurgery
cyclophosphamide, adriamycin, and reduces recurrence to <10%.3 Clear cell,
vincristine. Hydroxyurea has also been papillary and rhabdoid cell types have a high
administered as an adjunct chemotherapeutic rate of recurrence.1
agent in recurrent and unresectable
meningiomas to achieve dramatic SURVIVAL RATE
cytoreductive effect on meningioma cells by The overall survival period is 12years for
inducing an apoptotic cascade.11 WHO Grade II meningiomas, compared with
3.3years for Grade III meningiomas
COMPLICATIONS (anaplastic).7 No means of prevention are
Complications, depending on location, known, presently.3
include sinus invasion, thrombosis,
haemorrhage, intracranial oedema, CONCLUSION
intraosseous extension and metastasis to non- Meningiomas can easily be diagnosed and
neural non-cranial structures. Metastatic characterized radiologically according to their
disease is rare, but has been reported. typical sites and peculiar salient features in
Pulmonary metastases from a benign this era of modern neuroimaging. Though
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