Meningioma presentation by dr,Mumtaz Ali narejo

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Neurosurgeon Mumtaz Ali Narejo

Meningioma is described in detail its origin , type , presentation and management

MENINGIOMA
DR.MUMTAZ ALI NAREJO
CONSULTANT NEUROSPINE &
CEREBROVASCULAR SURGEON

OUTLINES
? Main features
? Common location
? Investigations
? Types
? Sindou et All
? Surgical principles
? Simpson grading
? Histopathological grading
? Recurrence rate
? Radiotherapy

Main Features
? Most common primary intracranial tumors
? Extra-axial
? F:M = 1.8:1
? Mean age : 45 years
? usually slow growing
? circumscribed (non-infiltrating)
? benign lesions
? arachnoid cap cells (meningothelial cells)
? Ectopic meningiomas
? Psammoma bodies

INVESTIGATIONS
? XRAY SKULL
? Calcification
? CT SCAN
? Calcification
? Hyperstosis
? MRI
? T1WI:
? Iso
? T2WI :
? Hypo or iso
? CSF cleft sign
? Contrast :
? Intense enhancement
? Broad base
? Dural Tail
? Angiography
? Feeders

TYPES ; SPHENOID WING
? lateral sphenoid wing (or pterional):
? Middle third (or alar)
? Medial (clinoidal):
?ICA
?MCA
?cranial nerves
?optic nerve
?compress brainstem
?Total removal is often not possible
?Pterional craniotomy

PARASAGITTAL MENINGIOMA
? 50% invade SSS
? anterior :
? 33%
? H/A and mental status
? Middle :
? 50%
? Jacksonian seizure
? progressive monoplegia
? contralateral foot drop
? Posterior:
? 20%
? H/A, visual symptoms
? focal seizures
? mental status changes
? Parietal craniotomy

OLFACTORY GROOVE MENINGIOMA
? Foster Kennedy syndrome
? Anosmia
? ipsilateral optic atrophy
? contralateral papilledema
? Mental status changes
? frontal lobe findings
? Apathy & Abulia
? urinary incontinence
? optic apparatus
? visual impairment
? fornix
? short-term memory loss
? seizure
? Bifrontal craniotomy
? Subfrontal Approach

PLANUM SPHENOIDALE & TUBERCUM
SELLA MENINGIOMA

FORAMEN MAGNUM MENINGIOMA
? Anterior : 31%
? Lateral : 56%
? Posterior : 13%

CONVEXITY MENINGIOMA
? Pre-coronal
? Coronal
? Post-coronal

SURGERY : PRINCIPLE
? Preoperative embolization
? Autologous blood donation
? Early interruption of the blood supply
? Internal decompression
? Dissection of the tumor capsule
? Removal of attached bone & dura

RADIOTHERAPY
? RECURRENCE RATE : 5�C15 years
? total resection : 4 %
? partial resection without XRT : 60%
? partial resection with XRT : 32%

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Meningioma presentation by dr,Mumtaz Ali narejo

1. MENINGIOMA DR.MUMTAZ ALI NAREJO CONSULTANT NEUROSPINE & CEREBROVASCULAR SURGEON

2. OUTLINES ? Main features ? Common location ? Investigations ? Types ? Sindou et All ? Surgical principles ? Simpson grading ? Histopathological grading ? Recurrence rate ? Radiotherapy

3. Main Features ? Most common primary intracranial tumors ? Extra-axial ? F:M = 1.8:1 ? Mean age : 45 years ? usually slow growing ? circumscribed (non-infiltrating) ? benign lesions ? arachnoid cap cells (meningothelial cells) ? Ectopic meningiomas ? Psammoma bodies

4. COMMON LOCATIONS

5. INVESTIGATIONS ? XRAY SKULL ? Calcification ? CT SCAN ? Calcification ? Hyperstosis ? MRI ? T1WI: ? Iso ? T2WI : ? Hypo or iso ? CSF cleft sign ? Contrast : ? Intense enhancement ? Broad base ? Dural Tail ? Angiography ? Feeders

6. INVESTIGATIONS

7. TYPES ; SPHENOID WING ? lateral sphenoid wing (or pterional): ? Middle third (or alar) ? Medial (clinoidal): ?ICA ?MCA ?cranial nerves ?optic nerve ?compress brainstem ?Total removal is often not possible ?Pterional craniotomy

8. PARASAGITTAL MENINGIOMA ? 50% invade SSS ? anterior : ? 33% ? H/A and mental status ? Middle : ? 50% ? Jacksonian seizure ? progressive monoplegia ? contralateral foot drop ? Posterior: ? 20% ? H/A, visual symptoms ? focal seizures ? mental status changes ? Parietal craniotomy

9. SINDOU ET ALL GRADING

10. OLFACTORY GROOVE MENINGIOMA ? Foster Kennedy syndrome ? Anosmia ? ipsilateral optic atrophy ? contralateral papilledema ? Mental status changes ? frontal lobe findings ? Apathy & Abulia ? urinary incontinence ? optic apparatus ? visual impairment ? fornix ? short-term memory loss ? seizure ? Bifrontal craniotomy ? Subfrontal Approach

11. PLANUM SPHENOIDALE & TUBERCUM SELLA MENINGIOMA

12. FORAMEN MAGNUM MENINGIOMA ? Anterior : 31% ? Lateral : 56% ? Posterior : 13%

13. CONVEXITY MENINGIOMA ? Pre-coronal ? Coronal ? Post-coronal

14. PETROCLIVAL MENINGIOMA

15. INTRAVENTRICULAR MENINGIOMA

16. CP ANGLE MENINGIOMA

17. SURGERY : PRINCIPLE ? Preoperative embolization ? Autologous blood donation ? Early interruption of the blood supply ? Internal decompression ? Dissection of the tumor capsule ? Removal of attached bone & dura

18. SIMPSON GRADING

19. HISTOPATHOLOGICAL GRADING

20. RADIOTHERAPY ? RECURRENCE RATE : 5�C15 years ? total resection : 4 % ? partial resection without XRT : 60% ? partial resection with XRT : 32%

21. THANKYOU

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Meningioma presentation by dr,Mumtaz Ali narejo

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