Atypical meningioma with large cyst. Case report

Area of Science:

• Neurology
• Neurosurgery
• Oncology

Background:

• Meningiomas are tumors arising from the meninges, the membranes surrounding the brain and spinal cord.
• Cystic meningiomas, though less common, can present with significant mass effect and neurological deficits.
• Atypical meningiomas have a higher risk of recurrence and more aggressive behavior compared to typical meningiomas.

Observation:

• A 29-year-old male experienced loss of consciousness, generalized seizure, right hemiparesis, and speech disturbance.
• Neuroimaging revealed a solid, enhanced tumor with a cystic component in the left frontal lobe, exhibiting surrounding edema and mass effect.
• The cyst wall demonstrated enhancement, suggesting potential tumor involvement.

Findings:

• Histological examination confirmed atypical meningioma with tumor cells present within the cyst wall.
• Complete tumor resection was achieved, but significant adherence of the cyst wall to the brain precluded its total removal.
• The patient underwent local radiotherapy to the residual cyst wall, receiving a total dose of 50 Gy.

Implications:

• This case highlights the diagnostic and surgical challenges posed by cystic atypical meningiomas.
• The presence of tumor cells in the cyst wall necessitates aggressive management, including adjuvant radiotherapy for residual disease.
• Adherence of the cyst wall to critical brain structures can complicate complete resection, underscoring the importance of multimodal treatment strategies.