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Rapid Recurrence of a Benign Meningial Perineurioma
Lukas Andereggen1, Istvan Vajtai2, Hans R Widmer3
1Department of Neurosurgery, University of Bern, Bern, Switzerland; Department of Neurosurgery and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Background:
We describe a rare case of a rapidly recurring benign meningial-based perineurioma. Clinical, radiologic, and pathologic features of a rapidly recurring falxial perineurioma are described; the perineurioma was discovered incidentally in an 86-year-old woman.
Case Description:
Due to progressive gait disturbances and radiologically proven progression after a 3-year symptom-free interval, subtotal resection of a large falxial-based meningeal tumor was performed.
Conclusions:
The pathologic examination confirmed the diagnosis of a perineurioma (World Health Organization grade I). Follow-up magnetic resonance tomography 5 months later due to neurologic deterioration revealed an abnormally rapidly growing and extensive local tumor recurrence. Due to the mass effect, reoperation was performed and adjuvant radiation of 20 Gy to the tumor bed was implemented thereafter. Meningeal-based perineuriomas of the central nervous system are extremely rare, and literature on proper management is scarce. Although histologic classification reveals a benign lesion, follow-up may be considered for this type of tumor.
Insights
A rare, benign falxial perineurioma recurred rapidly in an 86-year-old woman, requiring reoperation and radiation. This case highlights the need for vigilant follow-up of meningeal tumors, even when histologically benign.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Pathology
Background:
- Presents a rare case of a falxial perineurioma, a benign meningeal tumor.
- Details the clinical, radiological, and pathological features of this incidentally discovered lesion in an elderly patient.
Observation:
- The patient experienced progressive gait disturbances and tumor progression after a 3-year symptom-free interval.
- Subtotal resection was performed for a large falxial-based meningeal tumor.
Findings:
- Pathologic examination confirmed a World Health Organization grade I perineurioma.
- Rapid local recurrence was observed 5 months post-surgery, necessitating reoperation and adjuvant radiation therapy (20 Gy).
Implications:
- Meningeal-based central nervous system perineuriomas are exceptionally rare with limited management guidelines.
- Despite benign histology, close follow-up is crucial for these tumors due to potential for rapid recurrence.
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