J Korean Neurosurg Soc.  2015 Apr;57(4):258-265. 10.3340/jkns.2015.57.4.258.

Intracranial Meningioma with Leptomeningeal Dissemination : Retrospective Study with Review of the Literature

• Park KS
• Kim KH
• Park SH
• Hwang JH
• Lee DH

• KMID: 1956423
• DOI: http://doi.org/10.3340/jkns.2015.57.4.258

Abstract

OBJECTIVE
The purposes of this article are to present 5 cases of intracranial meningioma with leptomeningeal dissemination (LD) and investigate the characteristics of this disease.
METHODS
We present a retrospective case series of 5 females at our institutions (age ranged 21-72 years, mean 54.6 years) diagnosed with LD of an intracranial meningioma after surgery between 1998 and 2013. A database search revealed 45 cases with LD of meningioma in the English literature. Characteristic features were analyzed and compared.
RESULTS
The incidence rate at our institutions of LD of meningioma was 0.9% (5/534). World Health Organization (WHO) grade was distributed as follows: I : 2, II : 2, and III : 1. Time to LD ranged from 2.5 months to 6.9 years; the patient with WHO grade III had the shortest interval to LD. The patient with an intraventricular meningioma (WHO grade II) had the second shortest interval to LD (1.7 years), and simultaneously revealed both LD and extraneuronal metastases. Four of 5 patients showed a disease progression, with the survival ranging from 1 month to 3.8 years after LD. Based on the literature, the initial tumor was an intraventricular meningioma in 9 patients, and their time to LD was shorter on average (mean 1.9 years). Histologically, 26 of 45 (58%) were initially diagnosed with a WHO grade II or III meningioma, and 6 of 19 patients (32%) with WHO grade I revealed malignant transformation.
CONCLUSION
This study shows that intraventricular location and histologically aggressive features seem to increase the chance of LD of meningioma.

Keyword

Meningioma; Leptomeningeal carcinomatosis; Intraventricular; Malignant

MeSH Terms

Disease Progression
Female
Humans
Incidence
Meningeal Carcinomatosis
Meningioma*
Neoplasm Metastasis
Retrospective Studies*
World Health Organization

Figure

• 

  Fig. 1 A : Preoperative enhanced magnetic resonance imaging (MRI) showing a right cerebellopontine angle meningioma. B : Postoperative MRI displaying Simpson grade II resection of the tumor. C and D : Approximately 2.5 months later, follow-up MRI revealing the local recurrence (curved arrow) and new lesions in the posterior fossa (closed arrow), suprasellar (open arrow) and spinal region (arrowheads). E : Spinal MRI demonstrating multiple leptomeningeal disseminations (arrowheads).

• 

  Fig. 2 A : Preoperative MRI displaying a left sphenoidal ridge meningioma. B : Four months later, MRI showing the local recurrence (arrowhead). C and D : Approximately 18 months later, MRI revealing multiple meningiomas around bilateral convexity (arrowheads).

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  Fig. 3 A : Preoperative MRI demonstrating a meningioma in the trigone of the left lateral ventricle. B : Approximately 1.7 years later, brain MRI showing the local recurrence (curved arrow). C : New lesions in the right cavernous sinus (closed arrow) and posterior fossa (open arrow) on enhanced MRI. D : Postoperative MRI after a second surgery for posterior fossa (open arrow). E : Four months later, positron emission tomography-CT showing multiple extraneuronal metastases in the skull base, ribs, spines and pelvic bone (arrowheads). F : Spinal MRI revealing leptomeningeal dissemination (arrowheads).

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