An 85-year-old male patient, medically free, complaining of a fall with trauma to right side of the head, and complaining of heavy tongue and right-sided weakness.
Contrast was given after review of initial precontrast scan as it shows mass unrelated to trauma.
CT shows small focus of acute bleed in right frontal lobe.
Enhancing mass lesion of about 4.0 x 3.9 x 3.9cm in left frontoparital region have broad dural base over innertable with hyperosteosis. Surrounding edema and causes mild midline shift to the right side, consistent with hemangioma.
Meningiomas are the second most common primary neoplasm of the central nervous system, arising from the arachnoid "cap" cells of the arachnoid villi in the meninges. These tumors are usually benign in nature; however, they can be malignant. Meningiomas may occur intracranially or within the spinal canal.
Meningiomas commonly are found at the surface of the brain, either over the convexity or at the skull base. In rare cases, meningiomas occur in an intraventricular or intraosseous location. The problem of classifying meningioma is that arachnoidal cells may express both mesenchymal and epithelial characteristics. Other mesodermal structures also may give rise to similar tumors (eg, hemangiopericytomas or sarcomas). The classification of all of these tumors together is controversial. The current trend is to separate unequivocal meningiomas from other less well-defined neoplasms. Undoubtedly, advances in molecular biology will allow scientists to determine the exact genomic aberration responsible for each specific neoplasm.
Mortality and morbidity rates for meningiomas are difficult to assess. Some meningiomas are discovered fortuitously when CT or MRI is done to assess for unrelated diseases or conditions. Therefore, some patients die with meningioma and not from it. Estimates of the five-year survival usually range from 73 percent to 94 percent.
A systematic review of the literature regarding the clinical behavior of small, untreated meningiomas suggests that most meningiomas 2.5 cm or less in diameter do not proceed to cause symptoms in the five years following their discovery. Patients with tumors 2.5 to 3 cm in initial size went on to develop new or worsened symptoms 17 percent of the time. Those that do cause symptoms can usually be predicted with close radiographic follow-up.
Meningiomas usually grow slowly, and they may produce severe morbidity before causing death.
Factors that may be predictive of a high postoperative morbidity rate include patient-related factors (eg, advanced age, comorbid states such as diabetes or coronary artery disease, preoperative neurological status), tumor factors (eg, location, size, consistency, vascularity, vascular or neural involvement), previous surgery, or previous radiation therapy.
Race and Sex
Meningiomas are more prevalent in Africa than in North America or Europe. In Los Angeles County, meningioma is reported more commonly in African Americans than in others. Meningiomas afflict women more often than men. The male-to-female ratio ranges from 1:1.4 to 1:2.8. The female preponderance may be less pronounced in the black population than in other groups. Meningiomas are equally distributed between boys and girls.