CASE REPORT   

Chirurgia 2018 June;31(3):112-5

DOI: 10.23736/S0394-9508.17.04749-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Spinal metastases of malignant intracranial meningioma through the central nervous system

Tonko MARINOVIĆ ^{1, 2}, Marina RAGUŽ ¹ ✉, Domagoj DLAKA ¹, Vesna MARINOVIĆ ³, Andrea BLAŽEVIĆ ⁴, Darko OREŠKOVIĆ ¹

¹ Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia; ² Department of Surgery and Neurosurgery, School of Medicine, University of J.J. Strossmayer Osijek, Osijek, Croatia; ³ Department of Dental Prosthetics, University Hospital Dubrava, Zagreb, Croatia; ⁴ School of Medicine University of Zagreb, Zagreb, Croatia

Meningiomas are neoplasms which give extracranial metastases in only 0.1%-0.2% cases. Vertebral and intraspinal metastases are rare, complicate treatment and worsen prognosis. We present a patient diagnosed with an atypical meingioma in the left posterior cranial fossa. The patient underwent a surgical resection. Due to oncologist recommendation, radiotherapy was not conducted. Within a year, tumor reccurred on the same place. Recraniotomy with subtotal resection was performed, and radiotherapy was conducted. Nine month after, another recidive occured. Third surgical removal of the tumor was done. Six months later, multiple intraosseus lesions in the cervicothoracic region, without intracranial recurrence occured. Within five months patient underwent radiotherapy which resulted with complete eradication of spinal masses, but small intracranial recurrence was noted. Although WHO Grade II meningiomas are considered benign, with recidive rate of only 3%, and most extracranial metastases occuring after the recurrence of the tumor, available literature suggests that it is not that rare and highlights the importance of following up low-grade meingiomas. Spinal metastases are often diagnosed after patient’s complaints of a pain with no intracranial recidives. Control MRI scan of the spine should be considered in those patients. Although there are few treatment options: symptomatic or chemotherapy, surgery and radiation, reported outcome is mostly not satisfying. There is no established standard of care for the menagment of these patients so furher investigation in this field and clinical follow up is required. Proper neurosurgical treatment and regular radiological scans may improve the prognosis.

KEY WORDS: Meningioma - Neoplasm metastasis - Spine - Surgical procedures, operative