Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 526-530
DOI: 10.1055/s-0043-1771328
Case Report

Acute Hemorrhagic-Onset Atypical Meningioma: A Report of Two Cases with Emergent Resection Achieving Mid-Term Tumor Control and Neurological Preservation

Takahiro Tsuchiya
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
,
Yuki Shinya 
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
2   Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
,
Tomohiro Inoue
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
3   Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
,
Kenta Ohara
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
4   Department of Neurosurgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
,
Teppei Morikawa
5   Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan
,
Takeo Tanishima
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
,
Akira Tamura
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
,
Isamu Saito
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
,
Hideaki Ono 
1   Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
2   Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

The majority of meningiomas are slow-growing benign tumors that can potentially be highly vascularized; however, acute hemorrhagic onset is rare. Herein, we describe two patients who presented with disturbance of consciousness and severe hemiplegia due to spontaneous hemorrhage from a falx atypical meningioma. A 49-year-old female presenting with a sudden disturbance of consciousness and severe left hemiplegia was found to have a falx meningioma and acute hemorrhage. Emergent resection achieved neurological relief and tumor control. A 60-year-old female with aphasia and severe right hemiplegia also had falx meningioma and hematoma, and successfully treated by emergent resection. Tumor was diagnosed as atypical meningioma in both cases. Both patients achieved mid-term tumor control for 4 and 7 years. Both patients were treated successfully with emergent surgical resection, and neurological relief and mid-term tumor control (7 and 4 years, respectively) were achieved. Given this success, immediate surgical resection with hematoma evacuation should be considered an acceptable therapeutic option for acute hemorrhagic atypical meningioma.

Keywords

atypical meningioma - hemorrhagic onset - resection - tumor control

Patients' Consent

This study was reviewed and approved by the institutional review board. The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.




Publication History

Article published online:
25 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery 1982; 10 (04) 437-444
    CrossrefPubMedGoogle Scholar
  • 2 Chen ZY, Zheng CH, Tang Li T. et al. Intracranial meningioma surgery in the elderly (over 65 years): prognostic factors and outcome. Acta Neurochir (Wien) 2015; 157 (09) 1549-1557 , discussion 1557
    CrossrefPubMedGoogle Scholar
  • 3 Martínez-Lage JF, Poza M, Martínez M, Esteban JA, Antúnez MC, Sola J. Meningiomas with haemorrhagic onset. Acta Neurochir (Wien) 1991; 110 (3–4): 129-132
    CrossrefPubMedGoogle Scholar
  • 4 Munivenkatappa A, Shukla DP. Atypical meningioma and acute subdural hemorrhage. J Neurosci Rural Pract 2014; 5 (02) 203-204
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Niiro M, Ishimaru K, Hirano H, Yunoue S, Kuratsu J. Clinico-pathological study of meningiomas with haemorrhagic onset. Acta Neurochir (Wien) 2003; 145 (09) 767-772
    CrossrefPubMedGoogle Scholar
  • 6 Pressman E, Penn D, Patel NJ. Intracranial hemorrhage from meningioma: 2 novel risk factors. World Neurosurg 2020; 135: 217-221
    CrossrefPubMedGoogle Scholar
  • 7 Louis DN, Perry A, Wesseling P. et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro-oncol 2021; 23 (08) 1231-1251
    CrossrefPubMedGoogle Scholar
  • 8 Lin R, Shen C. Meningioma with purely intratumoral hemorrhage mimicked intracerebral hemorrhage: case report and literature review. J Med Sci 2016; 36 (04) 158-161
    CrossrefGoogle Scholar
  • 9 Mangubat EZ, Byrne RW. Major intratumoral hemorrhage of a petroclival atypical meningioma: case report and review of literature. Skull Base 2010; 20 (06) 469-474
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Kuzeyli K, Cakir E, Usul H. et al. Intratumoral haemorrhage: a clinical study. J Clin Neurosci 2004; 11 (05) 490-492
    CrossrefPubMedGoogle Scholar
  • 11 Bosnjak R, Derham C, Popović M, Ravnik J. Spontaneous intracranial meningioma bleeding: clinicopathological features and outcome. J Neurosurg 2005; 103 (03) 473-484
    CrossrefPubMedGoogle Scholar
  • 12 Sumi K, Suma T, Yoshida R. et al. Massive intracranial hemorrhage caused by intraventricular meningioma: case report. BMC Neurol 2021; 21 (01) 25
    CrossrefPubMedGoogle Scholar
  • 13 Lefranc F, Nagy N, Dewitte O, Balériaux D, Brotchi J. Intracranial meningiomas revealed by non-traumatic subdural haematomas: a series of four cases. Acta Neurochir (Wien) 2001; 143 (10) 977-982 , discussion 982–983
    CrossrefPubMedGoogle Scholar
  • 14 Abolfotoh M, Brzezicki G, Fiester P, Tavanaiepour D. A rare case of life-threatening multicompartmental spontaneous intracranial hemorrhage from a grade 1 convexity meningioma. Cureus 2021; 13 (11) e19178
    PubMedGoogle Scholar
  • 15 Pasi M, Sugita L, Xiong L. et al. Association of cerebral small vessel disease and cognitive decline after intracerebral hemorrhage. Neurology 2021; 96 (02) e182-e192
    CrossrefPubMedGoogle Scholar