Overview.
The presence of two or more meningiomas within the skull that are not connected to each other is called multiple meningiomas. Multiple meningiomas are most often seen on the convex side of the brain, scattered around a larger meningioma, or at the base of the skull. Sometimes multiple meningiomas can be seen both inside and outside the ventricles of the brain, or both supratentorial and infratentorial. It is also common for intracranial meningiomas to coexist with acoustic neuromas or intraspinal chordomas.
Etiology
The etiology of multiple meningiomas in general is unknown, except for combined neurofibromatosis which is thought to be cytogenetically related. The reappearance of multiple meningiomas after meningioma surgery can be explained by dissemination of tumor cells with the cerebrospinal fluid, but not by primary multiple meningiomas. Any pathologic type of meningioma can be present in multiple meningiomas, and the same patient can present with different pathologic types of meningiomas at different sites.
Symptoms
Patients may present with headache, nausea, vomiting, limb weakness, and visual disturbances, while the incidence of seizures is lower than in solitary meningiomas. Patients with accompanying auditory neuroma or intravertebral chordoma will have corresponding symptoms or signs at the same time.
Examination
1. CT scan
Because of the rich blood supply of meningioma, the tumor will be strengthened uniformly on enhanced scanning. Meningiomas often cause reactive hyperplasia or invasive destruction of the adjacent skull, and CT scanning can show the changes of the skull clearly.
2.MRI
T1WI meningioma shows equal or slightly low signal, T2WI shows equal or slightly high signal, and the enhancement scan shows obvious uniform enhancement.MRI can make up for the shortcomings of CI in displaying the posterior cranial recess and the top of the skull because of the advantages of multidirectional and multiplanar imaging, so as not to miss the smaller lesions in this area.
Diagnosis
Multiple meningiomas have variable locations and therefore diverse clinical presentations. Symptoms or signs localized to multiple tumor sites may appear simultaneously, but symptoms are often more pronounced at the site of the larger tumor. For example, bilateral tumors often have symptoms on one side, and rarely have symptoms on both sides at the same time. After removing one side of the tumor, the symptoms of the other side of the tumor will be more obvious. Compared with single meningiomas, multiple meningiomas have more prominent symptoms of increased intracranial pressure because the total volume of multiple tumors grows more rapidly than that of a single tumor.The diagnosis can be confirmed by MRI.
Complications
Depending on the location of the tumor, the following complications may occur after surgical treatment if it is performed:
1. Intracranial hemorrhage or hematoma
With the improvement of surgical techniques, this complication has become less frequent. Postoperative intracranial hemorrhage can be reduced or avoided by careful hemostasis of the wound and repeated irrigation before cranial closure.
2. Cerebral edema and postoperative high cranial pressure
Dehydration drugs can be used to reduce intracranial pressure, and glucocorticoids can reduce cerebral edema.
3. Neurological deficits
It is related to intraoperative damage to important functional areas and important structures. Intraoperative damage should be avoided as much as possible. Symptomatic treatment can be active after the appearance.
Treatment
The surgical indications and principles of surgical management of multiple meningiomas are still a problem that needs to be further explored. Since the patients are generally of high age and in poor physical condition, comprehensive and integrated considerations should be made before surgery, including the size and number of the tumor, the location and the possibility and danger of surgery for each part of the tumor. Most scholars believe that surgery should first relieve the patient’s major symptoms and resect tumors of larger size, i.e., the principles of large before small, supratentorial before infratentorial, and superficial before deep. Tumors in adjacent areas can be resected at one time, and tumors in different areas can be operated in stages. Smaller, asymptomatic or mildly symptomatic tumors with deep location can also be treated with X-knife or γ-knife without surgery and close observation.
It should be noted that, for multiple foci with large tumors in both hemispheres or both supratentorial and infratentorial tumors, resection of one side of the tumor alone may induce various brain hernias, so we should strive for surgical resection at one time under adequate preparation.
