A Rare Recurrent Intracranial Meningioma with Variable Histopathological Grades and Pulmonary Metastasis: A Case
Hailong Ji1, Zhinan Ye2, Huanghuang Jin1
1Department of Neurosurgery, Municipal Hospital Affiliated to Taizhou University.
Abstract:
Meningiomas are predominantly benign intracranial neoplasms, with extracranial distant metastasis occurring in fewer than 1% of all patients; pulmonary metastasis represents an exceedingly rare complication of meningioma progression and recurrence. We describe a 44-year-old male patient with sequentially recurrent intracranial meningioma exhibiting dynamic histopathological grade evolution combined with synchronous bilateral pulmonary metastatic lesions, followed for an unprecedented 18 clinical years. Across follow-up, the patient received four open craniotomies, two sessions of stereotactic Gamma Knife radiosurgery, a CT-guided percutaneous lung biopsy, and minimally invasive pulmonary radiofrequency ablation. Post-intervention serial neurological and radiological monitoring documented favorable functional recovery: final Glasgow Coma Scale (GCS) = 15 and Modified Rankin Scale (mRS) = 1 at latest follow-up, with complete resolution of initial left lower limb weakness and stable control of both intracranial residual sinus-associated tumor and all pulmonary metastatic nodules without newly emerging systemic metastasis. This long-duration real-world clinical cohort highlights the critical necessity of full-body systemic imaging screening and lifelong standardized periodic surveillance for meningiomas with superior sagittal sinus invasion and progressive pathological upgrading, to facilitate early identification of occult distant pulmonary metastasis and formulate individualized combined surgical-radiation-ablation treatment regimens for high-risk recurrent meningioma.
Insights
Meningiomas rarely metastasize to the lungs. This case study details an 18-year follow-up of a patient with recurrent meningioma and lung metastases, emphasizing lifelong surveillance for high-risk cases.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Meningiomas are typically benign intracranial tumors.
- Extracranial metastasis is rare (<1%), with pulmonary metastasis being exceptionally uncommon.
- Recurrent meningiomas can exhibit dynamic histopathological grade evolution.
Purpose of the Study:
- To report a unique case of sequentially recurrent intracranial meningioma with synchronous bilateral pulmonary metastases.
- To highlight the importance of long-term surveillance and advanced imaging in managing complex meningioma cases.
- To emphasize the necessity of individualized treatment strategies for high-risk recurrent meningiomas.
Main Methods:
- Case report of a 44-year-old male patient followed for 18 years.
- Treatment included multiple craniotomies, Gamma Knife radiosurgery, CT-guided lung biopsy, and radiofrequency ablation.
- Serial neurological and radiological monitoring, including full-body imaging.
Main Results:
- The patient experienced sequential recurrence and histopathological grade evolution of intracranial meningioma.
- Synchronous bilateral pulmonary metastatic lesions were identified and managed.
- Favorable functional recovery was achieved (GCS=15, mRS=1), with stable control of intracranial and pulmonary disease.
- No new systemic metastasis emerged during the 18-year follow-up.
Conclusions:
- Lifelong surveillance and systemic imaging are crucial for meningiomas with specific risk factors (e.g., superior sagittal sinus invasion, pathological upgrading).
- Early detection of occult pulmonary metastasis is vital for timely intervention.
- Combined treatment regimens (surgery, radiation, ablation) can be effective for managing high-risk recurrent meningioma with distant metastasis.
