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Reverse seeding of recurrent intraspinal malignant meningioma
Atilla Akbay1, M Kadri Altundağ, Yavuz Ozişik
1Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey.
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.
Insights
Malignant meningiomas can recur after surgery. In a rare case, an intraspinal tumor spread upwards via cerebrospinal fluid, suggesting unusual seeding patterns in brain tumor recurrence.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Pathology
Background:
- Meningiomas are common primary tumors of the central nervous system, accounting for 15-20% of intracranial and intraspinal tumors.
- Malignant meningiomas represent 10-15% of all meningiomas and are typically treated with surgical resection.
- Recurrence of meningioma after surgery is frequent, but the mechanisms of recurrence (incomplete resection, tumor seeding, or independent growth) remain unclear.
Observation:
- This report details a 40-year-old woman diagnosed with an intraspinal malignant meningioma.
- The patient experienced multiple recurrences of the tumor following initial surgical resection.
- Notably, each recurrence appeared sequentially upwards from the primary tumor site.
Findings:
- The pattern of upward recurrence suggests tumor cell dissemination via cerebrospinal fluid (CSF) flow.
- This observation supports the hypothesis of 'reverse seeding' through the CSF pathway in intraspinal tumors.
- The findings challenge conventional understanding of meningioma recurrence mechanisms.
Implications:
- Understanding tumor seeding patterns is crucial for effective surgical planning and follow-up care for meningioma patients.
- This case highlights the importance of considering CSF dissemination in the recurrence of intraspinal malignant meningiomas.
- Further research into the migratory behavior of tumor cells within the CSF is warranted to improve patient outcomes.