Questions you may be concerned about
How to stop multiple meningiomas from growing?
Multiple meningiomas are common benign tumors, drugs or food alone can not inhibit the growth of the tumor, if the tumor size is small, it can be followed up for observation; if the tumor is large, surgery, radiotherapy, gamma knife treatment should be taken to inhibit the growth of the tumor.
1. Multiple meningiomas are smaller. When multiple meningiomas are small, patients often have no obvious symptoms and can be followed up for observation. If the multiple meningiomas are located at the base of the skull or other parts of the body, gamma knife and radiotherapy can be considered to inhibit tumor growth.
2. Multiple meningiomas are large. When multiple meningiomas are large, patients will have symptoms of dizziness, headache and impaired neurological function, and should be given timely surgical treatment after evaluating the patient’s physical condition and illness. After surgery, patients should be given radiotherapy in time to prevent recurrence of multiple meningiomas.
It is recommended that the patient should go to the hospital in time and under the guidance of the physician to carry out the relevant treatment.
Prognosis
The prognosis of multiple meningiomas is better after total resection of the tumor, but due to the presence of tumors in multiple parts, one operation often cannot completely remove the tumor, and multiple operations will bring a heavy burden to the patient physically and psychologically, and the postoperative complications will increase accordingly, so the prognosis is often not as good as that of the single-issue meningiomas. Especially for multiple meningiomas combined with acoustic neuroma, the chances of postoperative recurrence are more than that of simple multiple meningiomas. Intraoperative resection of tumor tissue and involved dura mater as much as possible and postoperative adjuvant radiotherapy are effective methods to reduce tumor recurrence. In addition, gamma-knife and X-knife irradiation of small intracranial multiple meningiomas is also a more ideal approach.
Questions you may be concerned about
How long can one live with multiple meningiomas?
Most multiple meningiomas are benign tumors that do not usually have a serious impact on the patient’s life and can be survived for a long time.
Patients with multiple meningiomas, need to go to the hospital, through the examination of the head CT or MRI and other tests to clarify the situation of multiple meningiomas, if necessary, surgical resection of meningiomas, after the operation to send pathology examination, to clarify the nature of meningiomas. Successful surgical removal of the tumor usually does not have much effect on the patient and does not pose a threat to the patient’s life.
However, if the meningioma is not treated in time, it can gradually increase in size and show signs of increased intracranial pressure, and in serious cases, it will produce local symptoms.
Therefore, once multiple meningiomas are detected, it is necessary to go to the hospital in time and actively cooperate with the doctor for treatment, so as to avoid delaying the condition and affecting the therapeutic effect.
Can multiple meningiomas with convex surface be cured?
Convex multiple meningioma refers to the existence of two or more meningiomas in the skull which are not connected with each other. Whether it can be cured or not needs to be judged according to the specific condition, and some of the patients can be completely cured, the details are as follows.
1. Curable: if the location of convex multiple meningiomas is relatively concentrated, and the postoperative pathological examination finds that the meningiomas are benign, then complete removal of meningiomas can be achieved through surgery.
In addition, since most of the meningiomas are benign, the probability of recurrence of meningiomas after surgery is relatively low, and the recurrence rate can be reduced by postoperative radiotherapy, so that some patients with multiple meningiomas with convex surfaces can get a very good prognosis at this time.
2. Cannot be cured completely: if the location of convex multiple meningiomas is scattered, it is difficult to remove the meningiomas completely through surgery, and the residual meningiomas may continue to grow after surgery. In addition, if the pathological examination finds that the convex multiple meningioma is malignant, then the probability of recurrence of meningioma is higher, and even if postoperative radiotherapy is performed, the convex multiple meningioma is still difficult to be cured.
It is recommended that patients with convex multiple meningiomas should go to regular medical institutions for timely consultation and standardized treatment under the guidance of doctors to strive for a good prognosis.